For a recent HTN Now webinar on the subject of digital leadership now and in the future, we were joined by a panel of experts from across the health and care sector, including Penny Kechagioglou, CCIO and consultant clinical oncologist at University Hospitals Coventry and Warwickshire; Kath Potts, chief digital officer at University Hospitals Plymouth; Simon Brown, head of digital at Royal Papworth Hospital; and Harry Thirkettle, director of health and innovation at Aire Logic.
“I’m very passionate about the subject of digital leadership,” Penny told us. “For me, it’s the collection of digital assets starting from people and platform, through to the technology, and our processes. It’s about improving outcomes for patients, reducing costs, reducing inequalities, and generally adding value in terms of productivity.”
Harry told us about working as a doctor prior to joining Aire Logic, and helping to support the NHS Clinical Entrepreneur Programme part time. “Aire Logic is a health tech consultancy that builds lots of the big national systems for the NHS, like the Spine and the vaccination service, as well as supporting trusts at a local level,” he said. “In my view, digital leadership is about empowering and creating the space for people to be creative and ambitious, focusing on end-users and solving real-world problems, removing blockers and challenges that might be in people’s way. It’s also about bridging the gaps between organisations and teams.”
“Before joining this world, I was working within digital agencies, but I transcended into digital after studying social innovation at Cambridge Judge Business School,” Simon shared. “On a personal level, it’s looking at how I can use all of the digital leadership and skills I’ve learned working my way through to the top in the agency world to support healthcare.” He noted the importance of thinking differently and embracing innovation, suggesting that digital and leadership be seen as two separate but related functions. “As digital leaders, we need to address and own innovation, not run away from it or bury our heads in the sand – understand what our people are looking for from us, getting that trust and credibility to drive things forward.”
Kath talked about her current focus on leading University Hospital Plymouth’s EPR implementation as part of the One Devon EPR. Kath shared: “It’s about putting patients and staff at the forefront and understanding what they need, making sure what you’re doing is co-signed. The digital role has become far more about that transformation and being a strategist, thinking about culture, innovation, and those things that have become much more prominent in the role; alongside that being very agile and flexible.” It’s key not to be afraid to take risks and then stand back and acknowledge where something didn’t work, she went on.
How has digital leadership changed?
From her perspective of having moved over into digital from clinical and operational roles in the last few years, Kath noted the shift toward digital being more clinically-led, rather than solely technical, and its move to the forefront of the wider transformation and innovation agenda. “We’re talking now about the digital enablers to these things we want to do in transformation and productivity, and it’s very much being that support, enabling our colleagues to do that, and working hand-in-hand with frontline staff to see what solutions are needed,” she said. “One of the things that is very different is that we’ve got a huge market out there in what we have available to us, but it’s not always the right answer – it’s going back to the core principles of what we need, getting feedback, and trying things along the way.”
“Digital leadership is becoming more strategic,” Penny observed, “and I think that’s going to evolve even further.” That has been necessitated by scarce resources and high costs of implementation, requiring greater consideration from leaders. “We’re seeing more CDIOs at board level, which is a really important aspect of driving top-down digital innovation and ensuring digital is part of the organisational strategy,” she continued. “The other thing to consider is how we make sure we have the right people skills to actually communicate the need for change and bring them on that journey with us.”
Harry emphasised the value of agile working, explaining how Aire Logic has acted as an advocate for an agile approach and helped drive its adoption across NHS Digital and NHS England. “A core part is having a relentless focus on end-users, as already mentioned, looking to what the actual problems are that you are solving for people, using the technology, and taking an iterative approach to it. Identify where you can release the most value early, build that as a simple iteration, take on board feedback from end-users, and build that back into your development.” The tendency is there to try and map out absolutely everything a solution could possibly do, he carried on, “whereas if you’re agile in your approach, you can deliver in small increments, and over time you end up going much more quickly”.
Royal Papworth has just formed its strategy to 2031, Simon highlighted, with his role as part of “Team 2031” being to help drive forward the strategy’s digital elements. “Royal Papworth is kind of a leader in terms of clinical excellence and its specialism around heart and lung, and everywhere that sits around it,” he said. “Like Penny said, it sits at the top, at a strategic level, but also at the heart of all the different stages and levels, with agile definitely feeding into it.” One thing we should have more of is user experience, he commented, helping to understand not only the processes but the people and how to engage them. “Agile working doesn’t always fit in the NHS world, but what has changed in the last five years is everyone is now more fluid on how we use digital and tech in our everyday lives – we need to find ways of embracing the expertise others have and embedding that through user journey and user experience.”
