For our latest HTN Now panel discussion, we were joined by Sarah Hanbridge, chief clinical information officer (nursing, midwifery & AHP) at Leeds Teaching Hospital, and Ciara Moore, unified EPR programme director at Mid & South Essex and Essex Partnerships University Trust, for a conversation focused on engaging boards and workforces with digital buy-in.
Sarah and Ciara began with sharing their background and current role, as well as some of the digital projects and focuses they have at the moment.
Sarah provided insight into her time so far as CCIO at Leeds Teaching Hospital focusing on digital transformation, innovation and research. “The last 18 months have really been boots on the ground for me. In my first three months I did a piece of discovery work which involved engaging with staff from shop floor to board, interviewing around 150 people, trying to understand what the digital agenda was in Leeds and what that meant in terms of transformation.”
From this, Sarah continued, she learned more about the challenges and expectations from her staff members. The next consideration, she added, was the What Good Looks Like framework, which she was “keen to digitise” based on her prior experience as a regional CNIO for the North West and her work with fellow CNIOs there.
“We started to look at how we could digitise that process and did a six-month pilot implementing What Good Looks Like, working with clinical service users to understand where they were with the seven success measures. It was critical work, because that enabled me to get that engagement piece off the ground. I had engagement from the onset as a result of the work I’d already done engaging our staff, and so using the actual framework was an easy process.”
Sarah also shared that her team has successfully developed their latest nursing, midwifery and AHP strategy, which has created two work streams, one of which focuses on continuing work on the What Good Looks Like framework, and then the visualise, optimise and digitalise (VOD) programme.
Ciara talked about her 30 years’ worth of experience in health, beginning in a finance department before moving into operational management and transformation, always maintaining an interest in technology before ultimately landing her current role in Essex around four years ago. There, she is working on projects such as Patients Know Best and supporting the EPR programme in both organisations.
Ciara highlighted her team’s work over the last couple of years on a business case for a “first in type” electronic patient record (EPR), which she described as “really exciting”. She noted that “getting an EPR out to everyone, with just under 23,000 staff and nearly 3 million prescriptions to be managed across both organisations, is a challenge. We are aiming for a clinically- and operationally-led, digitally-enabled EPR, that will deliver those significant workflow integration benefits, not only for the organisations; but also into the community and regionally as well.”
Engaging with the board
When it comes to engaging with the board, Sarah said that her team are “really fortunate” to have a chief digital information officer with an executive position who is part of the board, as well as a chief nurse who she describes as having “a real strong voice” and understanding of the digital agenda.
“We launched a digital commitment in March that empowers our staff to look at some of the digital systems and processes we currently have in place, and how they could be more efficient or effective. We’ve just done a big education piece around MS Teams and how to make full use of its functionality. Those conversations have had a ripple effect, because you have to be very clear on how you empower staff. We use the term ‘digital confidence’ a lot in Leeds, because people will tell you they’re not digitally savvy but if you look into it, they usually know more than they think.”
Sarah also told us about a digital confidence scale that a member of her team recently carried out within the training department, which has been “critical in people benchmarking and understanding where they are in alignment with their job description and what the key skills are they require for their day-to-day job”.
She added: “One thing I’ve learned at Leeds is that you have got to build your digital army using your digital advocates, your digital forums and so on; because a lot of our advocates have expertise that the rest of us don’t, and you need to utilise that and spread it wherever possible. Also, use your opportunities to talk about the key agendas and empower people to move with your new journey, with the strategy. That’s how you can start to change the culture around the digital agenda.”
Ciara went on to share some key points when it comes to engaging with the board, including training for the change and the impact it will have from board level down to individual level. “The NHS Providers digital training for boards is excellent, and one of our board members has already completed that training, which has helped them understand about digital in their role on the board,” she shared.
Another of Ciara’s points focused on fitting digital into the broader strategy and working it into every part of that strategy. She commented on how engagement sessions and face-to-face summits with members of the board had helped to “keep those regular reports going in” and keep members informed.
On the nuances of collaboration, Ciara noted the need for getting the governance signed off. Her team has been working on a memorandum of understanding that they are referring to as a “prenup agreement”, which outlines how stakeholders will operate going forward, who is going to be in charge, who will employ staff, and who’s going to be the contracting authority for suppliers.
“We’ve split this work so that the first part of it is the memorandum of understanding, getting the business case through.Then we will be looking at how we will operate as a programme until we go live; then for go live we’ll have to have another part of it focusing on things like contract management,” she said.
As a final point, Ciara noted that having four CCIOs and two CNIOs across the programme helped to drive it forward, and that this also helped with the clinical safety element. She added that the programme was also “really lucky” to have the strong sponsorship and subject matter expertise that these roles bring.
Key challenges in engaging the board digitally
We asked Sarah and Ciara what they thought were the key challenges when it came to getting the board engaged digitally, and how those could be tackled.
Sarah noted the importance of some of Ciara’s earlier points around strategic decision making, adding that risk management, accountability and transparency “are also really important at that level. Identifying the risk is a crucial part in the process, especially when it comes to resource management, finance, operational disruptions and cybersecurity, looking at data privacy, cyber threats, and so on.”
When she first started at Leeds, Sarah pointed out that one challenge she faced was that she didn’t have the resources. She recognised that “there was quite a lot of risk” if she didn’t get the positions in post to support her with the work on What Good Looks Like, strategy and implementation.
“I was going to the exec team and my CDIO, letting them know that we needed the funding for these posts, because of the importance of the work on What Good Looks Like and the need to understand levels of digital maturity across the organisations,” she said. “We had the HIMSS assessment, but we didn’t really know what it was like at grassroots across the 25 clinical service units; whether we had smart foundations, safe practice, patient support and user engagement in place.”
