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.
Engaged users are a prerequisite to the success of any technology project, and those in healthcare are no exception. Any chief information officer therefore needs to be focusing as much on clinicians as they do on their IT colleagues.
But getting clinicians to work side by side with informatics professionals can sometimes be a little difficult. It's like a meeting of different worlds with different languages. Here are some things that I have found help:
The first thing to get right is customer service – because often the only contact clinicians have with IT is via the service desk and engineers. These members of your team need to be skilled and able to fix things quickly, not just to ensure quality and safety but to make sure clinicians trust their informatics colleagues.
Often I hear people cry: “Let’s outsource the service desk!” I completely disagree. It’s the last thing I would outsource - for instance, if a nurse rings and is told he will be called back, you will rarely find him again to resolve his issue.
He will be on different shift patterns, with patients, in different locations and he will feel he has been ignored. Worse still, you might cause harm by not resolving an issue. Having highly skilled front-door staff who resolve issues first time at the point of contact is essential for quality, safety and satisfaction.
Wider face to face engagement with clinicians helps to build relationships and rapport between clinicians and the CIO and the wider informatics team.
You need to make sure these communications are as positive as possible. I have used events such as “Mobilise the NHS” – our hack day with the Greater Manchester academic health science network – to drive engagement and dialogue with a wide range of staff, from consultants to mental health practitioners and microbiologists. Using co-creation also helps to get the right answers.
From a distance, many clinicians feel IT and technology is frustrating and that information is not as readily available as it should be. They rightly point to other industries and ask why we can't get it right. Taking time to listen is important – you have heard this all before but they need you to hear it from them.
For those clinicians that challenge me, I make time to explain: go into the complexity of systems, clinical risk, the supplier marketplace, the legacy systems, the historic low levels of investment in this part of the NHS. Usually this is best done over a coffee with a book to scribble diagrams in: to allow them to visualise the complexity of information.
Such conversations also allow clinicians to understand the current and future art of the possible within the constraints and bounds we have.
On the flipside, as a CIO you need to build understanding of the environment in which clinicians work. Showing an interest in services, visiting departments and working alongside clinicians for "perfect day or week" initiatives also helps you to appreciate their landscape. Listening shows your willingness to learn.
For big business cases, building story boards around a patient journey can allow a shared reference point for clinicians and informaticians. When I was CIO at Bolton, we created a patient called “Eric”, and he became our beloved shared language on a patient journey. He ensured everyone’s focus was on what mattered most – the experiences of our patients.
From my experience you need the correct governance and structure to engage clinicians within an organisation. IT and information can often physically and conceptually closed door for many clinical staff.
Although governance may be a yawn-inducing word for some, it is needed. An ability for clinicians to interface with and be part of the formal governance of informatics helps.
Having a broad range of clinicians in the governance structure gives it strength and robustness. Clinicians as part of programme boards are essential, even for what you might regard as an architecture project.
Many organisations are now lucky enough to have one or more chief clinical information officers in post, and their experiences are helping build the benefits case for clinicians and informaticians working side by side. However, in a world of cost pressures it can be difficult to make the case for appointing a CCIO.
In my previous CIO role we were pressed due to financial savings but I found a handful of clinicians – not just doctors think nursing, therapies etc – who had passion and drive to improve IT.
I had no longstanding money, so I paid them for certain sessions and they also gave some of their own free time. This really allowed those with commitment to step forward and show the difference they could make. On the back of this temporary arrangement, I made the case for substantive appointment and investment.
Management of clinical risk within informatics is another strong card I have played for investment in CCIOs. Those clinicians who can advise and manage risk for the organisation play into the quality and safety agenda.
I guess you might call me mean, but I have asked all the CCIOs I work with to complete professional qualifications in informatics. I feel they need to be able to see the world from our perspective and speak the language. It helps them to challenge and support informatics, and helps them grown in confidence.
Once you have successfully created clinical engagement in IT, whether through CCIOs or less formal collaborations, be sure to find ways to celebrate the mutual successes.
Whether it is local awards, national awards or even just reflecting on success – it builds a great relationship when you can look back at what has gone well and what has been achieved. Remember your clinical IT champions are your and your team’s gateway back into the wider clinical community – a community which will determine whether IT projects fly or fail, so look after them.
Rachel Dunscombe is chief information officer at Salford Royal NHS Foundation Trust. Previously, she worked at Bolton NHS Foundation Trust, where she created a team of chief clinical information officers.
Rachel is also a CHIME ambassador to the UK, and a board member of KLAS.
I was once told that there are only two industries that refer to their customers as ‘users’. One is of course IT, the other is the illegal drugs trade. I leave this to your interpretation, but I would suggest IT’s traditional view of ‘users’ can have a major bearing on the degree of adoption and ultimately the level of success your IT strategy will deliver.
If we simply view end users as those to whom we apply change then they will simply feel ‘change is happening to me…’ None of us like change where we are not able to influence it or feel part of it.
Therefore, we must take a different approach in influencing and on-boarding those who will ultimately benefit from our strategy. So let’s drop the somewhat archaic and passive term ‘users’ and refer to them as they should be: ‘customers’ or perhaps even better, ‘partners’.
This is even more important if you are responsible for a strategy that involves staff who are devolved from your organisation but who will ultimately become a beneficiary of it.
How do you plan your engagement in a way that will motivate and make your devolved community want to get on-board or, even better, become impassioned about it?
Firstly, you must ignore the obvious barriers like the org chart or politics. People need to feel excited about a strategy to begin buying into it, and once they become excited about an initiative they often motivate themselves and others both up and down the chain of command.
Of course, you need to know how to get people excited and to convert them from the unbeliever to the faithful follower… For some it’s natural, for others this is a learned skill. The next step is learning how to keep the enthusiasm going.
In supporting large and perhaps unconnected groups, you must take every opportunity to be inclusive. Ensure that key stakeholders – including ‘those on the ground’ – are involved in project boards, steering groups and that partners are engaged via virtual teams comprising members from across the community.
The real trick to keeping a partner community involved and engaged though is to trust them. This does not mean you simply hand over work packages and the like and wait to see what happens. Frequent and productive communication is the key to trust. Having a clear and well aligned IT strategy is of course important but you need to consider the softer ‘relationship strategy’ as well to underpin it.
“You have two ears and one mouth: use them in those proportions”. This is good advice. Setting a strategy in stone and being dogmatic about it will almost certainly lead to failure. Listen to your teams and be open to adjusting your strategy. Remember a strategy is tested as it becomes reality. No one will ever have a perfect strategy – the sooner you accept that the better.
Listening to your partner community and validating their concerns will go a long way to keeping them on board. Never be afraid of bad news. It’s better to know sooner and be able to do something about it than discover all too late that the opportunity has been missed, which can often cost you in reputation as well as money.
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.
