Reflections: 18 Months in at KGH

When I started as Chief Digital Information Officer at Kettering General Hospital NHS Foundation Trust, I committed to myself to write some reflections every 6 months, influenced heavily by the reflective discipline shown by my ex-NHS Digital colleague Matt Edgar.

Although I’m pretty-reliable at producing my weeknotes, this is an opportunity to take a longer look back.

L-R, T-B: Exec Black Lives Matters Videos, Clinical Trainee and Trainer Awards Event, Bespoke Masks, Saying Goodbye to the Director of Finance, Visit to Princess Alexander Trust, KGH Thank You Award for the Digital Team, Thank you cream tea, Coding Team HSJ Award, Conversations with Leanne about Digital and nursing

I’m going to using the same structure as used for my reflections at 12 months.

Things I’ve Learnt?

1. I’ve found my voice on the Board. It’s taken me some time to feel qualified and able to express myself fully at Board meetings in particular, but in this last six months I’ve noticed I’ve contributed more to the meetings and felt more confident to do so. I think much of that is to do having much deeper grasp of what is going on, and a greater confidence gained from delivery credibility. The challenge for future roles/situations to myself is to be able express myself earlier before those things are in place.
2. The role I can play as a white ally. I was asked to be the Exec sponsor for our BAME staff support network in June. Through spending time with this group and the excellent co-chairs, I’m listening to their lived experience and understanding a little more about the impact of racism has had on their lives. I’ve tried to educate myself through reading as well as listening and have more to learn, but aim to be the best ally I can be to that group.
3. How to be comfortable with moonshot thinking. I wrote about this in June, but to summarise, I had a bit of a revelation in how I approach future thinking. In a coaching session, my coach introduced the change model from David Hall, where basing thinking on what has been done before only gets you so far. Focusing on ‘what might be’ encourages new ways of thinking to tackle mental blocks to achieve more than doing what we’ve always done. As someone who feels a lot of my reputation is linked to strong delivery, this approach initally felt risky, but was a real eye-opener. If I hadn’t already thought that coaching was essential prior to this, this conversation would have sold it to me.

David Hall model for change — moving to ‘moonshot’ thinking

What has gone well?

1. My team are flying. Every week when I write my weeknotes, I see another week where my team have done amazing things. All the posts in my leadership structure are now in place, with the final gap filled by Christian joining the team as Head of Coding. A few years ago I read something that said something along the lines of you know when you have a good team when there’s less of you asking them to do things — “the pull”, and more of them driving things forward and saying ‘let’s do this! ‘— “the push”, which I’m certainly experiencing. I’m even more proud of them to have developed this team cohesion when we haven’t spent a single moment all together physically. Furthermore, those good people have recruited more good people, and we’ve been able to roll off all of the contract help we had on the EPR programme and it was done with no drama. My hope is that staff in the digital portfolio feel more positive about what we’re doing and are more aware of where we’re going compared to 12 months ago.
2. We adapted to COVID-19. Like all Trusts, we did great things and did them rapidly. I noted six months ago what we’d done in those first few weeks. The work continued and by July we had deployed over 500 extra laptops, stood up a VDI solution being used by distributed staff and will be used for clinical collaboration, worked with a digital agency to develop a Virtual Visiting solution, tried three virtual consultation solutions, trained 100s of staff virtually and worked out how to automate COVID-19 result alerts from the lab to the hands of clinicians. We used a number of agile tools during this period, just as daily standups and a kanban board — which was a new experience for some, but they adapted and flourished.
3. Building the reputation of KGH. We feel we’ve made some good progress over the past few year and feel justified to shout about it. The move of conferences to be wholly online has increased the number of speaking opportunities over the last six months. We held our own Digital Seminar in July. Anna spoke at a Shuri Network event. Ian joined the NHSX Show and Tell, and talked about our work with Virtual Visiting in a number of places including the Leeds Digital Festival in September. We also won a HSJ Value Award for the Operations and Performance Initiative of the year for our Clinical Coding Transformation. I believe this is the first HSJ Value award we’ve ever won as a Trust (we’ve been finalists before). Over the next 6 months I’m confident that there will be more.
4. Digital is being owned by the Trust. Slowly and surely, through repeated messaging that the approach we’re trying to take is for everyone, is landing. For me this was marked by Andrew the Medical Director quoting me (quoting someone else) in a meeting that “There is no such thing as a Digital Strategy, just a strategy in a digital world”, and in July Leanne, the Director of Nursing recording some videos on the impact of digital on care.
5. We are working in the open. Along with the various speaking engagements above, Ian and I continue to blog about our progress and others in the team are taking slow steps to build a Twitter presence. I’m really proud that we published our Health Intelligence Strategy in July, our refreshed roadmap in and also our Cloud-First Policy in October. The next step I’d like to see is sharing this information in other more accessible formats than PDF and also other members of our team starting to blog.
6. We kept the EPR programme going. I get the impression from some Trusts that they stopped much of their digital programmes during the height of COVID. Through carefully prioritisation, we agreed to continue four key projects, which led to going live with electronic non-urgent referrals in June, and in ED in September. We went live with Patient Flow electronic whiteboards in August and started the rollout of EPMA in September. I was proud to see how the team adapted to test these components in a distributed way and primarily train staff virtually.

