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HTN Now: Ideal Health on women in digital transformation

Last week at HTN Now: November, we heard from a team from Ideal Health on the topic of women in digital transformation.

This session took the form of a panel discussion. Hosting the session was Katy Lethbridge, Marketing Director at Ideal Health, and the panel included:

  • Alison Walker, Ideal Health Associate in the strategic consultancy practice with expertise in organisational development and digital transformation.
  • Jo Smith, CIO and consultant with in-depth digital health experience.
  • Katherine Church, Digital Transformation Specialist with experience in mentoring women and start-ups, independent consultancy and women-focused activism.
  • Victoria Betton, Digital Health Consultant focusing on human factors such as user-centred design.

The webinar set out to explore the impact, skills and benefits that women bring to digital transformation in health and care following the publication of the UK’s first women’s health strategy and the appointment of the women’s health ambassador. In addition, Ideal Health wanted to examine the changes needed to drive investment and representation of women as users and providers of health tech.

Katy began by providing some background to Ideal Health, describing the organisation as a specialist consultancy purely focused on digital transformation in healthcare. They deliver support to NHS organisations undertaking digital transformation through strategic consultancy, project delivery and specialist resources. With experience from “200 or more” digital transformation programmes in the NHS, Ideal Health has “really in-depth understanding of the NHS, roles, challenges, environment, processes and workflows. It’s also given us a very good vendor knowledge, so we know all the key suppliers of digital systems into the NHS.”

Along with being tech-focused, Katy said that Ideal Health are “focused on preparing people for change. We’re specialists in change, training and go-live, and as we all know they are essential for any form of digital transformation.”

To start the discussion, Katy provided Victoria with a question: “One of your specialist areas is user-centred design. Based on your experience, firstly, is there any difference in how women engage with technology and secondly, how do we design services and products which work well for women?”

Victoria responded: “Put simply, user-centred design is about getting a deep understanding of the problem you are trying to solve before you design or develop a solution. It’s about designing and developing for users’ needs and goals, whether they are patients or staff.

“The first thing I want to say is that we are not a homogeneous group as women. A working class black woman’s experience will be very different to the experience of a middle class white woman. So we need to think about women in all different shapes, sizes and backgrounds. Those social determinants of health are really important because digital is a means of people being able to improve their health and wider social conditions. If we don’t have equitable use of technologies, we can end up with a data shadow – the data that is generated from the technologies doesn’t show the lives of all women.

“It’s so important that women are part of designing and developing technologies because they bring tacit understanding of not only what it is like to use the technology as a woman, but also the sorts of technologies that might be of particular interest to women as well, such as period trackers or menopause apps. Women’s bodies are different to men’s, women’s social conditions are different, we do have to re-steer the ship in that sense.”

Victoria provided a recommendation for further reading, Invisible Women by Caroline Criado Perez, in which the author discusses how health services are designed around men’s bodies as a default.

“We need to have more women designing, developing, founding, but also as users of digital technologies. We have a moral imperative, but it also just makes good business sense.”

Coming back to user-centred design, Victoria continued: “We need to understand problems and challenges before design and development and we need to do this inclusively. That’s not necessarily straightforward or easy, it means we have to put extra work in – I’m always really taken with the NHS digital standards, one of those is around doing the hard work to make it simple. They stress putting people at the heart of everything you do. All of those principles are grounded not only in the GDS standards, but also in the NHS constitution.

“We’ll know whether we are designing for women if we include them in the design process. Women use technologies differently from men, they may use technologies the same as other women, or they may use technologies differently to each other as well. But user-centred design gives us the mindset, methods and tools to really get that deep understanding so that we do the right thing.”

Next, Katy posed a question for Alison. “Your work is at the crossover of organisational development and digital transformation – organisational digitalisation. From your experience, and given that 71 percent of the NHS workforce is female, what are we doing to support women in that workplace so that they can thrive and be successful in the use of tech, but also in their digital careers, if that’s the route they want?”

