Interview, NP

Interview: “It’s about opening up opportunities to get to the grassroots and bring people on that journey with us” Sarah Hanbridge, CCIO at Leeds Teaching Hospitals

For a recent interview, we spoke to Sarah Hanbridge, chief clinical information officer for nursing, midwifery and allied health professionals at Leeds Teaching Hospitals NHS Trust, about some of her recent projects, plans and priorities for moving forward with digital in 2024 and beyond.

Starting out with an introduction to her current role and career to date, Sarah shared that her background is predominately in acute medicine within the North West region, before a move to the North East about 18 months ago which she said has been “interesting and challenging at the same time”.

“My passion is around patient care, and my journey into digital was an evolution,” Sarah explained. “I was lucky that I worked in an organisation that was very forward-thinking back in the mid-1990s, and which was on the journey towards an electronic health record. It was an organisation that focused on lean methodology and how we could be efficient and productive by using technology to enable patient care, so that’s where my passion came from. I was also one of the first digital Florence Nightingale scholars back in 2020, during the pandemic, and that opened doors to doing regional work. After that, I became the North West regional CNIO as well.”

Sarah also talked about her passion for education, telling us how she was previously an educator and remains dual-registered as an adult registered nurse as well as a practice educator lecturer.

“A lot of digital innovation is around education and teaching, so I feel like the four hats of clinical leadership, education, and digital fit really nicely with me,” she said. “I’m in a job that makes me get up in the morning, so that’s really positive.”

Launching a new clinical digital strategy

On developing the trust’s new clinical digital strategy, Sarah explained that she spent her first three months at the trust conducting “discovery work” across the organisation, interviewing stakeholders from “shop floor to board”.

“During those discussions I really started to profile what the organisation wanted, and mapping a parallel process of where the organisation was, and where it needed to be. I reached out to a nurse in the North West for her help with visualising what the stakeholders had been telling me; because how do you create a message to an organisation with the playback of all of those interviews, without it being a lengthy document? She used artistry to present that picture, and then that was shared with a number of other organisations across the UK as an idea for how to send these kinds of big messages.”

Sarah also shared that at the beginning of the process, the team had a relatively limited understanding of the actual digital maturity level across the organisation, and hadn’t been utilising the What Good Looks Like framework.

“I needed to quickly utilise that framework to get to the grassroots of the feedback that I’d had from the discovery work,” she said, “so as a consequence of that I realised that I didn’t have the right infrastructure within the clinical digital team. We created some new deputy posts – a deputy midwife, deputy AHP and a deputy CNIO, and we already had an associate CCIO. I split the portfolios, because the organisation is so big – we’ve got 25 clinical service units (CSUs) that we needed to work with to understand their digital maturity. This enabled us to work collaboratively and in partnership with CSUs for them to own their digital agenda.”

As a small team, Sarah highlighted the importance of thinking from a “spread and scale” perspective, stating that by collecting information and completing a benchmarking process, the team could start to build-up a picture of what the strategy needed to look like.

“We set up a task and finish group to do that, got everybody in the clinical digital team involved, and then they liaised with their CSUs to come up with their own key priorities,” she shared. “That’s how the story was built. Jess, the digital nurse who helped create visuals for the strategy feedback, came to work for us and helped us create all the illustrations and artistry that came from the original vision.”

On this note, Sarah commented that helping people to understand the digital agenda is “a very visual piece of work”. She described how sometimes people would demonstrate that they knew the EPR was important but they didn’t understand why, or they didn’t understand the data sitting behind it and the importance of using that data to make decisions to improve outcomes. When software such as Microsoft Teams was implemented during the pandemic, “people had to just run with it”, she pointed out; meaning that there is lots of functionality within Teams that people “don’t utilise, or don’t know how it can help them in their day-to-day life, working clinically and operationally”. Sarah’s team is planning a skills sharing event in March this year to introduce some of those skills that can help people in their roles.

