Becoming a chief information officer in the NHS is a big step. To recognise this, the Health CIO Network is putting together a handbook for health CIOs. If you would like to contribute to a chapter, or have a great idea for one, then contact Digital Health managing editor Lyn Whitfield.

Chapter 4 Contents

Becoming a successful leader

Within most NHS organisations, the chief information officer role is a leadership position and requires a particular set of skills and behaviours to be effective. Typically, these skills and behaviours would be very different from those which are normally found in IT management role.

This chapter explores the difference between management and leadership, and suggests a number of actions to support the transition into a leadership position.

What does a good IT manager look like?

IT managers come in all shapes and sizes but, in my experience, those that are most effective tend to be focused on running an efficient operation.

They emphasise slick processes (such as accounts and kit for new starters being delivered on time) and strong governance (documentation and paperwork in place – for example hard disk destruction certificates neatly labelled and filed).

I would expect to see rigorous supplier management in place, with third-party IT companies held to account for their performance, and a strong emphasis on financial and commercial aspects. It wouldn’t be unusual for IT to sit within a finance directorate, so tight maintenance of budgets would be expected.

In short, a good IT manager is well organised, task orientated and focused on delivering a consistent, high quality IT operation.

How is leadership different?

In a leadership role, I would argue that there is much less emphasis on operations (doing the same things consistently and well) and a much greater emphasis on innovation and development.

The role becomes much more outward looking, more future focused, and less structured. A different approach to relationships is needed too, since a CIO will need to work with a much broader range of stakeholders.

Better to ask forgiveness than permission

One of the important characteristics of leadership is a broader scope of responsibility. There is an expectation that leaders are proactive, bold and have the authority to make decisions which affect the whole enterprise.

It is accepted that more senior roles have a different risk profile. As an IT manager, it would be reasonable to assume a risk-averse mentality, since the priority is keeping the operation running smoothly; in a more senior role, it is likely that calculated risks will need to be taken.

Ultimately, being a CIO is about effecting organisational change; just keeping the ship steady will not be sufficient for long term success. Clearly, this depends on the culture of the organisation, so it is very important to understand the parameters of the leadership role at the outset.

Nevertheless, it should be recognised that this may be very different from the philosophy of operational IT management where stability is sought after, so a change in mindset may be needed.


Think about how you approach risk. What approach will you take to adjust your mindset from risk averse to taking controlled risks? What are parameters of your role? What authority do you have? Where will you get support from?


Following the theme of change, it can be useful to set yourself Big Hairy Audacious Goals. Be ambitious. If you can see something that can be improved – and as CIO you are in a perfect position to spot opportunities – act on it.

Also make sure that your goals are aligned with organisational targets; improving quality and efficiency are key issues for many trusts. As part of your leadership role, you will need to be aware of the scale of the change required across the whole piece.

Also make sure your goals are aligned with organisational targets. Improving quality and efficiency are key issues for many trusts; as part of your leadership role, you will need to be aware of the scale of the change required across the whole piece.


Think about what organisational changes may be needed. How can you help define and articulate these? What skills and knowledge do you have that can make these changes happen? Who will you need to work with to develop delivery plans?

Being outward focused

One of the components of the NHS leadership model is systemic thinking. This means having a deep understanding of your place in the overall system; within the context of this model, “system” may refer to the management team, the organisation, the local health community or the NHS as a whole.

As a CIO, knowing where you fit in to the broader agenda is essential, and I would say that an appreciation of the organisational context – and your position in it – is an essential critical success factor.

CIOs have a distinct perspective, which will be valuable to other leaders. However, it is important your role doesn’t become narrow, and overly focused on technology.

Maintaining a strategic, business-oriented view of the wider health economy will be key. For example, many NHS organisations are looking at integrated care organisations and information sharing to support risk stratification.
Be aware there will be a “political” aspect to this work, and as such will be much more complex than a typical IT project.


Map out your place in your local system. Work out who the key stakeholders and influencers are. Think about what it is that you bring to the party, and what other peoples’ expectations of you might be, both inside and outside your organisation.

Relationships: up, down and across

One of the consequences of a more outward-focused approach is a much wider network of relationships. To be effective you need strong links with people across (and outside) the business – irrespective of hierarchy.

Putting together a stakeholder map would be a very worthwhile exercise, but that’s only the start. Making a real effort to get to know stakeholders will be essential.

It is also very important to understand and acknowledge other peoples’ challenges and the context of their roles; if you can proactively offer help to senior colleagues (and deliver on it!) then this will be a sure way to cement your position in the senior management team.

It is also important not to make assumptions about other people; the best approach is to find time to sit down with them and chat with them, making clear that you are here to help.


Find time to meet senior stakeholders, over a coffee if possible, and let them tell you about their perspective. Induction meetings are an ideal time to this.

Be clear about what you can and can’t offer. At the end of each meeting, try to come up with at least one deliverable you can commit to, and ensure that you deliver on it.