Alison began by looking back on her previous work in politics: “20 years ago, I was running a private office for the Minister for Business. We were over at the House of Commons talking about the set-up of the Skills Council and wondering why there weren’t more women coming into IT. What could we do to encourage girls into the sector? It was a real problem.

“Last week, I went to the launch of the Skills Development Network and NHS England were presenting. They said that their new digital health graduate programme had 5,000 applications and of the 120 people who went through, 42 percent were women. I thought that was a fantastic bit of progress. Yes, it’s over 20 years, but we seem to be moving in the right direction.

“But what more can we do in terms of retention and recruitment of women coming into digital careers? I think we’ve seen a lot of change in the public sector recently, there are more women who are visible in the IT space.” She touched upon the image of working in digital in the media, with examples such as The Big Bang Theory and The IT Crowd. “It’s completely incorrect, we need to reset that.”

Moving onto practical ways to improve recruitment, Alison said: “I’ve had the opportunity to work in many different HR teams across the NHS, councils and in government. There are a few habits I have observed from there that we could use. First of all, in terms of descriptions for digital; because the NHS and public sector are always competing against remuneration packages with the private sector, there’s a tendency to put as much as you can into the job description to bring it up to the level of pay that you need to attract people into the NHS. It’s a real issue and quite excluding in some ways because they’re asking for things like five to ten years of NHS experience and, actually, we want to get people in with non-NHS experience.”

Alison picked up on Victoria’s points around user-centred design. “I had a great opportunity to work with Virgin Atlantic for a year,” she shared. “At that time, they were designing the new planes that have just come in, the energy efficient ones. I saw firsthand some real user-centred design – they had all the suppliers who were equipping the plane from the engines to food to fabric in a huge hangar at Gatwick. They invited in lots of customers to go around and look, taste, try everything. The way they did it was really good. In the NHS, we talk a lot about user-centred design, but it tends to be more of a testing facility rather than involving people in the choice. But I think it’s something that can be done quite easily – there are very good patient engagement groups all over the NHS. We need to pull those people through and make sure we’ve got the right number of women in the room and all different types of women as well. One size doesn’t fit all.”

Alison shared how she is currently working on a project with a trust looking at choosing a maternity system, describing a piece of work in which impacted mothers are looking at how the apps that they want to use are connecting through to the maternity system. “Some of the information coming through from the mums is quite counter to the systems and how they are built,” she noted. “Obviously you buy a system, you implement it, and you adapt it; largely that is a set process. So I think that is a route we really need to look at and explore, and I think it’s on the suppliers as well, to involve women in the design of their apps and the design of their systems.

“I think there’s quite a lot we can do in terms of retention as well – showing the career paths that are available to you. All of us here have had circuitous routes into digital. People like us talking to younger women about how you work your way through the NHS, across the ICS, into councils, into the voluntary sector… there’s a huge number of routes opening up for women with digital skills. I think there’s something around promoting that and being more visible – buddying, mentoring women as they come through, and also being open about the barriers that we perceive and calling them out. I think that’s our responsibility as well.”

Next, Katy turned to Jo: “I’ve heard data described as the golden thread that runs through good service delivery. From your experience as a CIO, how important would you say it is to capture gender identifiable data and why would that be?”

Jo said: “Data underpins everything. Without data we can’t have good research, without good research we can’t have good outcomes.

“Sometimes special category data can get a bit emotive. I understand that, there’s a sensitivity, and of course how you choose to identify may not necessarily be your physical genetic make-up.

“But it is really important that we capture that information correctly, especially in terms of personalised medicine and self-care. Self-care is becoming more and more important, and we can’t produce the right supporting materials through the right pathways or the right solutions if we don’t have the fullest, most accurate picture.

“So this information is absolutely critical, notwithstanding some of the sensitivities people may have around feeling that they are providing what can be personal and perhaps invasive information. But without it, we may miss a key piece of the picture that enables us to build a great solution.”

