What 35 years as an NHS CIO taught me about digital leadership

Digital leadership is not about technology, but about improving care, writes Ian Mackenzie, chief information officer (CIO) at Surrey and Borders Partnership NHS Foundation Trust 

Around 35 years ago I first became a CIO in the NHS.  Of course, the title hadn’t yet been invented but the role was much the same.

Since then I’ve learnt a lot and have been asked a number of times to distil my thoughts into what makes good digital leadership.

This is my personal guide, shaped by experience as to what I’ve seen work, what hasn’t, and what really matters when you’re responsible for digital services in the NHS.

Purpose comes first

Everything starts with purpose. Digital leadership has never been about technology for its own sake. It is about supporting people who need care, keeping them safe, and enabling colleagues to deliver the best care they can.

Digital only adds value when it reduces harm, improves reliability, and eases pressure on the workforce.

My intent has always been to make life easier for those doing the real work.

Purpose must be explicit and shared. Leadership involves being clear about what “better” actually looks like: safer services, fewer failures, and systems that genuinely help rather than hinder.

Leadership is not judged by strategies or presentations, but by what people see leaders do

That purpose cannot remain abstract. People need to see how their daily work connects to something bigger, otherwise it quickly becomes just words.

I’ve seen this land well when I frame the work we’re doing explicitly around improving patient care and colleague experience.  An example of this was our recent electronic patient record (EPR) optimisation programme where every metric we tracked showed a clear increase in benefits for all staff groups.

Delivery requires ownership. When something matters, I take responsibility for it. I don’t sponsor work from a distance and hope it turns out well. I stay close to delivery and accept accountability for the outcome.

Leadership is not judged by strategies or presentations, but by what people see leaders do, particularly under pressure.

It’s all about people

Care is delivered by people, not systems. Digital services succeed or fail based on how well they work for colleagues and patients. That means building teams you trust, supporting them properly and creating the conditions for great work.

I believe high standards and compassion belong together. You can expect professionalism and accountability while still creating an environment where people feel safe to speak up, learn, and improve.

Clinical safety and assurance are leadership responsibilities

Clinical safety and governance are not box-ticking exercises; they are leadership responsibilities. I expect clear ownership of risk and honest conversations about it. When things go wrong, the focus must be on learning quickly and acting decisively.

Clinical safety and governance are not box-ticking exercises but core leadership responsibilities

Blame does not make services safer; learning does. My role has always been to ensure services are safe, resilient, and worthy of trust, and that the right people understand the risks we are carrying.

Detail matters because harm lives in the gaps

Details matter more than people sometimes like to admit. In healthcare, harm often exists in the gaps between processes, systems, and assumptions.

Good intentions are not enough, and cutting corners has a habit of reappearing at the worst possible time.

In a previous trust I worked for, we assumed that an automatic update had worked for every device, and then only to find out that a large percentage of PCs hadn’t been updated with the right version of a script so a key application didn’t work properly.

It ended up taking longer to check every PC than it would have done just to check in the first place. It was a lesson learned that if you trust some automatic process, you’ll get badly burned.

Decision making creates momentum

Indecision is costly. Not deciding creates risk, drains energy, and erodes confidence.

Decisions will not always be perfect, but standing still is usually worse. I value decisions that are informed, timely, and move things forward.

When circumstances change, adapting matters more than defending a position that no longer makes sense.

One example was when we decided to reset an EPR optimisation programme because the governance wasn’t working as well as it could have, leading to scope creep and general uncertainty around delivery. The reset put it back on target and we completed on time, on budget and on scope.

Delivery builds credibility and we inspire confidence in what we do

Great governance and planning matter, but delivery builds credibility. Trust grows when leaders do what they said they would do.

When delivery is at risk, the right response is early transparency, clear explanation, and honest options.

It’s not enough to believe something has been delivered well — people need to see and feel the difference in their day-to-day work

False optimism damages trust far more than difficult truths.

Trust is shaped by perception as much as intent. It’s not enough to believe we have delivered something good; people need to see the difference in their day-to-day work.

That requires clarity of intent, honesty about progress and visible outcomes. If people do not see the outcome the work is not finished.

Presence at the point of care

Staying close to the frontline is essential.

Digital leaders cannot lead effectively without understanding how systems feel at the point of care. Time spent listening to colleagues keeps decisions grounded in reality rather than assumption.

Our new ENHANCE EHR improvement programme was all driven by what colleagues have asked for. It includes a wide range of EPR optimisation elements as well as ambient voice technology, a patient portal, referral portal, digital ECGs, ePMA and pathology and radiology results and requesting.

Clinical need is foremost in what we are doing.

Integrity above all

Above all, I have tried to act with integrity. Keeping promises matters. When I cannot keep one, I explain why and agree a different way forward.

Trust depends on keeping the gap between words and actions as small as possible. If it doesn’t make care better, it isn’t worth doing.