Reflections: One Year 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 Christmas Meal, Movember, Board visit, Making Data Count Ambassador, Dragon’s Den, Leadership Bookclub, Delivering Pizzas to staff, Visit to the Pathology Lab, We Care Awards Evening

I’m going to using the same structure as used for my reflections at 6 months.

Things I’ve Learnt?

1. People are Watching. In this role, particularly as it is my first executive role, I’ve realised more than ever just how much people observe how you operate and if that matches up with the things you say and the organisation’s values. There have been a couple of minor situations where I’ve not been visible to some of my teams, and although I’m checking in with my leadership team regularly, I’ve not walked the floor as often as I’d like, which has consequences of people not thinking you care for them and are not bothered about their work, which is far from the truth. I’m reminded of the stuff I read in Don Clifton’s book First Break All The Rules which talks about the basic human need of attention. The penny has dropped that the exec role comes with higher expectations that you can do all the stuff on your task list AND be be visible, but the latter needs to come first.
2. Focus is everything. The things put in place over the past few weeks in response to the looming COVID-19 crisis were done rapidly, and to a good quality. Some things required substantial funding, such as moving wards, buying new equipment, but other things haven’t taken much money, such as altering work patterns and working with clinicians to use Teams to support virtual consultations. It has helped to have some funding to support this work, but my key observation is that when everyone is focused on a single objective, they can do amazing things, and of course the money has helped to enable that at pace. In many roles I’ve worked with teams to try and reduce the work in progress to help that focus, but nothing has had the dramatic observable effect of the COVID-19 response. It will be fascinating to see what things we put aside during this period that we previously thought essential and important have turned out to have no consequences of being delayed.
3. More about how the Trust Works. The best value 12 hours I spent over the past 6 months was in December when I shadowed the site team overnight. I mentioned it in my weeknotes, and actually made a vlog of the night, which shows me looking increasingly pale as the night goes on. I wish I’d done that earlier but it helped a lot to understand the flow of patients around the hospital, and also get better at navigating around the crazy collection of buildings from every decade and associated architectural style!

What has gone well?

1. I’ve built my team. I’ve managed to recruit to most of the posts in my Senior Leadership Team. Kenny and Natasha started in January and Ian in March, and although they’ve not started, the incoming Head of ICT and Head of Coding are working their notice. As the team has grown, I’ve had to adapt from feeling like I need to do it all, to working out what things I need to delegate to others and what things remain on my plate.
2. We’ve responded to COVID-19. I’ve written a lot about stuff that’s happened in my weeknotes, but a colleague mentioned to me this week about the fact that things are moving so fast it’s easy to forget what we did. I’m delighted at how my teams have responded. Here’s a quick summary for the record: following the national enabling of Microsoft Teams, we enabled and rolled it out to 2500 devices in a day, we upgraded our VPN solution from supporting 300 users to 1050, we ordered an additional 300 laptops and are rolling them out as quick as they come in, we also supported loads of moves of people and kit around the estate as we prepare for the expected numbers of COVID-19 patients and a lot of stuff in supporting reporting.
3. Setting up the Leadership Bookclub. It’s something I did at NHS Digital, and was well received, so I’ve started it at KGH. There’s a small band of keen people joining in and we’re currently on book No 3. We’ll be meeting in our own time and via Teams until PC (Post-COVID-19).
4. Stuff has gone Live. We’ve managed to get a number of modules for our EPR live. In the three months from the start of October to the end of December, the Trust moved to electronic observations in all adult inpatient wards, migrated to a new theatres system, introduced electronic handovers and moved the main recording method in the ED (Emergency Department) to be electronic. It produced a great buzz in the organisation, which continued in 2020 by increasing the availability of electronic handovers into the wider clinical community and introducing electronic observations into paediatrics. In February had a semi-informal assessment by NHS Digital of our EPR programme that was extremely positive.We also completed a big PAS (Patient Administration System) upgrade, got our long-awaited NHS Mail migration completed and have just about migrated all devices to Windows 10.

Summary of digital delivery in 2019/20

What have I struggled with?

1. Handing stuff over. Ironically, it is probably the case that I’ve been down in the detail and managing more at an operational level more than my previous two roles. Some of this has been through necessity whilst I didn’t have a leadership team to help and some of this has been driven by the level of change that’s been happening. As I’ve brought my leadership team onboard, we’ve been working out what I can hand over. Given it took me over 6 months to get to the position where I feel confident in saying “I’ve got this”, there is an inevitable reluctance to release the reins. The advent of the COVID-19 crisis has actually helped accelerate my ability to hand things over, as I’ve observed how capable my leadership team are, and the sheer number of things to get done in a short space of time.
2. Those fires keep on burning. In my 6 month reflections I talked about the need to balance attention between the things on fire and planning the future. There’s been a few things that have happened in this last 6 months that offer to remind me that there are plenty of things still to get sorted. For example, we had a network issue in March that was largely self-inflicted. People worked incredibly hard over some long evenings and into the weekend to fix it, but it served to remind me we’ve got some way to be where I want us to be. My deputy Ian has a phrase about doing “the basics brilliantly”, which he’s helping to support people to do, but I do wonder when we’ll be able to get to a position where the fires are a much rarer occurrence.

