Reflections: 12 months into NUH CDIO role

I’m now at 12 months into my role as Chief Digital & Information Officer at Nottingham University Hospitals.

I use my weeknotes as a regular reflective discipline. However, this is an opportunity to take a longer look back, as I did at 6 months in into this role.

L-R, T-B: Histopathology. Data Warehouse, DBA and Interfacing Team. Shadowing Porters. Application Management Team. Genetics. Childrens Assessment Unit. NUH Hospital Radio. Trust Catering Team. Speaking at CIO Watercooler event. Visit to Pathology. Laundry Visit. Access and Training Team. Preparing to open Leengate. Cyber Security Exercise. Arts trail. Speaking at Imperial College. First Time Board-Level CDIO Programme.

What has gone well?

1. Digital and Information Strategy Approved. I’m really pleased on how the engagement with this went during the last 6 months, with great input from across the Trust. This was approved by the Board in January 2024 and we’ll now be reporting in progress through the Finance and Performance Committee. Not managed to get it on the website yet, which will be something to push in the next few weeks.
2. Approval of the Electronic Patient Record Business Case. This case has had a rocky ride through the course of the last 9 months, due to a misunderstanding we made as a Trust back in March 2023, and as a result we’ve been rightfully under scrutiny at a national level as our hybrid Outline+Full Business Case made its way through the various approval steps. So it was relief and delight that the approval letter arrived recently. Of course this is only the first step, now the real work of implementation begins.
3. Visiting Teams and Areas. Each Monday the Exec team visit different areas of the hospital. I’ve also been working through visiting all of my 38 teams, and just about completed the list. Both of these have been fabulous for me to learn more about the work that we do as a Digital and Information Team and also as a Trust. I’ve enjoyed the eye-opening conversations and being more aware of the challenges in differnt teams and areas.
4. Board-Level CDIO Programme. After what felt like a long time in coming, we had our first cohort of the programme in October. The feedback was incredibly positive and we are in the planning for the next cohort.
5. Skills Development Network. I’m co-chair of the Midlands Digital Skills Development Network. I was delighted at how well our second annual conference went in September, along with the continual delivery of a programme of training throughout the year.
6. Prioritisation Method. In the previous six months we’ve made some steps on the prioritisation of our work and the need to do Fewer Things Better. This has now been articulated in the Digital and Information strategy, by moving away from a roadmap with false certainty to using a Now/Next/Later approach, with prioritisation against an agreed scoring matrix. There’s more to ensure the transparency across the organisation and docking the revised list into wider governance, but there’s been good progress.

How our Now/Next/Later prioritisation is working

What have I struggled with?

1. Performance Reporting. At my 6-month reflection point I mentioned the struggle to get a grip of numbers, and whilst there has been some progress towards regular reporting in the bi-monthly performance reviews, it still feels like they are a collection of metrics that can be collected, rather than ones that properly indicate how we are doing and is driving action.
2. Cyber Security Resilience. Last year we did a good desktop exercise, which was helpful, but I still know there is plenty to do in this area and being able to provide greater assurance on our ability and approach to recovery from a Cyber Security incident. I’ll be reporting to the Board later this year on this issue.
3. LIMS. In my first few weeks in the role I identified this project to upgrade the Pathology Laboratory Information Management System (LIMS) as one that required some focused attention, so have been closer to it than many other projects. I’m not sure I’ve been a help and potentially my involvement has been a hindrance at some times. The project still remains of high concern and the absolute drop-dead date to be off the system is approaching fast.

What have I discovered about myself?

1. I’m getting better at presenting. Back in 2020 I had some feedback that said I didn’t make the impact I ought to do when I spoke — both in meetings and in more formal presentation circumstances. Keen to address this, the organisation I was at the time supported linking me with an acting coach Ken Rea, who worked with me on a few techniques. It doesn’t come naturally to me, but when I draw upon those techniques, combined with a trusted template and sufficient preparation time, I now think I can do ok. I was particularly pleased with how the Digital and Information strategy landed with the Trust Leadership Board, when Colin and I thought very carefully about the message and how we’d articulate it. So, whilst it is certainly not in my comfort zone, I now recognise the tools I need to use to be effective.

Me presenting at the Midlands Digital Skills Development Conference Sept 2023

What are the things I have appreciated?

1. Getting to know Exec Colleagues. This last 6 months I’ve gone from being the new bloke, to embedding into the Exec team. We’ve managed to spend more time together, and learnt to trust each other more. There’s a lot of movement out/in over the next few months, so we’ll have to keep paying to attention to this.
2. Working Closer to Home. On rare days, the time from desk to home can be about the same it was on a good journey from UHN, but the novelty hasn’t worn off. Even when the traffic is super heaving coming out of Nottingham, there is something psychologically satisfying when the SatNav says 25 miles to home (compared to the 90 miles when I was working in Northamptonshire).

Update on some things I committed to do in my last reflection:

• To have a Digital and Information strategy approved by the Board. Achieved — approved by the Board in January.
• To have got regular performance reporting in place. This is in place for our performance meetings, but its not a coherent set of metrics used elsewhere to see how we’re doing. [TO BE CARRIED FORWARD]
• To have improved the way our governance works. Thanks to Nikki, some changes have been made in the way the weekly cycle of meetings focus on different things, and I feel we now have a more appropriate balance of looking at risk, the future and day to day issues.
• A cloud-first policy in place. Not achieved. It is called out in the Digital and Information Strategy as a commitment to do. [TO BE CARRIED FORWARD]
• To have a smooth-running prioritisation method in place that ensures organisational-wide buy-in. As mentioned above, there have been good strides made on this, but still a bit more to do to make it fully BAU.

What will I work on over the next 6 months?

• Articulation to the organisation of what the EPR means in their terms. Due to the uncertainty about funding, we’ve held off talking about what is coming next to the organisation. However, now we’ve got our funding agreed, we are more free to give the organisation hope that we have a coherent strategy for reducing the number of systems used each day towards a core Electronic Patient Record and when that is likely to be over the next 2–3 years.
• Setting up a Shadow Board to the Digital and Data Strategic Committee. I wrote about this in some recent weeknotes. This is the first step to having a Shadow Board that gives the Board insight into greater diversity of thinking.