The role of digital leaders in creating a safe space for innovation
Offering her thoughts on innovation and how digital leaders can help create a safe space for people to innovate, Penny said: “Having studied innovation at PhD level, I know it’s a messy process, not a linear process as many people think. The agile aspect is important as we know things will not always work out; we need to be honest, and that’s where psychological safety comes along. If we pilot something, we can’t be afraid to say that it didn’t work – innovation comes in different shapes and forms – it’s a journey, it’s a process, and it’s important people are engaged with that.” It also works both ways, she went on, with the need for leaders to play a role in helping to share learnings and what has worked across and beyond the system. “Learning from failures and moving to improvement is where psychological safety has the major value,” she concluded.
“From our experience, what works best is when we work as part of a properly blended team,” Harry shared. “Yes, we’ve got people with excellent technical expertise, but NHS organisations have people with that frontline clinical knowledge and a deep understanding of the organisation. Where successful projects happen is when you can mesh those two together and take advantage of both. The other key thing is making sure those teams are upskilling each other, so you’re leaving those skills behind.”
There’s something about viewing end-users as a customer, and trying to replicate what big tech firms have achieved over time when they have done things at scale, according to Kath. “Now, you buy a handheld device like a mobile phone, and there’s no need for instructions – everyone automatically knows what to do. It’s flipping the focus when we’re trying to innovate and looking at the customer at the end, and whether what you’re doing fits what they want. From there, it’s scalable, and we’ve then got all the opportunities to share learning and do it at scale across the NHS.”
From working with and observing the interplay between the NHS’s typically hierarchical system and Aire Logic’s low-hierarchy approach, it has been interesting to note the role of that hierarchy in jeopardising psychological safety to innovate, Harry told us. “That makes me wonder if there are any benefits to be had from flattening the NHS hierarchy out a little bit, and how we would do that.”
Roles that fall into middle management, like CDIO and CXIO, have a huge role to play in bridging that gap, Penny considered. “For me, they are certainly the voice of the front line, and that voice is extremely important. We know that only over the last few years we have seen clinical safety officers, for example, and it’s actually having those structures where we can discuss clinical safety in digital, what’s safe and what isn’t, so that experience from the frontline can be transmitted upwards.” It is ultimately about patients, which leaves little room for hierarchy, she continued, “and at the end of the day, it’s about adding value, so we all need to talk the same language and support each other in making the right decisions”.
“I don’t think we’re ever going to flatten that hierarchy in the NHS structure completely,” said Kath. “But I think there are ways to manage that and still give people space, building trust with leaders at every level of the organisation. Being a leader isn’t about hierarchy and your post or title; it’s about how you’re seen by the group of people you work with.”
How will digital leadership need to evolve to meet the needs of the 10 Year Plan
“Digital is in all three dimensions of the 10 Year Plan,” Penny considered, “and things like the shift to community are going to require digital interoperability, a lot of infrastructure change, and workforce change in the way we’re operating.” Digital will be the biggest enabler when it comes to delivering care in the community, alongside data and connectivity, she explained, “and the way hospitals and community work together needs to change, so as leaders it means we need a different skillset to make siloed teams more outward-facing – more of a system-wide approach”.
“Part of leadership in this space is going to be about thinking how we can do things more efficiently and do things once,” Kath shared, “maybe doing things on a small scale but then scaling up quickly, across multiple places, and potentially our community providers and primary care.” Building on economies of scale will help bring value, she noted, “and there’s a real opportunity in how we as leaders reach out to each other and work collectively across the NHS”.
Harry pointed to the shift to community and the shift to prevention as requiring strong leadership to help bridge gaps and think at more of a system level. “There can be some imbalance, and maybe acutes in some areas have a slightly louder voice than some of the community providers,” he said. “We need to think about how a patient that lives in an ICB wins as a whole, which could mean uncomfortable trade-offs or even some damage to your host organisation, but it’s being brave and seeing the bigger picture.”
When it comes to prevention, some estimates have stated that we’ll be spending $47 trillion per year globally on chronic diseases if nothing is done by the middle of the next decade, Harry told us, “and as a vendor who has worked with digital health tools and other things I feel could really help in making that shift, the thing we run up against is in-year funding cycles and short-term thinking”. Making the push to move toward a longer-term view and making investments now to bring rewards later is essential, he added, “and that’s got to be something we try to get to together”.
“One thing I’m looking to introduce now is hackathons or workshops,” Simon shared, “and when we’re approaching organisations to help us with it, we tend to wrap ourselves up with tight procurement requirements and bureaucracy, so that we tie our hands. We have this great 10 Year strategy, but do we have the means and the processes to enable it? All these things we’re talking about – we need to make them happen, but by the time we’ve had to go to a steering group, then a sub-committee, then another committee, that idea might have lost momentum or interest.”
