Welcome back to our podcast HTN Let’s Talk!
For this episode we interview James Freed, chief digital and information officer at Health Education England (HEE). We discussed key digital projects James has been involved in, his thoughts and experiences in developing the digital workforce and more.
To start, James spoke about his current role and career background. He explained that every CIO or CDIO role is different, with each role playing “to the strengths that we bring to those roles and what the organisation needs from such a role. My role is there to try and help the organisation get the greatest value from data, information, knowledge and technology.”
James is also the senior responsible owner for a programme of work called Digital Readiness Education, supporting the delivery and development of the entire health and care workforce in digital skills.
On his background, he commented: “I didn’t come up through the server room and in fact I wouldn’t really describe myself as a technologist – I’m more of a change manager by background.”
James started a PhD in cancer research before moving to work within change management roles in the NHS. “I moved into central bodies, spent some time with the national programme for IT and then moved to the Health Protection Agency and Public Health England as their head of information strategy before moving to Health Education England,” he said. “That was eight years ago this summer, and that was my first CIO role.”
On challenges and successes
One of the biggest challenges, James noted, is the word ‘digital’, as it means “lots of different things to lots of different people.”
He explained that he is working on a product alongside NHS providers, organisations and membership bodies to support NHS trust senior leaders, executives and non-executives in developing their own digital skills. “This isn’t about the chief information officer, it’s the chief operating officer, the chief executive, the chair – those roles you wouldn’t traditionally consider ‘digital’.”
The first thing they do in development sessions is have a conversation about what digital means. “We get that out on the table, try to work out what it means for a board to talk about digital,” he said.
Highlighting that it is important to recognise how digital underpins all of our lives now, James said: “Fundamentally technology has changed everything about how we experience life. It has massively changed our expectations about how we want to buy, sell, interact with one another.”
It’s also important that the board is fully engaged with digital, he pointed out; it is not something that can be pushed at people.
Another challenge James highlighted: “The technology needs to be there, but it’s everything else around it that needs to make it work,” he said. “It’s about the change management package. 70 percent of digital projects fail, but of those failures, only 20 percent fail because of the technology. 50 percent fail because of culture.”
Developing digital across a workforce
In 2017, James said, he was involved in a project which asked over 1000 digital professionals in the NHS a question: What did digital readiness mean and where are the gaps? What do you need to start, stop or do differently in order to achieve digital readiness?
With many varied responses received over several months, a model was developed to help structure conversations about what digital readiness means. “Digital readiness is being both digitally willing and digitally able,” James explained. “And that digital willingness and digital ability is at two different levels – there’s me as an individual, and there’s the organisation that I work for. You need that ability and willingness in both.”
Willing organisations, meanwhile, allow their workforce to make those changes, whilst a “digitally able organisation provides the digitally willing workforce with the right tools and data in order to make those changes happen.”
A separate consultation was held with 600 members of nursing staff. “They talked about the shiny stuff – AI, machine learning, robotic process automation. But they actually only wanted four key things.”
The first three things were access to modern devices with a camera; connectivity; and an electronic patient record. The fourth was a desire for more ease of use, with policies that allow them to make use of the first three elements.
“We’ve been heavy on governance, which means we slow things down,” he noted, adding that one positive outcome from the pandemic was the way it turned that on its head. “It didn’t mean we could be less safe. It just meant that we had to move fast. We couldn’t take 10 years to develop telemedicine solutions.
“That’s what the Topol review from 2019 predicted just before the pandemic,” James added. “The predictions based on the best available evidence suggested that telemedicine would hit an 80 percent prevalence in the NHS over a 10 to 20 year period. With the pandemic, suddenly we had telemedicine hitting an 80 percent prevalence in more like 10 months. It was a remarkably quick period of time to get substantial technological adoption and change within the NHS. It’s because we had to, we were forced to rebalance that governance and innovation model.”
However, James pointed out, there is a question around how you can educate every single person in every organisation to be digitally willing and able.
He outlined areas of support. The first, a digital boards development session, is aimed at creating digital willing organisations. “By the end of this financial year, we will have delivered 100 development sessions to trusts,” he shared. “That means about half of NHS trusts will have had development sessions – it doesn’t mean they’re perfect, but they’re on the road.”
Secondly, James described how he has developed a digital skills assessment tool which will shortly be launching, which focuses on “trying to develop the digital literacy of the entire workforce at scale. There are six broad domains, including things like basic digital safety, but also things like communications, learning and teaching, content creation and so on.”
The tool asks 32 questions with two dimensions. James provided an example: “Where do you think your job requires you to be and where do you think you’re at? The deficit between those two assessments points you through the tool to a set of learning products that are focused explicitly and uniquely on your needs.”
Achieving and measuring success within the digital readiness work
It’s always been difficult to measure impact, James noted. “As you get more specific it becomes easier, but it’s still very hard. Ultimately, through our digital readiness education work, we aim to deliver more value through the health and care system tomorrow than we did today.”
“Value” he added, “is described in the NHS’s Five Year Forward view and other policy documents through four areas; patient outcomes, population health, cash releasing benefits or efficiency criteria, or workforce satisfaction, and we want our contributions to add to at least one of the four areas.”
As part of the digital health leadership programme a chief information officer is supported with a learning module. “They are involved in one of the six modules, the one that is all about user-centred design. They spend their time developing a product that actually meets user needs rather than failing to do so,” James said.
He noted that this can often be a major contributor to failure in digitally delivered solutions. “Not concentrating on user needs and instead concentrating on perceived needs, guest needs or just organisational needs means that products end up not delivering value.”
What success looks like
For James, success in the future means that we can stop using the word digital. “Someone once said that there aren’t IT projects anymore, there are just change projects. I think that’s true.”
At the moment, James believes that the word still has value. “It’s still useful in terms of describing a change of philosophy and a certain approach,” he said, one where we can move to a more user-centred, iterative, devolved and trusting world with less hierarchies in place.
“Digitally mediated change is just a part of every single change that we undertake anyway,” he said. “When it becomes commonplace, when it’s just the way we do it – that’s when success has really hit home.”
When you can measure the value that you provide, he said, it should become a habit to measure the impact of each service and to empower the people running those services to improve on that value.
“When we listen to our patients and service users more, when we enable those individuals to take more control of their own health and care – I think that all of these are little indicators that we are on the right track.”
Advice to anyone wanting a career within the NHS
James shared that he also undertakes work with school leavers. “There are two projects that we support, one around university technical colleges and one in partnership with an organisation called Avada,” he said. “They run a programme called Fast Futures and they train every cohort once a quarter or so. They train about 1000 school leavers and university leavers through a bootcamp for digital skills, I sometimes do talks for them. The big thing that I say is that the NHS is not just about doctors and nurses. Every single career is represented somewhere in the NHS.”
If you want to save lives, James said, the NHS is the best place to work. “You can do that as a lorry driver or a porter, as a software developer, as an agilist, as a user-centred designer, an IT helpdesk professional, a knowledge manager, a librarian.”
Over the next few years, he added, “We’re going to see more structure and career paths – more opportunities and recognition for all of these people in digital, data, technology and knowledge services.”
Many thanks to James for sharing his time and thoughts.
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