Reflections: First 6 months at KGH

I had the privilege of working with the super talented Matt Edgar whilst I was at NHS Digital. One thing that impressed me was his dedication to regularly review and improve himself and his teams. I noted that he blogged openly about his first 6, 12, 18 and 24 months at NHS Digital. Challenged and encouraged by Matt’s example, here’s my stab at reflecting on my first 6 months as Chief Digital Information Officer at Kettering General Hospital NHS Foundation Trust.

Quoting Matt: These thoughts may not all reflect the opinions, strategies or positions of my employer — but I’m working on that :)

Leeds Canal with mirror-like water

What has gone well?

1. I’ve survived. At times over the first 3 or 4 months in particular, it was little more than that. There were so many things requiring my attention and needing extensive analysis that my head was spinning. About a decade ago I took on a new job that was very much out of my comfort zone. I learnt through that process, that the feeling of uncertainty eventually passes. That period of transition in my two subsequent job changes seemed to pass by fairly swiftly, but in the move to this role, it felt a long time coming. I’m only just feeling I’ve come out of the other side now. I’ve got some thoughts why that is, but that’s probably best left in my head for now.
2. I was able to draw upon my network. Over the past 3 or 4 years I’ve put more effort into building a network, to share and learning. But over this period I’ve realised that a network is not a nice to have, it is essential. I’ve appreciated a number of CIOs that have given up their time and energy to help me understand the Acute sector. I’m trying to spend 20 minutes every 2 weeks ensuring I’m tending that network.
3. I’ve made enough organisational connections. One of the things that is hard when you join a new organisation is understanding how to get things done; how do you procure a new piece of software, how do I monitor my budget, who is the expect on a particular aspect of the Trust. Given my portfolio was newly established, it didn’t feel like there wasn’t an established framework for me to plug into, so I’ve had to work out who are the “go to” people for various things. I’ve discovered some heroes and some plodders along the way.

What have I struggled with?

1. Finding my resilience has a limit. I’ve been used to driving my professional life pretty hard, but there were times when I wondered if I was good enough for this role.
2. Working in the Open has its limits. I’ve found that doing weeknotes is enormously helpful for me, even if no one else reads them, but in this job there are an increased number of things that I can’t write about, both things at work and my interpretation of them. As a way of tackling this , I created a set of shadow weeknotes, where I noted my deepest thoughts on certain events, plotting my sleep quality each week (plot spoiler – it was pretty bad). I note that my additions to that shadow document has diminished over the past couple of months, which is a reflection of a) my deepening relationship with my peers and the associated support, b) my perception that I’m making some progress and c) frankly being too tired to maintain a dual life.
3. To properly articulate what I mean when I talk about Digital. It’s no surprise that I’ve discovered a vast difference in perception and interpretation as to what Digital is. It is certainly not simply IT just rebadged. I need to find ways of talking about the culture, tools and approach that supports meeting user needs, that *may* be facilitated by technology. I’ve got an action on my objectives to create a presentation on this for my colleagues, but it always slips down my priority list.
4. Balancing putting out the fires and planning the future. Everyone who holds a Trust CIO role who I talked to before starting warned me being sucked into the real and immediate problems, but it has still been a struggle. There were times in the first couple of months when there were so many things needing to be addressed that I struggled to prioritise properly, let alone think about the future. Over more recent months I’ve established a clearer sense of direction in my mind which has helped work out some future steps.

What have I discovered about myself?

1. Preparation only got me so far. Coming into the job, I did more preparation than for any other job previously. I arranged to meet people already in post, talked to suppliers and read at lot — here’s the list:

• On Becoming a leader (not recommended)
• Re-read Personal Kanban (first 10 pages tell you all you need to know)
• Who says Elephants can’t dance (general interest, but I do love a bit of a tech company biography)
• Midnight’s children (useful for crazy state you’ll find yourself in)
• Re read management 3.0 (recommended)
• Digital Transformation at scale (I didn’t want to like this because of some poor experience with some ex-GDS people, but it was excellent)
• Work together anywhere (useful for when just starting this way of working. We have some way to go)
• The First 90 Days (really found this helpful and properly engaged in the completing the reflections/exercises — rather than reading over them, which I can normally be tempted to).

Cover of The First 90 days book

So despite arriving with a draft 90 day plan, complete with day 1, week 1 and month 1 outcomes, that all changed dramatically when it came in touch with reality. That’s ok, and I adapted it as I went on. I just expected to feel a bit more of the benefit of this preparation. One regrettable thing I failed to get a grip of until a few months in was my true budget situation and the route on how to secure additional funding. I’d made some assumptions which turned out not to be the case, so needed to do some adjustment and learn how the business case process worked in a hurry. That sort of thing wasn’t in the 90 days or other books, so there must be an assumption that *normal* people would make that one of their key actions in the early days. Note to my future self — as well as all the culture stuff in 90 days, there a number of practical things that you need to know:

• What are the steps for a procurement? What approval steps are there? Who can raise a requisition? Are people familiar with G-Cloud? Is there a stock template that references the requirements for NHS Tech Strategy alignment for inclusion in invitations to tender?
• What’s the method for securing funding over and above budget? Who chairs that group/committee? Clarify if revenue and capital are managed by the same finance partner.
• What’s the steps for recruiting staff, agency or contractors. What approval steps are there? Who has responsibility for which parts?

2. I’m a Doer. Not so much as a discovery, more of a confirmation. As a team we completed Belbin and Hogan assessments. Belbin has me as an Implementer/Specialist and Hogan shows me high on Diligence and Duty. We shared the outcomes of those assessments within the exec team and it has really helped with understanding each other and for me to find my place.

3. I *really* hate driving to work. I live about 80 miles from work, so get the train most days, but there are odd days when meeting arrangements or Exec Team bike rides means I need to drive. I’ve found I get grumpy when I don’t have my train journey, as I find it so essential to use the time on the way prepare for the day and finish the day well on the way home. It gives me about 2.5 hours interrupted time each day and when I don’t have that journey, I find I spend the whole day feeling like I’m catching up.

What are thing things I have appreciated?

1. The support of my family and friends. Several people have said encouraging things to me at the right time. I particularly remember a conversation with Ian Thomas that came at just the right time. I’ve also appreciated growing connections with my new colleagues who have become my allies and friends.
2. Learning and applying. I’ve really enjoyed learning new things or thinking on how to apply the things I know in a new environment. In the team Hogan profile it revealed that only a couple of us appreciate formal learning, so I’ve been attempting to share what I’ve learnt in different ways, e.g. through presentations and sketchnotes.

What will I work on over the next 6 months?

Beyond my agreed objectives, there are things I want to look back on in 6 months and feel I’ve made progress:

• To have influenced more across the Trust and beyond just technology
• Looked further out than just the things currently on fire
• Developed my teams and given them opportunity to flourish
• Contributed to a culture of learning and openness to new possibilities
• To have accurately articulated what I mean when I talk about Digital