For our latest HTN Now panel discussion on the topic of building a great digital team, we were joined by panellists including Tom Mann, digital transformation lead at Sheffield Children’s NHS Foundation Trust; Penny Kechagioglou, chief clinical information officer and deputy chief medical officer at University Hospitals Coventry and Warwickshire; Andrew Carter, assistant director of digital, data and technology at Bury Council and IT locality lead for Bury in Greater Manchester ICB; Michelle Cole, clinical director at Solutions 4 Health; and Kishore Sankla, CEO at Solutions 4 Health.
Our panellists discussed a range of areas around building digital teams, including driving a culture of innovation, skills and capabilities, what works, digital leadership, challenges, and more.
We began by asking each of our panellists to give a brief introduction to their role, their organisation, their team, and their structure.
Tom explained that Sheffield Children’s provide specialist paediatric care in acute settings and in the community. As digital transformation lead, he reports to the head of digital programmes, who in turn reports to the chief information officer. “In terms of the structure of our team, the central tenet of our digital strategy is that ultimately we want everybody to feel part of our digital team,” he said. “In terms of our formal clinical leadership structure, we have a CIO but we also have a CCIO, a matron for digital technology, a clinical safety officer who is also a consultant paediatric surgeon, several lead nurses for digital technology, and clinicians with dedicated time built into their job roles.”
Michelle said: “I’m the clinical director at Solutions 4 Health – we are a provider of healthcare services, 0-19, sexual health and healthy lifestyle services. We have small team and we’re developing our digital offer at the moment. My background is health visiting and school nursing, primarily, but most recently I’ve had roles in clinical governance and safeguarding in local authority, in NHS, and in the charity sector.”
We next moved on to Penny. In her role as CCIO and deputy chief medical officer, she explained that she reports to the chief medical officer; the trust also has a senior responsible officer for the EPR programme in the chief financial officer. “Over time, we built a team of two deputy CCIOs, we’ve got a clinical safety officer, and we managed to get dedicated time for senior clinician consultant level in the job plans to support EPR and other digital projects moving forward,” Penny shared. “We also have representation from the junior doctor team, and support from the chief registrar. I work closely with our chief nursing information officer who has also developed her own team, so we’re working as one big clinical informatics team, and of course our director of ICT and digital who brings the technical and analytics.”
Next up, Andrew said: “I’m the assistant director of the DDaT function of Bury council, which is a joint role with the Greater Manchester ICB. I’m the IT locality lead for Bury as well. This is my first foray into local government – my background is in the NHS, I’ve had 17 years in various digital teams, various hospital settings. The structure on the council side is we’ve got a team of around about 45-50, reporting to myself, and then I report in to the director of transformation. On the ICB side, I report to the CIO of the Greater Manchester ICB IT team, and we make up the digital function for the ICB. There are 10 locality leads, and then there’s a wider IT function, and we’re still on both sides of the fence, working through our structures.”
Finally on introductions, we heard from Kishore. “I’m the co-founder and CEO of Solutions 4 Health. Within the tech, the way we structure this is to ensure that each team has their own focus,” he said, “so we have an extensive tech team, but they’re broken up into specific areas of focus. Michelle and her team are specifically working on addressing challenges within workforce across the NHS, health visiting services, and so forth. We do it in quite distinct pieces of work, and that allows us to put in the appropriate resources, and have leaders who can lead on it without being distracted on what’s happening at a wider level.”
What’s the key to building a successful digital team?
Kishore said: “It’s important to have individuals who deeply understand the challenges within the healthcare sector, as they’re going to be the ones who lead on that product development. This needs to be coupled with individuals with good technical skills, but it has to be driven by people who have a solid understanding of the challenges that exist.”
Penny shared her view. “I think it’s important to start with them having a great vision of what a digital hospital wants to achieve,” she said. “I’m completely with Kishore about understanding the challenges – it’s also about where we are planning to go and why we need the digital team. It’s important that the team is valued and sits at board level in the organisation, but we also need to train them well and give them time to do their best work. That means looking at the job plans and incorporating digital within their day-to-day work.”
Tom gave his perspective. “When we think of our digital team, we need to think in terms of the wider organisation. One of our organisational aims is to create a brilliant place to work – part of that is creating a culture where colleagues can thrive, develop, be recognised, and feel safe. To do that, the leadership team has to play their part, modelling the change they want to see, and ensuring there’s multidisciplinary representation on interview panels and on the board, so that decision makers aren’t just people who look and think like me. I agree with Penny, it is about vision and staying true to that.”