To Katherine, Katy brought up the Women’s Health Strategy: “You’re passionate about this strategy and what’s in it, what it means going forwards. I read the ministerial foreword to it and it admits that 51 percent of the population, ie. women, face obstacles when it comes to getting the care they need. How can we support the NHS in delivering the commitments in this strategy?”

Katherine responded: “I was at the NHS Confederation Women’s Health Conference yesterday and I had the privilege of meeting Dame Leslie Regan, the first UK Women’s Health Ambassador. She is awesome, she’s got this massive drive and energy. She’s a gynaecologist by background so has huge amounts of experience in working around women’s specific health issues.

“I think what is really important is that over 100,000 women participated in the survey to set the priorities for the strategy. We live in a world that is predominantly either gender-blind or designed by men for men. For example, the contraceptive pill was originally tested on men; another example is that those of us who are taking or attempting to take testosterone as part of the menopause will find that the doses prescribed are meant for men who are body building. That’s what’s happening today, that’s what’s manufactured.

“We have the strategy, we have a commitment from the government to do something. But we are operating in tough economic times for the NHS, we’ve got huge competing priorities. We’ve got an ever-changing roster of ministers at the top. Dame Leslie needs our help.

“So I made the offer of help on behalf of women leaders in and around the NHS, to think about how we can design programmes, how we can engage either on a consultancy basis or in leadership roles within the NHS, to promote women’s health and agenda. When we are setting priorities at an ICS or ICB level, how can we actually come together as women leaders within our regions to define some of these priorities and programmes? How can we ensure that leaders engage properly and sensitively in user-centred design? When we are designing or implementing digital products, we need to take into account the views of women. How do we ensure that when we are designing our data solutions that we are actually collecting data in the right way, so that when we deploy, we are actually capturing data that shows the impact and any disproportionate impact? Not just on women, on a whole range of people with additional characteristics. We need to make sure that we are training women and giving women confidence to take part in the projects, to step up and lead.”

In her research, Katherine said, she came across interesting findings. “Female founders tend to have a much more inclusive view of the problem they are trying to solve with digital,” she shared. “Men tend to focus more on a single problem. For example, if someone has a bad back, a man is more likely to want to create an app that deals with bad backs, whereas women are more likely to view the problem as somebody in the household has a bad back and that impacts on the whole family. They are then more likely to want to design an inclusive solution that helps the community and the environment.”

Ultimately, she said, it is all about prioritising sensitivity in design, leading, selecting and creating data, training and bringing women into positions to allow holistic design. “We can do that with support from the top, but without needing massive government digital programmes. I think if we wait for those, we’re going to be waiting for it for a long time. Creating that connective tissue through all of our networks is exactly what Dame Leslie is looking for.”

Here, the conversation opened up to include the HTN audience.

What more can we do to show our youngest generation the routes to work in digital health, and that it is even an option available?

Victoria: Between us, we are all no doubt doing things to promote a digital career and show young women that you can be successful here, and that there are many different routes and roles within the NHS. Like many of my colleagues, I do a lot of mentoring. I really encourage the young women I come across to collaborate and to work together. There are some great networks and communities out there too, like the Shuri Network supporting and promoting black women in digital health, and also One Health Tech.

I chaired the inaugural One Health Tech launch in Leeds and a group of women who worked at NHS Digital stood up and said that they were the only women in a big team of developers. They said they can find it really intimidating. It was really salutary to hear and I hope things have changed for that group of women. But it really struck a chord with me.

I’d also like to make the point that men can act as allies, they can notice when women aren’t involved in something. They can take active steps to support more women to get involved. I’d really encourage our male colleagues to think resourcefully and creatively about how they can redress that balance as well.

Alison: One of the mentors I had in my early days was a man. One of the things he said to me was that women have a habit of talking about things like ‘we did this, we did that’. If you’re going to promotion boards, you have to say ‘I did this, I did that’. It was completely counter-cultural to me and felt very uncomfortable, but I’ll never forget the advice. Senior mentors who are male can actually be very instructive in that sense.

