Reflections: 6 months into NUH CDIO role

I’m now at 6 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 in my previous role at UHN (see reflections at 6, 12 and 18 months).

L-R, T-B: Visiting pest control team. Model Hospital data. Trust Leadership Board. Visiting mobile device team at City. Tme with Digital Nurses. Visiting mobile device team at QMC. Visiting Records management team. Presenting award to patient movement team at QMC. Lifts at QMC with EMPA adverts. First EDI Committee meeting. Time with End User Computing team at QMC and City. Presenting award at Linden Lodge. First monthly update. EPMA go live day at City.

What has gone well?

1. I prepared well. In preparing to start the role, I spent time thinking about the time at UHN, and going back over these reflections and then wrote down a list of things a) What I did well, b) What I could improve on c) What I’d do quicker and d) What I’d do differently. I’ve tried to refer to this list on a regular basis since starting to keep myself on track. What follows is mainly an assessment against that list.
2. I did a thorough diagnostic. I asked loads and loads and loads of questions and ensured the answers were documented and shared back out to the team. I started off with a list of about 50 questions, which then expanded considerably. I fed my observations back to the Digital and Information teams as they emerged and these findings have been shared with the Board and are helping to shape the emerging Digital and Information strategy.
3. Understood Finances. I got a good understanding of the budget I’m responsible for early on and where our pinch points are. Using Model Hospital data I could see that there are only two Trust that spend less per Full Time Employee (FTE) on Digital than NUH. That helped frame conversations with fellow Execs and the Board. I also articulated our device replacement arrangements early on — 18% of devices are 5 years old or older, with funding arrangements that don’t fully cover the number of devices needing replacement each year.
4. Communicated to the Clinical Body. I worked with the Digital and Information teams to create a monthly update that was initially shared out to all Consultants, but has expanded since then. This was one of the “do quicker” items as it took me over 6 months to put this in place at UHN and was in place in the first 6 weeks at NUH. This has been a really positive experience — some good feedback, plus examples of where the update has promoted colleagues to raise issues. I’m really pleased with the way this is now produced by the team and is shared out.
5. Setting up a Shadowing Schedule. I’ve set out an aim to spend time with every one of my 38 teams and have a schedule set out during the year. This has been really great — I’ve learnt a lot about the work different teams do and had some pretty decent cups of tea along the way.
6. Rolling out EPMA. We rolled out EPMA across both campuses and ED in May, June and July and it went phenomenally well. The transcribing from paper notes to electronic was completed ahead of time and the number of support calls dwindled very rapidly after each go live. I can’t claim any credit for the exceptional planning and execution on the day, but it has boosted the reputation of the Digital and Information team as folk who can get things done well and I hope we can continue to build on that.

What have I struggled with?

1. Prioritising. One of my early observations was that the Digital and Information team and trying to do too much and as a result end up spreading ourselves too thin. It was really hard to try and get a consolidated list of all the things we’re working on as a first step to propose some prioritisation to the rest of the organisation, on the principle that we want to Do Fewer Things Better. The reaction to the paper presented to the Trust Leadership Board showed me that we’ve got some way as an organisation to grasp the reality of prioritising in a constrained environment and that means pausing some things, however difficult that is and being able to “say no because there is a stronger yes”.
2. Digital and Information Governance. As I’ve got to know the various meetings that we have within the department, I can see some room for improvement on how things are escalated to the Board/Trust Leadership Team, both in terms of successes but particularly when issues emerge.
3. Size as an excuse. NUH is a massive organisation, but sometimes it seems that we use the size and complexity of our organisation as an excuse why we haven’t tackled difficult or pressing structural issues.
4. Getting a Grip of numbers. In the first week I started talking to the team about a set of performance metrics that we will use as a department to measure ourselves. We’ve had some good conversations about candidate numbers, there’s been some good work on a system dashboard, and I’ve got some benchmark numbers that have been helpful to set the scene to the Board and fellow Execs, but I’ve struggled to get a set of metrics that are reported on regularly.

Candidate metrics created as part of my preparation

What have I discovered about myself?

1. I’m no longer a novice. This is a bit of a strange thing to say I know, but if I compare the first 6 months when joining KGH to this last 6 months, there is a stark contrast. I spent much of those first few months waking up early and unable to get back to sleep due to having so much on my mind. That’s been very rare in this role and I attribute that to having a much better idea of what I’m doing, both in terms of getting a grip of the Digital and Information agenda, but also as my role as Board member.
2. Being Bold Didn’t Backfire. In preparation for starting the role, I refreshed my User Manual for Me. When I started at UHN I shared my previous version(s) in a team sharing exercise. This time I decided to be bolder and share a link to it via LinkedIn the evening before my first day and then included it in an email to my new Exec and Non-Exec colleagues on the first day. I shared it with some trepidation, but the experience was wholly positive and helped colleagues know a bit about me from the off, and it prompted other bits of sharing very early on, such as people sharing their 360 feedback or creating their own User Manuals. I’d thoroughly recommend it to anyone considering doing it as they start a new job.

What are the things I have appreciated?

1. Brilliant Colleagues. I’m really grateful for the way colleagues have welcomed me into the organisation and made me feel part of the team from the off. A lot of this has to be attributed to Anthony (CEO) and Nick (Chair) who are very experienced leaders, but also thoroughly decent people, motivated to serve.
2. Joining the BME Staff Network. I was delighted to be asked to be the Executive sponsor for the network and have enjoyed getting to know colleagues across the Trust, being involved in a number of events and spending 1–2–1 time with colleagues, learning more about their lived experience. I continue to try and be a better ally in this space.
3. Being able to cycle to work. Well before the NUH job was advertised, or indeed I’d considered moving, I’d worked on my personal goals with my coach. One of my goals was that my next job move would allow me to cycle to work. The hospitals are around 25 miles from home, so it is a long commute on a bike but doable. So far it works out ok logistically if I do it once a week and even when its tipping down with rain, I’m loving it.

View of one of the cycle compounds at QMC. I’m in good company!

What will I work on over the next 6 months?

• To have a Digital and Information strategy approved by the Board.
• To have got regular performance reporting in place
• To have improved the way our governance works
• A cloud-first policy in place
• To have a smooth-running prioritisation method in place that ensures organisational-wide buy-in