HTN recently hosted a panel discussion focusing on the future of the chief information officer role, looking at the role of the CIO at developing digital maturity and skills, across an integrated system, and more.
We were joined by panellists including Tim Cropley, CIO at Hampshire Hospitals NHS Foundation Trust; Will Monaghan, CDIO at University Hospitals of Derby and Burton NHS Foundation Trust; Lee Rickles, CIO at Humber Teaching NHS Foundation Trust; and David Newey, former interim CIO of Royal Marsden NHS Foundation Trust and director of transformation at Nervecentre.
Journeys into the role of CIO
To start, we asked each of our panel members to share insight into their roles, organisations, and their journeys to this point.
Will went first, sharing how he originally worked towards a role as a chief operating officer before he got into digital through working at NHSX. He then spotted an opportunity to “get back to what he loves” in acute hospitals by picking up his current role in Derby.
“I’m privileged to have an excellent team, and a lot of the work that they do is around the delivery of our digital programme,” he said. “That gives me the space to make sure that we are always centring our technology, our data, our digital, around the needs of users; everything from our governance and decision-making, to what we buy and the way we deploy everything. I think it is increasingly important in the role of CIO to bring that digital and data lens to all of our challenges.”
Tim shared his own journey, discussing how he had moved from working in finance to the NHS and noting the similarities between sectors in the ways that more and more activity was being moved online.
“I think when we look at the role of CIO within healthcare, we’re operating far more in an advisory capacity,” he said, “to help the trust look at its own internal transformation programmes and to make sure we’re supporting those. In the future, I think that one of the biggest changes will be around influence, from trust-level transformation to working as a system.”
Lee talked his role as CIO at Humber Teaching NHS Foundation Trust, which he likened to being “a translator, a bit of an innovator, a planner and a problem solver”.
He added that he doesn’t believe that there is a “standard” journey for a CIO yet, as “we’re still an immature profession. I think everybody ends up as a CIO for a slightly different set of reasons. I started in the pharmaceutical industry as an engineer, and then went into aerostructures and aerodynamics. It seems unrelated, but like a CIO, it is all about information and getting the information right.”
Regarding his journey to becoming a CIO at Royal Marsden, David referred to his 20 years’ worth of experience in the NHS digital healthcare space, beginning as a project manager for a trust in the Midlands, before working for a software company deploying chemotherapy prescribing. He went on to join the Royal Marsden in 2017.
“I think the CIO to a degree has to make themselves redundant in the organisation,” he said. “When you develop a certain level of organisational digital maturity, the CIO needs to move on to more horizon scanning and become in effect a chief innovation officer type role. They need to be looking at opportunities from AI, from robotics and so on. I think as more clinical data becomes digitalised, it gives us the opportunity as CIOs to really unlock the power and the potential of data-driven analytics and AI.”
Looking ahead: the CIO role in 5-10 years
We asked our panellists for their thoughts on what the CIO role will look like in the next five to ten years, looking at areas including leading transformation, developing infrastructure, and system working.
David discussed a piece of work he’d completed recently around Maslow’s hierarchy of needs, looking at the challenges around getting staff on board with exploring the possibilities of digital in their role when they are still coming up against issues like difficulties with logging in.
“There’s a real key issue around infrastructure, in that whilst you’ve got infrastructure issues and people are fighting with doing day-to-day tasks, they can’t innovate. From that point of view, we end up fire-fighting at the infrastructure end; doing some small transformation projects, picking one clinical department and putting in one clinical system. But we’ve got to get to doing that at scale.”
On developing the skills required to support digital transformation, David talked about the need to move to a model whereby we encourage clinician-builder type roles, requiring a change in mindset so that digital teams “cease to be the keyholders and the gatekeepers, and become more mentors and coaches.”
Will looked more closely at the role of the CIO in system working, highlighting the increased potential for this to allow CIOs to cater to the needs of local populations at scale. He also considered how patients do not tend to see their journey through the healthcare system as a set of different experiences, but rather as a whole experience; making it more important to make said experience as “joined up and seamless” as possible.
He shared a view that it is not always about ICS working specifically, but about sharing in general: “When it comes to solving a problem, I actually think we can get much more impact if we solve that as a group of large acute hospitals, than we do solving at an ICS scale. To be able to to work together as a system on issues like deploying an EPR – and so that we genuinely deliver an end-to-end and meaningful patient experience – it’s far easier for me to solve that with people who are in a similar business to mine in terms of the kind of healthcare that we deliver. We have to be able to take a leading role across the ICS, but equally as provider collaboratives, as that’s where you can really start to leverage value.”
Lee agreed that “from a productivity point of view”, working with similar organisations makes “absolute sense”. He also emphasised the need to be patient-centric, adding that sometimes too much focus on productivity risks losing connection with local partners.