Coming back to the strategy development, Sarah said: “Using the What Good Looks Like framework has been phenomenal, because it’s helped us with that benchmarking process; to understand the challenges at CSU level and then create the strategy based on what the key stakeholders initially told me back in September 2022.

“Engagement has also increased; we’ve developed a digital advocate programme and we’re now seeing the momentum of people understanding that digital is important and digital is your agenda. It belongs to all of us, just like infection control and safeguarding.” Before this work, Sarah said, the digital team “didn’t really have a voice in such a big organisation. People knew there was a digital service, but didn’t necessarily know there was a clinical team that sat within it. I think what the clinical digital team has been able to do over the last 12 months is represent those professions and have that clinical expertise with a digital heart. It comes back to effective education and communication. Our marketing and communications manager Jane Shepherd deserves a big shout out because she’s been critical to our comms efforts.”

Priorities in Leeds

Sarah talked to us about some of the main priorities within the clinical digital strategy, such as the paperless agenda. This led to the launch of a “paper picnic” over the summer, documenting every single piece of paper being used to support in-patients in practice, with Sarah’s team approximating that around 1,800 pieces of paper were in circulation.

“We had about 195 forms within PPM+, our electronic health record, so we started to do a deeper dive and actually map what was in there, and how that married with the paper exercise,” she explained. “We quickly picked up that we were missing opportunities – areas where things were in PPM+ but people were reverting back to paper. We did a massive piece of work around optimisation where we gave people direction in these areas. Because our EHR is developed and managed in house, we’ve never had a go-live; it’s been an evolving process. There was a tendency for people to think that it was an option and that they could revert back to paper. Getting exec buy-in was important for that, so it wasn’t just something the digital team was saying.”

Through this work, Sarah and her team identified all the aspects on PPM+ where paper could be removed to become more digitalised. “It’s also helped us do a bit of a scoping on what core things are still missing within our EHR, and what we need to put in to help with the patient pathway, help with data, and improve our patient outcomes,” she shared.

This process has been really important in encouraging engagement with the development of the clinical digital strategy, according to Sarah, empowering people to get on board.

“It empowered the clinical shop floor to recognise the importance of data, and to realise that doing intentional manual rounding and scanning is not helpful, because we can’t use the information and insights. It’s a wasted process. The form is already there on PPM+ – we can triangulate rounding with pressure sores, falls and so on, and really start to improve patient outcomes.

“In our VOD programme (visualisation, optimisation and digitalisation), we solely looked at nursing, midwifery and AHP, but now there’s discussions around the wider professions as well, because this isn’t just about nursing,” Sarah continued. “That will be one of our major priorities, but for that to happen, we need to align digital advocates, people who have seen the journey we are on and the vision that we’ve got. We’re also developing a catalogue of learning material such as videos and webinars to help people on the shop floor, as that was one of the playbacks from the discovery work that I did; people didn’t know where to start.”

Sarah described how part of this work involves linking the digital advocates to that learning catalogue, “because they’re powerful in disseminating that for their CSU. We had a face-to-face digital advocate session last month – their passion was really powerful as they shared best practice with their team. Then we’ve got the digital forum running parallel to that, so if you’ve got an interest in digital you can access the forum, understand what we are doing and find out how you can contribute. We put lots of information on there, we advertise training, and we offer access to conferences and things that might be of interest. It’s about opening up opportunities using our comms strategy to get to the grassroots and bring people on that journey with us. It’s building momentum, which takes time when you’ve got a 24,000-strong workforce that is already pressured.”

Creating a benchmarking tool

Sarah explained that she started a North West regional CNIO network during the pandemic. “I was reaching out to the chief nurses and letting them know I was setting this group up, so if they had someone in that role we could share knowledge and expertise. We realised we needed something we could use as a benchmarking tool, so one of the CNIOs went away and created this lovely Excel sheet. Then five of us went back to our organisations to complete the benchmarking process and came back to share our best practice.”