Andrew shared: “The vision is the key to what you’re doing, because it’s about understanding and aligning people to how you want to work, your team, your culture, and what you want to achieve. Tom talked about diversity – that’s absolutely huge; we know that diverse teams are more effective, and I think we’ve got great ability in the digital team for neurodiversity and really expanding the workforce so that you’ve got a team representative of the people you support.”
Michelle shared her thoughts on building a successful digital team, saying: “I think what Tom and Andrew said about service users and really listening to what they want is key. We can build the best team in the world, but if service users don’t want to engage, then they won’t. It’s about listening to how they want their services delivered and how they want that to look, having these focus groups, listening to that feedback, and developing the services in the way that they want.”
Driving a culture of innovation and change
We next asked our panellists to consider how they thought an organisation could go about driving a culture of innovation and change.
Michelle said: “Personally speaking, from a health visiting and school nursing background, it really is needed – we’re in real dire straits as a profession at the moment, so whether we want to or not, we’ve absolutely got to look at different ways of working. From a clinical governance and safeguarding focus, we saw during COVID that there was a spike in safeguarding cases for children. Now we’ve got the option to do things slightly differently; we didn’t have that then, we had to go to a digital-only delivery. I think we absolutely must lead on this and take this forward, because there’s been years of lack of investment in public health nursing services, and we really are in danger of being left behind.”
“I think it’s important that innovation is part of our organisational strategy,” noted Penny. “It’s important that it is reflected in the organisation’s values, and it’s important that we make it easy for innovators to come forward, and also have the right processes in place for people with ideas to support them, bring them in in collaboration with the industry and other providers, and actually make them feel valued.”
Challenges of building digital teams
“When you go through any kind of restructure and you’re bringing people on a new journey, the challenge is that to unlock the next set of potential, you’ve got to move with the times,” Andrew commented. “Bringing people on that journey is always a challenge; some people aren’t ready for it, and the only way you’re going to do that is through good communication, keeping people in the loop and feeling valued as part of that process. Innovation in general in public services implies a certain level of failure, because you need to try things; and there’s almost a zero failure tolerance in services using public money and public time. Part of the integration piece is making sure that everyone is on board; not only your own teams, but get them reaching out into other teams.”
Tom raised the “elephant in the room”: funding. “That is a challenge for everyone,” he acknowledged. “With NHS funding it always tends to be time-limited, rather than permanent and recurrent, so we have to apply and bid for funding. Clinical capacity can be challenging, and making sure that it’s baked into people’s jobs is probably one way to address that. There’s change fatigue too – at Sheffield Children’s there has been an enormous amount of change, just from a digital point of view, never mind everything else. We have a clinical advisory group which meets on a weekly basis which is focused on the development of our EPR. It’s chaired by the CCIO and it leads the change from a patient-facing, end user point of view. There’s got to be a commitment to co-production and design from board to ward, in terms of building quality improvement capability; it takes more time to involve stakeholders from the beginning, but ultimately it’s an investment worth making, because you get a better outcome.”
Kishore noted that whilst COVID led to a leap in progress, the passage of time has led to some progress seemingly reverting backwards with more resistance to change. “The fear is: are we going to go back to not adopting technology as fast as we could? Clearly, safety is critical and safeguarding is important; but trust in health tech is starting to go back down again, and we must be proactive to understand where the weaknesses are and how fix those.”
Michelle added a point around digital poverty. “We are still seeing lots of families not being able to access digital services, so even if we can get the buy-in and the rollout, there are still huge pockets of the population that won’t be able to access it. That’s something that really needs to be addressed before we can properly move on.”
Building strong and diverse digital teams
We asked our panel for their thoughts on kinds of skills mix required for digital teams, and how they would go about bringing those to the forefront of their own digital transformation.
Tom said: “For the people who are on the frontline, there is a digital literacy challenge. Getting those people out of their day job, when we’ve got waiting lists and other pressures, is really challenging. When they get training, they’re going to prioritise their clinical skills, understandably, so that’s definitely challenging in terms of what can we do to attract people into digital roles.”
Penny agreed. “I would see it in two ways: what’s in it for people, what do we offer, what is the value proposition for people to come to join digital; but also, it’s about the soft skills that people can bring. Implementation is really important in digital. We talk about strategy and what we’re going to do, but actually implementation is what’s going to bring an idea to fruition, to the pilot and then to a scale. We need people that can see through the whole journey, who have the skills to do that and the willingness to do that, and we can train them to acquire those skills. For me, digital is all about leadership. It’s about bringing people from different backgrounds and from different disciplines together, distributing leadership and giving people the autonomy to drive this.”
Digital leadership
What are the core skills for digital leadership, and how will those roles develop in the future within health and care organisations?
