For a recent HTN Now webinar exploring the role of the CNIO in digital transformation now and in the future, we were joined by an expert panel including Melanie De Witt, CNIO at North Bristol NHS Trust; Louise Croxall, CNIO at Calderdale and Huddersfield NHS Foundation Trust; Natalie Hayes, CNIO at Wirral University Teaching Hospital NHS Foundation Trust; and Laura Johnston, customer relationships manager at Radar Healthcare.
As well as considering the role of the CNIO in helping to drive digital transformation, panellists discussed their own experiences, their journeys into the CNIO role, and the potential for the role to go further in bringing the benefits of digital and emerging technologies to the frontline.
Journeys into the CNIO role
We first went to each panellist in turn for a brief introduction to their current role and background, with Melanie sharing that prior to coming into this role six years ago, she was a divisional lead nurse running neuro and MSK teams. “I saw the advert for the first ever CNIO role in Bristol, and we were just at the beginning of a re-procurement of our EPR – having been in a senior operational role, I could see the opportunities of digital technologies, and I wanted to get involved and try to make this deployment better than anything we’d ever done before,” she stated. “I had lots of senior leadership experience, but very little digital experience.”
Laura noted that her entire career has been spent in tech and digital transformation, formerly working with pharmaceutical organisations on introducing different innovations. “I realised quickly that the magic really happens when we come together and share ideas, share challenges, as opposed to acting as an island,” she reflected. “About 12 months ago I made the pivot into healthcare with Radar Healthcare, a company which started out solving issues around compliance and incident management, before moving into the quality space, capturing audits, action plans, and so on, with tech that allows management of those processes in a really structured way.”
After first getting into digital when Calderdale and Huddersfield went live with its EPR system around eight years ago, Louise talked about her journey from ED nurse to CNIO. “It came up as a secondment, and that meant if I didn’t like it, I could always go back to ED,” she said. “I was successful in the interview process, and did the secondment for 18 months until it was advertised as a permanent post. I’ve been doing it ever since, and I love the variety of the role – no day is the same, new things are happening all the time, and it’s just keeping your eyes and ears open to what’s out there that can help our clinical staff improve quality and safety.”
“I’ve been CNIO at Wirral since August 2025, before which I was in the same role at Mersey and West Lancashire for almost five years,” Natalie shared. “It’s definitely one of those roles you kind of fall into. I was a diabetes specialist nurse, and part of that role was that I took the lead on digital technologies like wearable tech for patients. Through that, I got a real passion for what digital can do for our patients.” Starting at a new organisation is like starting from scratch, with new systems and processes to learn, she considered, “but that’s what I love about this job”.
Sharing successes
Melanie pointed to her involvement with her trust’s nursing documentation as one of her greatest successes. “When we took on our EPR, it had quite a new noting offer, and nobody had really built out end-to-end nursing documentation in that system,” she said. “We have managed to do that, and the most exciting part of it has been watching our metrics improve for things like observations, risk assessment, care planning – you can see them really easily, which makes auditing easier and makes it clear how you’re contributing to the quality of patient care.” Another benefit is in helping to take away some of the cognitive load for nurses, she continued, “so they don’t have to remember the policies any more, because the digital tells them the next step, and they can concentrate on the patient in front of them”.
“For me, the biggest success has been establishing a Digital Champions Network, which launched yesterday!” Natalie told us. “Anyone can join – this can be a lonely role, and we need that workforce behind us, because a lot of what we’re doing is cultural change. It’s a network of good will, so people do it on their own time, and that’s why I’m so proud of it, because people have given their time freely to come along.” The first meeting was attended by a range of different roles, she explained, including lots of nurses, a porter, a surgeon, and a number of administrative staff.
Laura talked about working on a product advisory panel with Radar Healthcare, which has enabled leaders from across the health sector to come together and have conversations about challenges, what works, and best practice. “We believe in the power of partnership and community, and how important that is to shared success,” she shared. “The idea is to have a safe space for brainstorming, and that’s how we see our role, really, not just as a tech provider, but connecting the wider community and creating that space to share.”