With regards to recruitment in general, there’s a practice that I’ve spotted in some trusts where you have a deadline for a role and if they’ve got too many applications a week before the role, they’ll close applications down. I think that can be really damaging. If you’re busy, whether you’re a woman or a man, often you’re working to that deadline and aiming to meet the deadline the day before. I think at a time when the NHS is short of skills and trying to get digital people in from the private sector, they’ve really got to look at that practice carefully.

We haven’t mentioned culture yet. I think culture can be incredibly supportive or incredibly alienating. As a young woman, if your skills are in demand and you land in an NHS trust that has a bullying culture, you’re not going to stay very long. Not only can you earn more outside, the culture might be more supportive elsewhere. So I think that there is something around culture that needs to be unpacked. We need to be sure that we call out bad cultures and support good cultures that support women.

If you could give advice to young women wanting a career in digital transformation, what would it be?

Katherine: What is a career in digital transformation? It’s a career in research, it’s a career in data. It’s a career in coding, as an architect, as a change manager. The first part would be to say: open your imagination. Think about what you enjoy. Do you enjoy working on very logical problem solving such as coding? Or are you fascinated by how technology can drive and change organisational behaviour and individual behaviour? Think broadly, because digital is a very broad church.

Secondly, just to slightly counter a couple of things that have been said about things getting better; I’m not sure I agree on that. Recent research from Women In Data found that in 2021 we had significantly fewer female leaders in data than we did in 2014. That’s scary. We congratulate ourselves for getting close to the target of having 36 percent of women on boards, but we need to dig under those statistics. The vast majority of women are appointed to non-exec roles. Is that actually making a difference?

A key piece of advice would be to build up your allies – through university, through reaching out to other women in the workplace.

I’m very proud to work with an organisation called Grace and we focus on young women in tech, providing a supportive platform and wrap-around training support, along with learning and mentoring opportunities. Having early career support in particular is very important for retention, though I’d also say that the first place you try doesn’t have to be the place that you stay.

Another piece of advice would be to dig deep and be brave, because the change is happening but it is slow. Hopefully, women coming into tech can help to accelerate the pace.

Jo: I think Katherine has really said a lot of it, I would just echo some of the key points there. Networking is really important. When I made my move to my first proper CIO role, I had the usual challenges and imposter syndrome – that’s not a woman-only thing, though statistically, women do tend to suffer more with it than men. There are some great women’s networks and I would really encourage reaching out to them.

I also do really support the message around not just thinking about it as jobs in deep tech. The skills you need to be great as project managers, programmes managers, change managers, analysts… these are organisational and communication skills. Without wanting to stereotype, they are probably typically more female-type skills. And they are actually skills that will make all the difference here.

I’m going to be a little bit controversial here – I have a really personal view that as time moves on, we’re going to see a divergence in the skills you find in an organisation’s digital department. I think more and more, we’ll see really techy roles moving out to technical providers, and the skills and organisational roles will be about people and processes and managing how to get great service. So I think those skills around communication and critical thinking are going to be really powerful. I’m not sure we educate enough on that.

Katherine: I would add – look at the direction of software development. We’re moving towards clouds-hosted environments and low-code, or no-code programmes that write themselves and manage themselves. I agree that it will be what you do with the code, how you integrate the product, and how you change the business that will take centre stage.

Jo: In terms of thinking about a career, I think is important to understand a bit about yourself. Are you the person who likes to be loud and organisational and brave, you’re probably suited to a career in the corporations looking to understand how to change and benefit from digital, rather than being in the organisations building the underpinning digital platforms.

How can we look to encourage job specs to be more inclusive?

Alison: The agenda for change is a really great tool in the NHS. However, it was designed many years ago and I think in the current climate of digital skills shortages, we’ve got a real issue. We know, for example, that government skills jobs can now attract up to £40,000 uplift, so they can compete with the private sector. I’m not suggesting that this is something that the NHS want to do, or can do. But it does show you that there is really tough competition out there.