Penny started us off on this topic. “We need leaders who are credible and well-respected, and people who will drive that vision forward and create that important sense of purpose, of why we need to drive digital transformation and what could that look like,” she said. “It’s important that leaders bring people together through the common vision and the goals moving forward. It’s also important that when we talk about experimentation and autonomy, that we are making sure that people from top-down and bottom-up are very much aligned with what we’re trying to do. We need people to be given ownership and the permission to innovate and to fail; because without failure, there is no learning. The best ideas and innovations come out of failure.”
“I think it’s about soft skills like coproduction, stakeholder involvement, and then things like understanding procurement and finance,” Tom considered, “because that plays a big part in digital solutions and evidence-based decision making. There are just so many projects that are going on at any one time; they really need accountability and governance and we need to make sure we understand the bigger picture. From a leadership point of view, it’s not just the organisation they’re in, it goes beyond that; we need connections at regional and national levels, within frameworks, and we need to develop strong networks with other providers.”
Andrew talked a bit more about the need to recognise capabilities within digital teams, saying: “I think digital leadership is knowing where your strengths and weaknesses are; being cognisant of where you are short. It’s getting quite rare now to get people in senior leadership who’ve got a technical background, but you need to know that you’ve got people around you who can understand the technical landscape.
“It’s also trusting the people who you’re with to do their job to the best of their ability, taking a step back and giving them the responsibility and space to develop,” he added. “Again, let them potentially fail, but put a structure in around them that means if that happens it’s not the end of the world. Board representation of digital is still severely lacking in the NHS, and it’s causing a lot of issues in a lot of places that I’ve seen. Digital ends up becoming a subsidiary of finance or other things, so you’re then bound by someone else’s vision. Digital being represented at board level is absolutely imperative; you cannot run a service well without digital maturity. Having someone who can say when support is required, what we’re going to do and how we are moving forward, is really important. I know it’s a touchy subject but something I feel strongly on that we should have representation at board level to to give it the weight it deserves as a function.”
Kishore said: “I think one of the biggest challenges is that technology is moving at such a rapid pace, and every time we switch on the news it’s more innovation around AI. How do you keep your teams at least on an even playing field in an industry where there is so much demand? Getting people with the right skills is phenomenally difficult across all industries, particularly within local authority or the NHS, where we are constrained by budgets. We have to do things on a shoestring budget, and that comes with huge challenges in being able to attract and retain talent. We overcome that by empowering and investing in the team, making sure they don’t fear failure, they want to experiment, they want to learn.”
Future challenges and changes
We asked our panellists what change or challenge they would like to see tackled on this topic.
“It would be great to change the perception of IT and digital, so it’s seen as an enabler rather than an obstacle,” Tom said. “The Post Office scandal is very topical at the moment, and that’s a stark reminder of when IT systems aren’t implemented well; but I think it’s important that we overcome horror stories like that and show people the potential for good. It’s about getting round that ‘I don’t like IT’ response that people can have – they might say that about health tech, but they don’t tend to feel the same about online banking or online shopping. It’s a matter of changing perception.”
Michelle said that she would like to see more buy-in for digital from a board level, and “a bit more bravery from commissioners being prepared to take a chance on something that actually might revolutionise the healthcare system. There’s a lot of hesitation at the moment. Like Tom said, we’re using it in all other avenues of our lives, and we’re prepared to do our banking online, which is a big thing.”
Andrew shared his “potentially controversial” opinion, saying: “I think that the NHS and healthcare need to have a look at the way they structure pay, and at some point separate the clinical and non-clinical pay structures. I think it’s hampering both elements and it doesn’t serve either cohort at the moment. In digital, often we need to hire someone with a specific skill; but you’re going to get nowhere near the market value of that person, because they don’t handle a budget, they don’t manage a team, they don’t do things that you might need them to do as part of a pay structure. Likewise, when they want to look at pay restructure for clinical staff, for the nurses, they have to incorporate everybody who’s on the same grade in non-clinical, which doesn’t make sense either. At some stage, someone needs to look at that and take pragmatic action.”
Kishore agreed. “Andrew’s spot on there,” he said. “I was in Boston a few years ago and everywhere I went there were these massive signs for recruitment, and I was really shocked at the level that people were being recruited at. These were new graduates on six-figure salaries. How do you compete with that? We need to really think about how we can address that, but we also have to be realistic here; as a country under severe public health pressure, we don’t have that ability to be able to meet those sort of scales.”
Penny added: “From my perspective, I would like to see a move into data-driven integrated care systems; clinical teams and operational teams working closely with analytics teams, and actually data driving decision-making. I’d also like to see patients getting involved in the design process of digital technologies and having a say on what’s going to happen to the data.”
We’d like to thank all panellists for their time, and for sharing their insights and experiences on digital teams with us.