“Our proudest achievement is achieving HIMSS Level 6 across three models within the organisation over the last 18 months!” Louise highlighted. “Off the back of that, my proudest moment was probably walking round with the inspectors doing the accreditation, seeing how digital was so embedded, and hearing from everyone as we went around wards about how much digital helps them in their working lives.” That included impact on care plans and assessments, reduction in medication-related incidents, falls reduction, and more, she noted.
Louise also considered the impact of better data in improving patient safety and care quality, with real-time data now in place, rather than looking back through manual audits from months ago. “You can see your obs on time there and then, which is something we’ve been doing a lot of work on, and that highlighted issues like HCAs having to give out dinners on many of the wards, which led to a dip in observations, and it’s what the trust can do with that data to make improvements in quality and safety for patients.”
Overcoming challenges
When it came to achieving HIMSS EMRAM, the biggest challenge was with getting things like closed loop medication scanning to be seen not just as a digital project, and getting that recognition of the positive benefits the work would have for patients, according to Louise. “Once that flipped, and people could see it was helping patients get the right medication at the right time, it took off overnight,” she noted.
Natalie mentioned the challenges arising from organisational mergers, bringing together different cultures, processes, EPRs, and so on. “We’re trying to bring together services and merge those processes, but digital is absolutely essential to the underpinning of that,” she explained. “It’s the unpicking of the different ways of doing things, including everybody in those conversations, and making sure it’s happening in the safest way for our patients. It happened at my last trust, and it’s happening at this one, too, but the lessons learned and the challenges have been very different.” While the process is difficult, ultimately patients will benefit, she acknowledged, “so if we look at it through a patient lens, it’s very much the way to go”.
Even where merging two acutes both using the same EPR system, as was the case in her previous trust, there are differences in how it is being used, or how it has been designed to be bespoke to the organisation, Natalie suggested, noting that it was difficult to get the understanding that just because the two looked similar on paper and were using the same systems, that didn’t mean they weren’t actually very different. “That largely came down to getting people together and talking through end-to-end processes, having those conversations – even down to the fact there were two different skin check models in place for tissue viability. Senior leadership advice was to just pick one, but both of those services believed they were doing the right thing.” Often, there isn’t an evidence base for digital in the same way as there is for clinical, she considered, “so sometimes you just have to muddle through”.
“I think what’s been said is that the challenge isn’t a technical one, it’s a cultural one, and one that sits around the perception of technology as it’s embedded within an organisation,” Laura said. “As Louise said, it’s not about something being a digital project that sits in isolation; there’s a wider piece that’s about delivering better outcomes for patients, and that tends to work better when it’s owned by teams, rather than delivered in a top-down way.” That also extends to ownership and visibility of data, she continued, “where the full feedback loop is closed and the empowerment to take action off the back of data is there within teams”.
With all of the changes happening in and around the NHS at the moment and some uncertainty about changing roles, it can be really difficult to keep the focus on improvement and transformation, Melanie told us. Bringing cultures together and trying to get a range of perspectives to inform decision making can be challenging, she went on, and there can often be disconnects where tech teams might not understand parts of clinical complexity, or the different needs of specialties. “Having those constructive conversations where everyone is focused on the patient and listening to each other’s point of view to get to the right outcome, as well as being prepared to revisit the plan if it’s not quite right the first time, is probably the biggest challenge, in keeping all of those hearts and minds open when we’re in the middle of an enormous piece of change,” she added.
Harnessing data
For staff, driving and using data means having confidence in that data, Louise pointed out, “and one of the biggest issues has been people not putting it in the right place to allow for that to be used later on”. Often, what might happen is that people undergo the formal EPR training, but then go back to the wards where they’re shown quicker ways to do something, she elaborated, which might not allow that data to be used where needed. “I’ve got a team that are constantly going around the wards and working with staff on inputting information in the right place in the system, so we can get it out again, and we’ve set up a quality assurance dashboard, which is improving confidence in our data.”
It’s taken a long time to get everyone on board, and to iron out discrepancies or things that might not be currently getting picked up, Louise carried on, giving the example of food charts being filled out at the end of the day meaning that they were only recorded as having been done once, rather than three times. “It’s working with both clinical and technical staff to make sure that they can both see each different perspective, and so tech teams can see how things work in reality. It’s getting confidence in the data, then moving on to using the data, then looking at what that data is telling us, where we can concentrate our improvement efforts, and where we need to make changes.”