What have I struggled with?

1. Those Fires (again). At the 12 month reflection I talked about the fires that kept on burning and we’ve still had some. Our network has seen incremental improvement, but we’ve still had some wobbles. We have an intranet that is shortly going out of support. We still have a handful of machines not converted to Windows 10. We’ve made so much progress and delivered so many new things that it still hurts a lot when something fundamental goes wrong.
2. Wanting to do it all. There’s so much to go at that it is so tempting to try and tackle it all, particularly when the next issue that someone makes me aware of clearly has a patient impact. Prioritisation of the Trust’s capital programme towards the middle of the year has meant some things have been deferred to next year, which has been frustrating and will have an impact on what we can do in the following year.

What have I discovered about myself?

1. My role as an interpreter of models. I read a lot of blogs, books and consume a lot of podcasts and try to absorb a lot of information. On my holiday in July I read Matthew Syed’s Rebel Ideas and produced a summary for our exec team to discuss (I wrote about it in my weeknotes). This led to a good discussion about how to take some of the thinking forward. I realise that for a lot of my life I’ve been doing this, either by producing summaries of books or by creating sketchnotes, but I’ve not thought about it as explicit role I can take in a team before.

What are the things I have appreciated?

1. Stuff during lockdown. During the lockdown period I kept a log of things that I was appreciating from a personal point of view. I summarised this in a blog in September.
2. Seeing Patients Regularly. I recently visited a hospital where the Digital team were in a building on an industrial estate, several miles from the Acute base. It struck me very strongly during that visit how much I value and appreciate the constant reminder of who we are here for.
3. TeamKGH. There are loads of people who have done brilliant things over the past 12 months, and we attempted to recognise that at our KGH Thank You evening. It was incredibly moving to hear the tributes and messages shared during that evening.

Update on some things I committed to do at the 12-month point:

• Getting the Digital Leadership Team Humming. I’m confident that this has been achieved. I’m so proud of them and can’t wait to see what brilliant things they’ll do next.
• Playing my part at a system level. I’ve attended the Northamptonshire Digital Transformation Board more regularly in the last 6 months and have provided a level of support and challenge to that group that was perhaps missing. There’s more to do, but I think I get the role of that group more now and how I can make a contribution too.
• Revising the KGH Digital Strategy. With the advent of the KGH/NGH Group being realised in the appointment of a Group CEO in July, I’ve parked this with a view to contribute to a Group Digital Strategy later this year. But we continue to update the roadmap and share each month at the Digital Hospital Committee.

What will I work on over the next 6 months?

• Contributing to the Group Digital Strategy. This will be a key piece of work as part of the overall Group strategy and there’s loads of great potential to work in this way.
• More Statements of Intent. I’ve realised that the approach we’ve taken with the Cloud-First policy is really helpful to our staff and suppliers. To see the end destination clearly set out helps orientate everyone towards that goal. We’ve discussed creating other similar Statements of Intent, such as a People Policy.
• Work out how we take things to the next level. There’s things we need to do, such as developing more of a service design and user research capability. We demonstrated how well this can work with Virtual Visiting, but there’s scope through the Group model to explore how we do more of that.