Sarah also noted the need to look at the bigger picture, such as how data is informing what needs to be done on a digital level.
“It was quite challenging for me, as a new CCIO, to come in and make positive change, because as we know with digital we do get resistance,” she reflected. “The comms team was really important – we did a lot of branding to help the board understand the agenda and how they can help us. It’s just balancing that comms, the risk and the implications of doing things, and some of the benefits realisation. Thankfully, my board listened to me and invested in a deputy post, which has helped us to excel in our digital transformation agenda.”
Ciara also spoke of the importance of looking at the risks, sharing that her team has already registered 189 risks through their risk log, and voiced her agreement on the integral role of comms.
“Messaging has to be quite simple and easy to understand, so the comms piece is key,” she agreed. “At our face-to-face summits we learned what people were worried about, things like finances, patient safety, clinical safety. We’re developing a ‘bow tie’ approach, which brings your risks together but at a higher level that’s easier to understand. Then you have the benefits element, because we have to be realistic about the way these benefits are going to be realised, and the risk to not delivering those. Of course we’ve used evidence from other organisations as well, where benefits have been realised, and then we’ve got some new ones.”
Engaging the workforce with digital
Moving on to talk about engaging the workforce with digital, Sarah highlighted how she had first targeted those showing an interest in digital, and how her team had taken steps to hold informal discussions with staff, sharing information about digital projects and programmes, as well as information on becoming a digital advocate.
“We’ve built a team of digital advocates who are passionate about digital, and whose expertise has been key in some of the training we’ve done with our workforce. We’ve digitised the whole process, so we’ve got QR codes and our data in the background, which has been really empowering, so we can see where our digital advocates are within the clinical service unit. Then in alignment with our What Good Looks Like work, we’ve done our benchmarking where one of the criteria is about empowering staff and having digital advocates.”
In graduating from Teams to the Microsoft Viva Engage platform, Sarah talked about how this has been key to helping educate staff, collecting their opinions, and getting feedback on user perspectives.
“It does take a lot of energy, and a lot of that comes from our team, our passion and our drive to deliver. But we are on that road to changing the culture, because that’s the big thing for me around the digital transformation agenda. Until we set our strategy, I don’t think people were really clear on the shop floor level about what digital meant for them in their role, and the things they could access from a training and education point of view. Also, when we were doing the What Good Looks Like framework, we realised that we were quite red across the spectrum for research and innovation. We’ve got a homegrown EPR that’s full of data, but we’re not fully utilising it, we’re not looking at patient outcomes and our patient experience, and that’s the bit we want to focus on.”
In moving forward, Sarah shared that her team has started conducting clinical walkabouts and gathering feedback, and that a recent engagement day provided some reviews on Viva Engage that helped demonstrate the significance of training.
“I think that’s the beauty of being agile and being innovative in our thinking. I think we’ve got to do more of that on the shop floor, getting people to think out-of-the-box and understand that whilst EPR is the foundation, we need to start looking at what we’re doing with that data, the quality assurance, how are we using it to improve, and how we use our advocates or our people in the process to improve.”
Ciara shared that she always starts with the stakeholder engagement map, as a list of every department and site, and what their current state is in terms of their awareness of the digital strategy, the EPR, and how they’re using it.
“Last year, we did three big events to bring that digital strategy to life, including a ‘paper picnic’ which went viral on Twitter because it was just phenomenal,” she shared. “If you’ve got multiple sites it’s important you don’t just do everything at the main site where the executives are.”
There were two other projects on the shared care record and Patients Know Best, Ciara continued, “and we brought things in around learning and access for staff on digital literacy, we set up the digital champions network which now has 700 members. We’re also starting work on a people plan, which will set out our communications with people and the impact on their role.”
Building digital confidence
When it comes to building digital confidence, either for the board or the workforce, Sarah told us how this is currently something her team is working on.
“It’s our top agenda, actually, around optimising systems. We’re working closely with our clinical service units to look at what systems they’ve got and using our systems to their full capacity. The conversations that we’ve had over the last few weeks have helped us understand the individual and service requirements, and how to use that information to really empower your workforce, to understand what training they need. We’ve done things like bite-sized training, videos, and drop-in sessions for people to build their skills.”
Sarah also talked about current work with heads of nursing and matrons on Microsoft Forms, using those to collect data, which she calls “absolutely critical bread and butter stuff that needs to be addressed”. She added: “That’s the biggest thing for me – collect the data, show the evidence, build the business case, and the world’s your oyster.”
Ciara shared that her team is “in an early stage” of digital training and engagement, and had been pleased with the results from their digital literacy assessment; looking to build on this, they are currently working on designing a digital academy with the first module being on change management.
Looking ahead
Looking to the year ahead, Sarah shared that she is most excited about continuing the VOD programme, and reducing the digital burden, since during the paperless agenda “a lot of things have gone from paper to digital without really thinking about the people in the process”.
The team has a PhD student joining them this week to support them “with more of a research hat on – looking at how we can use that research lens with our data quality and look at the outputs from PPM+, improving patient experience and the quality agenda. Then we’ve got the audit process around What Good Looks Like. We’ve started the digital confidence framework and benchmarking for staff, and we’re also doing digital health checks as well around some of the standardisation in our clinical areas.” She added that they hope to develop blueprints based on their work, to be used across the seven sites and beyond.
On the year ahead, Ciara talked about her excitement around delivering the EPR with her team. “Delivering transformation and change is not an IT project, it’s people and purpose, and engagement; we can deliver the best thing in the world but if we don’t understand our people and how they work, then it’s not going to work.”
We’d like to extend our thanks to Sarah and Ciara for joining us, and for all of the insight they shared with us around engaging the board and workforce with digital.