I think a bit more flexibility around the must-haves and the essentials in job descriptions would help. Are you really looking for someone who 100 percent fits, or are you looking for the skills that you need to get the job done along with being prepared to train someone up to get the rest? Virgin, for example, were really good at recruiting for attitude and potential because everyone can be trained to do something new.

Also, the tech skills that you had 20 years ago aren’t going to be the tech skills that you need for the next 20. So everyone has to think about professional development.

I think that there is quite a lot that the tech community can do with the HR community. Of the HR communities that I’ve worked with, some are very tech savvy and some wouldn’t know some of the terminologies that are popping into job descriptions. They need to work in partnership to make sure that nobody is being excluded, and also looking at how jobs can be structured and what is really needed.

Jo, you were one of the first female CIOs. CIOs are not often at board level and also there are not enough women CIOs in general. What can be done to change this?

Jo: Actually I would say that in my experience the NHS does have quite a lot of women in tech and I see more women as CIOs in the NHS than I see in other industries. I think we should credit the NHS with that.

The question of CIOs at board level is a challenge. It’s hard to say how we can change that. It’s really about trying to help your organisation understand the risk of not having your CIO on the board, regardless of gender. It’s a conversation I’ve had to have a number of times and not always successfully.

In terms of women as CIOs, research shows that although there are typically only around 20 percent of women in digital roles, around 50 percent of the women who do go into digital go onto be successful in leadership. I think that says something about the fact that we are great communicators, collaborators, and we can explain things in more accessible terms. I think that is part of what enables women in tech to be successful.

The answer comes back to the fact that we need more women going into tech early and we need to grow those roles, as I believe these people will naturally rise. I think we then have to help CEOs understand the risk of not having them at the board. No-one else can represent tech at the board other than a tech leader. So I think that there is a multi-pronged approach that we have to take to that.

I encourage people to talk to us. I’m very happy to talk to people on LinkedIn, for example. It’s about spreading the word and being brave – sometimes you just have to take some risks, which is easy to say and not always to do, but you have to believe in yourself.

Katherine: I would add that when I was in the NHS, I saw IT feed into finance a lot and I hadn’t seen that elsewhere. Finance exist to look after budget and cost, and I think that if you see digital as a cost to be managed, not a value creator, then you’re starting off having the wrong conversations.

Would you say that women are more inclined to wait until they are 100 percent ready and have the skillset before applying for a role?

Alison: Yes, we are all nodding vigorously in agreement! I did some research years ago when I was in the Department for Business and we were looking at how to get more women onto leadership programmes. We looked at external research which suggested that women wait until they have about 80 percent of the skills on a job description, then apply, whereas some men tended to have a more scattergun approach. It’s quite well known in the HR community that this has long been an issue.

The way we tackled that was to go out actively and encourage women to apply for our leadership programmes. We got mentors out there, we had a big communication and engagement campaign, we ran workshops in the departments saying “come along and talk to us”. Senior figures could tell women that they wanted them to apply and not to wait. I think that is a good model to look at and think about how it can be used to encourage women in moving into digital.

Any final comments?

Katy: As a woman, put your foot forward and do it. If this is an area that interests you – and as we’ve said, you don’t have to be a techie – just be brave.

Victoria: I’ve been struck listening to the conversation because I have two daughters in their early twenties. When I was their age, I was a real feminist activist and I thought the world was going to change, I thought we were on a straightforward progression to equality. I see my daughters grappling with very similar issues. So I really want to encourage men. You need to be part of this answer and I would really encourage you to think about how you can notice inequalities and to proactively take steps as allies to promote more women in digital health.

Katherine: I imagine that everyone listening or reading to this will be involved in delivering some kind of service to women, for women, or changing some kind of change. I would encourage every one of us to take up the opportunity that is offered by the Women’s Health Strategy and think about how we can be the middle part – that connective tissue – and take the steps we discussed earlier to promote change.

Many thanks to our panel to joining us; the panel can be viewed in full below.