Extract from the KGH “Digital Manifesto”

What have I discovered about myself?

1. I’m not normal. My wife has been (lovingly) saying this to me for some time. Before I expand on this, I need to declare I fully understand I’m a flawed human and have loads of things I don’t do well and struggle with. What I’ve thought about more over this past few months is how my personal expectations butt up against my expectations for others. I’m very driven, professionally and personally, meaning it I can sustain my effort and energy for sustained periods without it getting too much. I spoke about this back at at conference in November, in that there’s a lot of me that’s working to stay true to my teenage self who got the tech bug and over time has come to understood the potential for technology to enable improvements for people in a big way. Although its dead obvious and I’ve always known it, I’ve reflected more in the last 6 months that not everyone is like me (thank goodness), and that means needing to be more thoughtful to understand other people’s emotions, comfort with structure and detail, energy levels and motivations, all which will differ from mine.

I am definitely not normal. A picture of me aged about 17 with some prizes I won for my electronics projects as an apprentice at Marconi Electronic Devices Limited. I can’t take any credit for the nasty wall plates.

2. My Role in Meetings. I got some feedback in the Autumn on how I was coming across in a particular Board committee, and how I wasn’t demonstrating sufficiently how I had a handle on all aspects of my portfolio. This was an important lesson for me on the difference between optics (the way things appear) and reality (the way things are). That person kindly gave me some pointers on how I could improve the way I operated in those meetings, and improve the optics by making some small changes to how I introduced each paper, and contributed to the discussion in a slightly different way. The more recent feedback I’ve had tells me that the small tweaks I’ve made is now working. I’m really grateful that that person took the time to give me that feedback, and to do it in a way that was specific, delivered kindly, actionable and as a gift.

What are the things I have appreciated?

1. My Colleagues. Several years ago I was part of a management team that got on ok, but I don’t think we ever gelled as a unit, and there were some people I would if pushed say that I disliked. When I think about this now, I can see that some of this was about egos, about people feeling threatened and some was about a reaction to challenging the status quo, and probably some of it due to my immaturity at understanding how to operate in a political (small p) environment. I can see it caused daily micro-stresses and a lot of energy spent on anticipating reactions. Later on, when I moved to being in more tech-focused management teams, this didn’t seem to be the case and I wasn’t aware of tensions of that sort as much; perhaps because we were all more similar, or more closely focused on the same narrower domain space — which has its advantages and disadvantages I guess. Now, as part of a Exec team with a range of skills and personalities, with accountability for the whole of an organisation, I’m really appreciating my colleagues, their talents and I can say I genuinely like them, which sounds glib, but I know how much more difficult this last 6 months would have been without that.
2. The honour to serve the NHS. It’s been astonishing and very emotional to see the reaction of the community to the COVID-19 crisis. Through the support, kindness and generosity of people who feel they want to help in some way. The brilliant people who have been using their 3D printers to make face visors and the Food4Heroes initiative are just a couple of the amazing actions people have taken to support our Trust and daily there is something else arriving. Truly humbling.

Update on some things I committed to do at the 6-month point:

• To have influenced more across the Trust and beyond just technology: The COVID-19 crisis has provided a platform to do that to some extent. Also as I’ve worked with more people, I’m able to demonstrate the value that different ways of working offer.
• Looked further out than just the things currently on fire: I was beginning to feel like we had a decent forward view of the plan of activities for this financial year BC (Before COVID-19), and I was hopeful that this would set a good platform to do it even better next year. However, working towards getting a replacement Office 2010 is a concrete development towards the future, in as much it doesn’t set on fire until some time after October 2020, or later with some management.
• Developed my teams and given them opportunity to flourish: This is very much in development. I’ve done some coaching with a couple of people which seemed to be well received. I’ve also expanded the remit of a couple of people who I knew can do more, and they’ve done brilliantly. I’ve not yet progressed the team-led professional development ideas I want to put in train, but I’ve discussed it with a few people.
• Contributed to a culture of learning and openness to new possibilities: To be honest, I’m not sure what I was thinking of when I wrote this item. Certainly, the developments around COVID-19 has given a necessity to try things, learn and adapt quickly.
• To have accurately articulated what I mean when I talk about Digital: I published the Digital Manifesto to the organisation in Feb 2020, which can be included the great quote from Dione — “we know we’ve got there when clinicans say ‘I never have to bring a pen to work’ ”. This has been a useful document to use in a variety of forms over the past few months, including promoting Kettering as a place going places with external funding bodies and colleagues in the national arms length bodies.

What will I work on over the next 6 months?

• Getting the Digital Leadership Team Humming. Establishing a full digital leadership team and being clear about the roles and accountabilities for us all. Developing the team team as a coherent entity, who enjoy work, serve and support our staff to meet the needs of our wonderful organisation well.
• Playing my part at a system level. Play a greater part in the Northamptonshire digital system, including our own burgeoning group model.
• Revising the KGH Digital Strategy. I inherited the current strategy that was written in Autumn 2018, and I think there it needs a refresh to reflect the delivery achieved and an improved articulation of the future. Of course there should be no such thing as a Digital Strategy, just a strategy in a digital world, but that’s a work in progress.