After setting this up within the CNIO network, Sarah started to put out feelers, to see whether any companies would be interested in working with them to digitise the process. Based on the original Excel sheet, Genome developed a data repository, and when Sarah left that role to join Leeds, she asked her CIO at the time whether she could use the tool for her new trust.

“It’s been an evolving, agile process, but it’s been pioneering in that we’ve digitalised in six months,” she stated. “It’s some challenge, going from an Excel sheet to digital to actually implementing it and getting results. We’ve got more data now and we’ve done the benchmarking process. We want to work with Genome more to figure out what the next steps are, how we can get to that next level.”

Referring to recent debates on the effectiveness of the What Good Looks Like framework, Sarah highlights Leeds as “a glowing example” of its potential impact, saying:

“We’re in the process now of making it part of our ward metrics. We’ve done digital health checks off the back of that, because we recognised that people didn’t necessarily understand what was required from a digital point of view. This was the first time I’ve had something tangible as a CNIO, that I could point to and say: ‘This is the standard NHS England has set, this is what we need to meet.’ We’ve started to see some of that transition over the last six months. I think the visualisation aspect of it with the red, amber and green is powerful, because when you see that transition then you get better engagement, and you can see that benefits realisation piece.”

The future of digital 

Taking a more general view of Leeds as a trust, we asked Sarah what she thought that the future of digital looked like.

She said: “We’ve got a lot going on in Leeds. We’ve got the theatre robotics, and we’re doing lots of work around virtual wards and virtual consultations. That’s why the What Good Looks Like framework is really important, because everybody has their own digital transformation agenda. It’s about working in partnership, using our expertise, and supporting that. We’ve got the new hospitals build, as well, with an ambition to open in 2030, so again there’s a lot of transitional work that needs to happen.”

Sarah talked about recognising the need to get nurses and other clinicians to start thinking differently when introducing all this new technology, to adapt to changes in workflows, and to develop the ways they collect and use data across the organisation. She also noted the potential for a digital control room to be implemented to help handle the size and scale of the trust once more digital technologies are introduced.

On hopes and aims for the future, she said: “We’ve got to start looking at the transition across our roles, whether we can get patients onto a virtual pathway, and we will be continuing to work on projects like our personal health record so that patients are more empowered with access to their information. We’ve got to shift to doing more health promotion and prevention, rather than managing the illness and disease process. I think the new curriculum is trying to do more of that, because we’ve got the technology now around that preventative model, so that’s one of the big tickets for the future. We’re starting to understand what that looks like, and by doing these proof of concepts on a small scale, it increases the appetite and understanding for these bigger changes.”

Reflecting that during the pandemic some of the “red tape” was cut in terms of digital, Sarah emphasised the need to ensure that this forwards momentum continues.

“We need to push back and look at how we can work differently in the acute sector, because we are going to have to start pulling money out of the acute sector to invest in community and primary care,” she stated. “You can see it now with the pharmacy model; who would have thought you could go into a pharmacy and get a consultation pre-pandemic? There’s lots of great stuff happening. The NHS is a really exciting place to work, even with the pressure and the stress. It’s a really rewarding job, and I would never leave it.”

If you could tackle one challenge, what would it be?

We asked Sarah what challenge she would like to tackle, if money and time were no issue.

“I think it’s coming back to the education and digital literacy,” she said. “Because of everything else on the agenda, I think we’ve made assumptions about different generations and their understanding of what digital is. I’d really like to invest that time in our patient pathways and our staff career pathways, looking at the absolute core skills are that are needed for different roles.

“In the future, I would like to see job descriptions going out which include the digital skills that are needed for certain roles. When I brought a midwife into the team, Misbah, she highlighted struggles around Wi-Fi – we’re trying to get mums to access things digitally, but some haven’t got phones. We’re looking at library services, and it’s just thinking out-of-the-box about what other services are out there to fill this gap, because without those skills, the technology can’t work.” HTN previously heard from Misbah about her work here.

We’d like to thank Sarah for her time, and for sharing with us some of the exciting transformation happening in Leeds.