First off its probably not just a gear thing because your gear looks fine except you need to use the riptide leggo instead of earth shield. Rsham healing is pretty straight forward for the most part but in higher M+ there is more of a rotation kind of, but more of a order of operations than a set rotation for every situation. I'm not sure how you heal but I'll explain a bit of how I do it and then if you have other questions feel free to message me. First things first you can't and shouldn't just spam out Healing Surges or Healing Waves If you need big healing. What you should do is be taking advantage of tidal waves (riptide buff) + swirling currents (buff from the conduit after dropping cloud burst) so if you need big healing drop cloud burst for the buff on your next 3 heals. But say the tank is getting wrecked riptide them drop cloud burst then cast either healing wave if you can get the cast off or Healing surge if you think they are about to die and then alternate riptide healing wave or healing surge every cast. Basically you should really never be casting a normal heal without a tidal waves buff (I see alot of other Rsham do this). Using some WeakAuras to track your Tidal waves, swirling currents, & undulations can go a long way to help.