Personal branding

Given you will be working with a broader range of people, give some thought to what you would like to be known for; your personal brand. Try to reinforce this brand at every opportunity.


Consider the following attributes; which three would you most like to be known for by your senior management peers?

Approachable. Friendly. Technical Expert. Delivery-focused. Strategic. People Skills. Problem Solver. Well-organised. Supportive. Decisive. Politically Astute. Innovative. Financially Literate. Excellent Judgement.

What other attributes might be appropriate? And to what extent are these likely to be valued by your senior management colleagues?


Moving into an NHS IT leadership role can be confusing; initially, at least. Gaining an early understanding of 1) the parameters of your role, 2) other peoples’ challenges and 3) the expectations on you will be crucial.

Thinking about how you approach work will also be important, and it would be sensible to consider how comfortable you will be in a riskier, less structured position, with a broader and more complex range of relationships to manage.

You will notice that in all of this there has been no mention of technology; clearly, the strategic use of technology will be key, but my view it is less important that the softer skills I have outlined above.

A final action is to think about what personal development will be needed to be successful in this new role. What sort of training and support will help you make the transition, and gain the new skills needed to be a success in an NHS leadership role?

Owen Powell

Owen Powell has worked in IT for more than 20 years, in a variety of technical, project and senior management roles. More recently, he has been focusing on organisational change projects, has led major IT service redesigns for the Arts Council and within the NHS, and is leading a programme of change within Surrey and Borders Partnership Mental Health Trust.

In addition to this experience in the IT field, Owen has gained a number of qualifications in psychology, and is currently working towards chartered occupational psychologist status.

He is very interested in the communication and behavioral skills of IT staff – particularly IT leaders - and has a firm belief that IT teams will only deliver real value when they improve the quality of their business relationships.

Identifying, and developing, leadership skills

There is more advice on leadership available today than you can shake a leadership consultant at; which may be a problem. Who or what do you believe?

To help with this challenge, let’s take a moment to look at the etymological history of the word leadership: ‘Leadership – ‘Lead’ from Old English lædere meaning "one who leads”’.

OK, so that was less than useful; but it does make the point this is one of those topics that is inherently difficult to nail down. It also suggests one key area that we can focus on, and one that needs to be mastered.

It is summed up well by former US president Franklin D Roosevelt who said: “It is a terrible thing to look over your shoulder when you are trying to lead — and find no one there.” So as a leader, how exactly do you get people to follow you?

Social skills

All leaders are different and that’s as it should be. What they have in common, though, is an ability to master and perfect their social skills. Dwight D Eisenhower, the 34th president of the United States and a five-star general in the US Army, put it this way: “You do not lead by hitting people over the head — that’s assault, not leadership.”

Some suggest that ‘Reflective Leadership’ can help to avoid this problem. This is basically a trendy name for seeing things from the perspective of human experience.

We sometimes use the idiom of ‘putting yourself in someone else's shoes’. Learning how to adopt this empathetic approach can reap rewards as a leader as you start to see how your actions, and decisions, directly impact other people.

You can then begin to predict how results will play out, both positive and negative. This, in turn, inspires confidence in your ability to lead by those affected.

Iceberg spotting

The well-known TED speaker Roselinde Torres summed up her 25 years of observing leaders at work. She has distilled her observations into a number of core areas, one of which is the ability to see what's coming and plan ahead. She describes it as seeing round the corner and planning today for what is to come.

A good leader is rarely bothered about the status quo – he or she is already thinking about what’s ahead and planning for it. Creating good networks of trusted peers at different levels across and beyond your organisation will help you spot changes coming your way, and mean you can avoid the greatly feared ‘change-mageddon’, safely navigating your teams around the icebergs.

Leadership today

The modern paradigm of leadership has shifted from "I" to “We": leaders have to put the interest of their organisation and teams first rather than focusing on their own personal success.

Succession planning and mentoring has to be a part of your leadership role. When done well it fosters a positive environment and creates bonds of trust in your abilities as a leader. Also, be aware that your own perception of what ‘good looks like’ may not always be accurate since no two people are alike. Be willing to work with people as individuals.

Leadership is knowing where you want to be, not necessarily knowing how to get there. There are many roads that lead to Rome and allowing your team to choose one over another will give them the empowerment they need. Also, allowing your team to influence your roadmap will mean they are more likely to buy into it.

Since we’ve quoted a number of US presidents, let's end with the words of President John F Kennedy who said: “Leadership and learning are indispensable to each other.”

Always be a trainee leader and continue learning. Let's not forget that the very best leaders are those who are happy to be wrong and adapt accordingly for the success of all.

Gareth Baxendale

Gareth Baxendale has worked in the technology industry for more than 20 years in both the commercial and public sectors.

He is currently head of technology for the NIHR Clinical Research Network. Gareth is also a Chartered Fellow of the BCS and vice chair of the BCS Health Executive.

Sorry, The Health CIO handbook is not compatible with your browser

The Health CIO handbook can be viewed on all modern browsers and on Internet Explorer version 9+.

Suggested browsers