Through the ‘Five Year Forward View’, NHS England has set out its belief that information technology and informatics are key to delivering efficiencies while transforming healthcare.
In ‘Personalised Health and Care 2020’, the IT framework that followed the plan, there is a very specific call for chief clinical information officers to be involved in this mission. The document also makes clear that CCIOs should not just be medics.
It is vital that the leaders of all health and care organisations are seen to champion information and digital capability as core enablers of effective decision-making, service quality, safety, effectiveness and efficiency.
They must empower CCIOs (drawn from medicine, nursing and the allied health professions) and social care informatics officers to lead local transformation programmes that support the take-up of information and technology and lead improvement.
Nurses and informatics
Informatics is a term for healthcare systems, information and technology that provides information and for solutions that enable healthcare delivery. It is, in essence, the way we use health information.
It is this information that helps clinical staff make decisions, plan care, deliver care, and benchmark and audit - and ultimately transform the service delivered to patients.
Nurses are central to the delivery of care, and they focus on quality, safety and efficiency. By doing so, they articulate and identify change opportunities.
Because nurses understand the depth and breadth of care, they understand how to develop and change pathways to improve that care, and ensure that patients remain central throughout.
All of these qualities mean that nurses are very well placed to get involved in informatics. As CCIOs or chief nursing information officers (CNIOs), they can play an essential role in shaping, leading and designing informatics solutions with nurses and patients in mind.
This chapter explores the advantages nurses have when it comes to getting involved in informatics. It also explores some of the barriers.
The advantages
1. The skills overlap
- Is a custodian of patient safety
- Naturally focuses on the patient; he or she influences the broader informatics agenda by making it real for patient care
- Is an effective problem solver
- Can articulate what the informatics team are doing and ensure the right stakeholders are brought in and bought in.
There is a clear overlap between the skills of a good nurse and those needed to be an effective informatics leader. A good CCIO, for instance:
2. Nurses are natural bridges between groups
Nurses are natural bridges, used to bringing clinical teams together around the patient’s journey. Building groups and coalitions is a key skill for an effective CCIO.
This includes groups wider than nursing and along the whole patient pathway: from hospital to community, social care and other healthcare providers and partners.
3. Healthcare delivery
Nurses in leadership roles are natural delivers of agendas. They understand the drivers and levers, and how to measure quality, safety and effectiveness.
That means they can help those in informatics services understand both the challenges and benefits of new ways of working. By working across service delivery lines, as well as with patients and suppliers, they enable solutions while challenging for excellence.
4. Building in safety
Developments in health informatics solutions and systems mean that safety is paramount, just as it is in nursing. Nurse CCIOs may be particularly well equipped to identify safety gaps and elements where safety assurance is required.
They naturally understand risk and, working with others, can quickly identify ways of mitigating risk to an acceptable level. Their natural approach to collegiate working and good governance means decisions will be made involving the right people.
5. Understanding of the opportunities across the patient’s journey
The health landscape is constantly changing and, while this can be challenging, it allows for opportunities for improvement to be identified.
Nurses are often familiar with the whole of a patient’s journey. This leaves nurses well placed to understand how informatics can make a difference at every point in a patient's care, by providing the key information and how it might be able to support care closer to home using the advances in healthcare technologies.
6. Communication
CCIOs will be talking directly to patients, commissioners, suppliers, frontline staff and with IT teams. They will need to communicate across boundaries – just as nurses do every day.
The barriers
Nurse CCIOs are immensely valuable key to organisational delivery, and have some key advantages in the role. However, there can be some barriers too:
1. Losing your identity as a nurse
This is probably one of the biggest barriers and risks of becoming a CCIO. Since there is no formal job planning for nurses – unlike for medics – the risk is that it is difficult to protect ‘nursing’ time.
This is a particular risk to those nurses who become part of the IT directorate. They can become marginalised or isolated; contacted only when there is an IT issue, instead of being involved in wider nursing or care issues. However, this is manageable by working with or being included with the nursing directorate team.
Having agreed work programmes, which benefit nursing as a whole, can also mean that professional identify and influence is maintained. Other approaches are:
- Having a clear reporting line to the chief nurse/director of nursing
- Inputting into the key governance and nursing policy and practice meetings
- Reporting regularly and using the informatics agenda as an enabler rather than a standalone item
- Delivering an agenda where information and healthcare technology become part of the solution with teams
- Listening to and using ideas from nurses
- Sharing successes.
With the onset of nursing revalidation, having annual reviews signed off with a registered nurse – ideally at chief nurse/director of nursing level – will ensure that work plans and programmes are jointly agreed and evaluated.
2. Specialist or generalist?
Nurses working in IT or as CCIOs can become specialised. This often happens when dealing with one product or an aspect of care or element of an electronic patient record system.
The risk of this is that CCIOs become very familiar with a product, but can then become niche in that area. Effective CCIOs work across the range of services but retain the fundamental values and aspects of nursing. They see the connectors and enablers rather than just the functionality, even for nursing.
One way to approach this is to ensure your focus is always on nursing care or impact to patients and not just the technology or solution. Suppliers recognise and appreciate nurses who can do this, and especially nurses who have vision where solutions are enabled by need for change.
3. Advising but not influencing
Some roles, especially those which are part-time, can turn into advisory roles. While this is not, in itself, a major issue, it means that the role can be limited. From the outset, it is important to make sure the scope and output of any CCIO role matches expectation and is achievable.
4. Not delivering direct care
Many nurse leaders do not deliver direct nursing care, but influence and shape the nursing and healthcare agenda in different ways. This also applies to some CCIOs.
While not directly being in clinical practice can be seen as a problem, there are ways to overcome this:
- Actively participate in clinical events
- Consider having clinical days in your specialist area
- Be visible as a nurse, ideally in uniform.
5. Being seen to focus only on nursing and not wider issues
This can be a perceived barrier rather than a real one, but it is potentially an issue all nurse CCIOs could face. In reality, any CCIO should intend to focus on benefits to patient care. In so doing, they will ensure they are seen as a credible partner to advise, help and assist teams – of all disciplines.
As part of annual reviews and business planning, consider getting feedback from teams to ensure that your focus is directed to where it is most needed. That may mean considering approaches such as 360-degree feedback, peer to peer discussions and surveys.
Conclusion
Nurses have many skills which make them ideally suited to a role as a clinical informatics leaders. There may be also barriers specific to nurses getting involved, but with careful planning and support these can be overcome. We need nurses as informatics leaders, and should commit ourselves to developing and nurturing nurses as informaticians.
About the author: Gerry is nurse clinical lead for ICT and clinical systems at Imperial College Healthcare NHS Trust. He previously held senior nursing roles at trusts and strategic health authorities, and spent a period at the Department of Health as part of the chief nursing officer’s professional leadership team.