Following on from Lee’s point, Will agreed that an end-to-end experience for patients is a priority for CIOs. He also commented that getting it right for staff is also important, highlighting the “collective duty” of “making it easier to be a clinician in the NHS over the next ten years”.
The role of the CIO in developing wider digital maturity and challenges in digital transformation
Following on from the points made by Will and Lee on making life easier for clinicians working in the NHS, we asked Lee to expand on the role of the CIO in developing wider digital maturity and building skills across an organisation, both now and in the future.
Lee considered the question, noting his thoughts on the need for skills to be something that is overseen by workforce and linked into mainstream organisational professional development.
“In our organisation that’s the way we’ve gone; I moved training and development out of digital, because we ended up with people that went through the standard process without any real context. It really is about doing proper discovery work, having good input and engagement from your services, from your governance, understanding the problem but also setting aspirations in the journey.”
Moving on to talk about the role of the CIO in supporting the shift from reactive to proactive care, Tim shared his thoughts on the likelihood of a move toward patients being more involved in their care, having access to things like test results and treatment plans, and the overall move in favour of patient activation.
“I think anybody who has used the health service in any capacity understands the frustration of being directed to different booking system for services like making a GP appointment, repeat prescriptions, and blood tests,” he said. “It’s very fragmented, and that’s just within one small locality; once you get referred elsewhere, it’s another completely different set of applications. I don’t think we are working at scale, and I don’t think that we are working holistically; we need to move from this very siloed view of the world, where we’re just providing IT services, to actually transforming services.”
Tim noted that sometimes, the way funding is granted to CIOs can often limit the opportunity to be creative.
He also talked about training, saying that the current model of training people to use IT systems isn’t an ideal approach, and that focus needs to be on training clinicians on how to do their job digitally. “If all your system does is replace a piece of paper, then all you’ve done is digitised the piece of paper; and a digitalised piece of paper is often harder to use than an actual piece of paper.”
Digitalisation “really involves the entire process change, all the way from the patient through to the administrators, clinicians, and so on,” he continued. “What we need to be doing is making sure that information is freely available, and really working on a far more digitally enabled world. And we need to work much more closely on making sure that all that information is brought together.”
Will raised the sense of collective duty around user-centred design. “The dream would be that the technology is inherently intuitive enough that the training becomes about how you leverage the technology to give you the most time to care, or to access the most information, and help you make decisions.”
On this, he added: “I think a core part of the CIO role going forward is going to have to be how we collectively push on the supplier industry, and how we make sure that we reward through our purchasing of those suppliers that have made the biggest strides in improving the user experience. That’s why we put massive emphasis when we were selecting our EPR supplier on the voices of the clinicians and administrators that would be using that technology every single day, because we know that by putting them at the heart of the decision-making process, we’ll get better results. But I still think the market has got a long way to go in terms of providing genuinely novel and interesting solutions in that way.”
Coming to the issue with insight from working as a CIO, as well as from a supplier perspective, David said: “My observation is that actually it’s the dichotomy between having clinical decision support systems that need the rigour around clinical safety cases. That’s where you get the real slowdown in terms of development, because you’re developing systems in a domain with high risks. However, workflow is not part and parcel of that, and there is definitely room to do both – but I think it needs almost like a dual stream, rather than it being completely based on one or the other.”
Digital skills and careers
We asked panellists for their views on creating a digital organisation and how the impact this has on digital departments can be managed.
David highlighted the need to develop careers and career pathways for job development within digital teams. “If we’re going to say to digital teams they need to start mentoring or helping with the governance of digital change, that requires a totally different set of skills.”
Picking up on Lee’s earlier point, he noted that the Royal Marsden also moved training from under digital’s remit and put it with learning and development. “We took transformation of digital and put it in with the transformation team, because ultimately if you’re going to be a digitally mature organisation, you’ve got to live and breathe the systems as a core part of your actual job. That also leaves uncertainty about the role of digital teams; and that’s where the CIO has got to have that vision and sell it to the organisation. They should also take digital teams along on that journey, because we should be developing them.”
Tim expanded on this, saying that quite often transformation skills are embedded within digital teams already, with individuals who might have a long record of expertise in working on implementations and transformations in one form or another.
Looking ahead
To conclude the discussion, we asked our panellists what single challenge they would solve if they could choose one to tackle over the next five to ten years.
Lee said that he would like to see more consistency in funding and strategy across the NHS, whilst David suggested that he would look at a new way to approach the agenda for change for digital skills and digital roles.
Tim echoed Lee’s thoughts on the need for more consistent funding, saying it would “make it easier to plan a transformation” if CIOs knew ahead of time what funding they would have for the year ahead.
Will agreed, but added that his ambition would be that as a profession CIOs will become known for “making it better and easier to deliver care in the NHS over the next 5-10 years”.
We’d like to thank all of our panellists for taking the time to share their views and insights with us.