“We don’t need to start from scratch when it comes to prevention, but we do know from NHS data where the gaps are, which means we can be a bit more targeted,” suggested Penny. “We know we can make a big impact in those populations that need it the most, whereas we tend to spend a lot for the people who are already healthy, and likely to remain healthy. Funding is limited, but we need to start more strategically and work to narrow down, using our data to tell us where the problem is.”
Attracting and retaining digital skills
Kath outlined how attracting and retaining digital skills is “probably the biggest challenge for all of us on this call”, with restrictions on pay scales and difficulties in matching both salaries and other benefits that might be on offer in the private sector. “We’re getting there in the NHS, but we’re still way behind other places, so we need to think creatively outside of the financial envelope,” she said. Promoting digital leadership and ensuring there is clear career progression is one key element, as is embracing the skills and expertise already on offer within the organisation. “Having worked in many roles across the NHS, you need all of that background and wealth of experience, and we need to focus on personal development and make sure we are making that investment.”
“I agree with Kath,” Simon shared. “If you look at software developers, their market scale is far higher than our banding permits, and I haven’t personally found a solution for that yet, but what if we could partner with tech companies or organisations with those skills, to have one of their staff members two or three days per week to solve a specific problem? Some may stay, some may not, but what they can do is share their knowledge and expertise with those already in the NHS.”
“The digital leaders of today have got a very diverse skillset – maybe they’re entrepreneurial, or hybrid clinical or operational staff working between the private and public sector – but we’re not giving those staying in the NHS the right incentives,” Penny stated.
As digital leaders, removing some of the blockers to innovation within the NHS could alleviate frustrations and increase people’s job satisfaction, Harry proposed, “because if they have developed a really great feature, but it isn’t going to get released for 12 months because it has to go through a series of approvals, that is frustrating”. Preventing people from being pigeonholed into their roles and offering more opportunities to go out and earn new skills is also important, as is giving them flexibility to go and work on things they are passionate about, he added.
Advice for aspiring digital leaders
Offering some advice for anyone who might be aspiring to become a digital leader, Simon noted the need to be aware of the challenges around changing entrenched processes within the NHS. “Maybe come in with a fresh face and an open mind,” he added, “because there’s so much we could be doing around things like smart buildings, RFIDs and tracking patients in their journeys – we’re just not embracing it, and it’s currently only being discussed in little pockets – we haven’t even got into the data and analytics discussion.” Waiting for things to be driven from the top might not be the best approach, he went on, “and we should start doing it ourselves now and that will unearth how we drive it forward to inform central and upwards”.
“Find a good mentor; not necessarily someone in digital, to help navigate the NHS and understand things like the bureaucracy,” Kath suggested. “Seek out opportunities and other experience, and don’t think too linearly in terms of this just being digital – think about the wider transferable skills that will set you apart from other people doing those jobs.” The digital workforce strategy might offer direction when it comes out, she highlighted, “but delivery of that plan and what that looks like tends to be very much up to us as individuals to work out”.
Penny talked about digital leadership being “a very exciting space”, adding: “It’s the future, and we will need strong leadership – don’t limit yourself to one space or one organisation, but build that experience in different areas, and that creates flexible, agile leaders. As far as skills for the future, that’s obviously training in digital, in tech, and AI, but we know that the majority of that work is about change, and it’s about leading people.”
Reflecting on his own transition from a clinical role into digital, Harry outlined a key feature of aspiring leaders as “relentless curiosity”. Learning by speaking to those on the front line, understanding what is going on, and getting to grips with the different pieces of technology in place across the organisation is a good start, he said, “and future digital leaders will need to be a lot more active in being an advocate for end-users – building the software will be the easy bit”.
Key takeaways
Before the webinar ended, we went to each of our panellists in turn for a key takeaway. “For me, if we are going to move forward positively with digital leadership, we should support the growth and development of leaders, and they need to have a strategic say in what needs to be done, and be brave about saying no so they can focus on things that matter,” Penny said.
Kath shared: “We’re very good at trying to jump straight to a solution; it’s about being clear on problem solving and using all of your leadership skills to get to a clear pathway on what the options might be to do that. Communication, negotiation, and conflict resolution are all part of the process to make sure you reach the right solution.”
“Bravery is something we’re really calling out for,” said Harry. “There are a lot of challenges, but there are also a lot of opportunities – if we have got good digital leadership in place, I think we can capitalise on that.”
“We have talked a lot about digital leaders being in CDIO roles, etc, but I think we can also pick up on digital champions,” Simon stated. “If you have somebody in your team who is an expert with data or AI, they themselves can and should be a digital leader – that knowledge and expertise will help them build that trust and credibility. Digital leaders aren’t just those who sit at the top of the hierarchy – they can be any role or function within an organisation, and we should be giving them the opportunity and platform to be that leader for ourselves and others.”
We’d like to thank our panel for taking the time to share these insights with us.
