Reflections: 18 months into NUH CDTO role

I’m now at 18 months into my role as Chief Digital & Transformation 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 and 12 months into this role.

L-R, T-B: TEDx NUH Event Sketchnote, How the Shadow Committee works, Winning the Nervecentre Football Tournament, Speaking at Rewired, Visiting University of Nottingham’s VR lab, National NHS Muslim Network Eid Al-Fitr Celebration Event, East Midlands Acute Providers Digital Design Collaborative Workshop, visiting Infrastructure Operations team, on stage at the Filipino Barrio Fiesta, Cohort 2 of First Time Board-Level CDIO programme.

What has gone well?

1. Enlarging my Portfolio. In March, as a result of an Executive portfolio review, I took on Improvement and Transformation, Financial Transformation and the Trust Programme Management Office (PMO), which resulted in my job title being changed from Chief Digital and Information Officer to Chief Digital and Transformation Officer. There is much about that immediate transition period that I could have done better in terms of communication, I’m delighted on how the teams have worked together and integrated. In my previous Trust I used to say repeatedly that these days there is no transformation without digital transformation, so I’m delighted to have the responsibility to seek to enable my teams to work together effectively in this space.
2. Embedding of the Digital and Information Strategy. Following Board approval in January, I’m really pleased how this is the document we keep coming back to to think about prioritising our work. We now have a monthly tracker looking at the KPIs set out in the strategy which gets talked about at the monthly Digital and Data Strategic Committee.
3. Getting Out There. In March, Anthony (CEO) and I jointly spoke at Rewired on Digital Transformation at Scale. It was a new experience to write a joint script and work in this way. At the time I mentioned how self-conscious it made me feel about sharing my thoughts ahead of time with someone else.
4. Setting up a Shadow Committee. In this period, we have added a shadow committee to the Digital and Data Strategic Committee, which was a commitment in NUH’s Workforce Inclusion Strategy. The committee started properly in July and I’m delighted how it continues to develop.
5. East Midlands Partnerships. With the advent of several Trusts in the East Midlands signing up to move to Nervecentre as their EPR, it has promoted some innovative and at times scary conversations on what we could do across the region as a result, which we’ve called the East Midlands Acute Providers Digital Design Collaborative (EMAP DDC). This presents a rare opportunity to collaborate on implementation, configuration and standardisation, with potential to take further.

What have I struggled with?

1. Getting Stuff Done. One of the consequences of our financial sustainability programme is the tension between being held to account to deliver on some ambitious savings targets vs working within a constrained environment where resourcing to support projects is very stretched.
2. Remaining Connected to the Organisation. During this period I completed the Kings Fund TMP (see more below). This required 5 x 4 days residential or online between Feb and June, which were full-on sessions, with little or no scope to check emails/phone calls, which when coupled with some leave, felt like I was either preparing to be absent, or catching up after absence every few weeks and made for unsatisfactory continuity of things. So when TMP finished, whilst I certainly felt that it was worth it, there was also a sense of relief of being able to fully reconnect.
3. Service Performance. We have a few significant outages in this period, including a lengthy Pathology Laboratory Information Management System (LIMS) outage and some a “week of doom”, which included issues related to an out of date certificate, prescribing system and call centre software.

What have I discovered about myself?

1. I’m Energised by Detailed Work. I’ve mused on this in my weeknotes, about how getting into a detailed review of something like a report or business case is the nearest I get these days to the flow state that was familiar when I used to write software for a living. There is a lot said about the need for Executives to rise above the detail and see the bigger picture, so I’m always conscious of this becoming what Gallup would say was an over-played strength. But I have observed a couple of times in this period where I’ve been flattened by a meeting or email and I’ve turned to a bit of detailed work that has reset me emotionally.
2. I may look it, but I’m not emotionally dead! Between February and June this year I completed this Kings Fund programme. The programme gave a lot of focus on emotional and political intelligence, including taking closer notice of my emotions. Through this I recognised that my calm exterior can sometimes send the wrong messages to others that I don’t care, when the reality is far from this. I also noted that my standard approach to conflict is to try and make things better, whereas there are occasions where I need to sit with the discomfort and lean into the difficult emotions. This has led me to adding an additional reflective question in my weeknotes “What situation caused the strongest emotional response this week?” which gives an interesting pause each week to wind back. What is fascinating to observe having done it for a few months now is that sometimes there is nothing to note, sometimes there are are things I can write about and often there are things that are not suitable for writing about which means I leave that section out!

My summary of the Kings Fund TMP Programme

What are the things I have appreciated?

1. The Energy of Colleagues. There were a few events this year that gave me a real boost. The International Women’s day discussion was very challenging and energising, leading to me adding item to the “How Not to Suck” series on Negotiation. I thought the NUH TEDx event was really amazing. Our collection of Chief Registrars had conceived of this event and put it on to a massively high level of production and professionalism. I have also appreciated the last couple of Digital, Information and Transformation leadership meetings where the energy and ideas from the team have been really encouraging.

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

• Articulation to the organisation of what the EPR means in their terms. PARTIALLY COMPLETED. As we get into the EPR delivery, this has happened to some extent, but more to do over the next 12 months where the move to Nervecentre for Outpatients and Theatres really starts to take shape.
• Setting up a Shadow Board to the Digital and Data Strategic Committee. COMPLETED. This is now in place and heading for a 6-month evaluation point in the new year.

and carried over from 6 month point:

• To have got regular performance reporting in place. COMPLETED. This is now in place and presented to the Digital and Data Strategic Committee each month. I think there is more to do to make this data used regularly as part of operational decision making and planning.
• A cloud-first policy in place. Still not achieved, although I did do some work on a draft in April. It is called out in the Digital and Information Strategy as a commitment to do. [TO BE CARRIED FORWARD]

What will I work on over the next 6 months?

• Get LIMS Over the Line. Work to ensure the LIMS programme delivers the upgrade.
• Prepare the Ground for EPR Delivery. Ensure we’re set up to be ready to go live with Outpatients and Theatres with Nervecentre by Autumn 2025.
• Fewer Weeks of Doom. Take the lessons from the post-incident reviews and seek to increase the reliability of our systems.
• Contribute to Financial Sustainability. Ensure that I deliver on the committments in the Standardise, Centralise and Digitise programme.