From Radar Healthcare’s perspective, a lot of focus is on making sure the data foundations are in place to enable frontline teams to input data as easily as possible and then access data when they need it, Laura shared. “Getting those foundations right before jumping ahead to look at insights is key, and once you have those dashboards available you can leverage some really interesting insights from there,” she explained. “We were working with a partner who had been analysing outcomes of audits for a long time, and that was yielding good outcomes on an audit-by-audit basis, but when they looked across the piece, there were broader themes that emerged – in specific areas these audits were being completed incredibly fast. That prompted an investigation into what was happening and what we could support with – that’s an example of using higher-level business intelligence to look holistically at what we can improve and what value there is to be had in closing that loop from insight to action.”
Skills and emerging technologies
When considering what skills are required for the CNIO role and how those might change in the future, Melanie told us that when her role was advertised, it “contained everything and the kitchen sink”. Since that time, it’s been a continual co-creation, she suggested, taking into account the needs of people like the chief nurse and CDIO, as well as the broader organisation. “I’m not sure that the skillset has changed,” she noted. “I would be surprised if the thing right at the top for anybody wasn’t communication – some days it feels like all I did all day was listen, but that comes back to the influencing, leveraging, changing, and connecting part of the role. Beyond that, every day I need to draw on all of my skills from my experiences in education, management, community, nursing; then probably general leadership and risk management. Every day I learn, which is what I love about this job.”
Louise shared her excitement about emerging technologies such as ambient voice, and the difference that could make in helping with documentation for clinical staff. “We want one solution that can integrate with all of our different EPRs, so we can do our documentation just by having a conversation with a patient and letting it capture all of that information,” she said. “The biggest challenge is how much is out there in terms of AI and how accessible it is for our staff – it’s making sure they’re using it the right way, not putting clinical data or patient identifiable information in there, and monitoring that, but it’s really exciting at the moment.”
Managing the balance between excitement around new technologies like AI and the caution and safety side of things is a key conversation happening in this space, Laura discussed. “We’ve taken a very controlled and careful approach to bringing AI into what we’re doing, and I think it speaks to what Natalie was saying about having an evidence base and being really conscious of looking at the validation of these models, then applying caution to the insight generated.” Staying grounded in clinical reality and not moving away from that is important, she continued, “and that’s the message that’s coming from those we’re speaking to, as well as what we’re trying to do”.
Natalie told us that her trust’s approach so far to AI has been taking things “gently and slowly”. While ambient voice is being piloted, the organisational merge is making it difficult to do anything more expensive or larger scale, and the focus is on enabling services to come together. “From our organisation’s perspective, it’s a priority that we deliver the merger activities safely in the first instance, and then we can move on to transformation,” she added.
“We also have a couple of pilots of ambient voice,” Melanie shared, “and my concern, as with a lot of technical innovations, is how do we keep the clinician in the loop and make sure every decision has gone through a well-informed clinical brain, that’s analysing the recommendations or the information being presented and using that to make a decision for the patient in front of them.” Just because we can do something, doesn’t mean we should, she noted, “and as CNIOs and digital clinical specialists, we need to think about what bits of care we want to delegate to machines and which we want to reserve for human beings”.
The future of the CNIO role
Talking about the CNIO role of the future and how that should evolve, Natalie said: “First and foremost, we need consistency. There is no consistency even just within England when it comes to job descriptions, banding, expectations, reporting lines – I’ve now been CNIO at two organisations, and those roles have been very different, even on the same patch. Some people have teams around them, some people have multiple sites they’re covering, and the variation is always clear when I speak to other CNIOs. When I was a diabetes specialist nurse, in contrast, the banding and expectations, no matter where you were, were always very clear.”
“It would be great to see a model CNIO approach, that’s replicated at a system and a regional level,” Melanie agreed. “We’ve actually lost ground on that – those regional posts were just starting to pull us together and help us standardise and share practice in a structured way, but we’ve lost that in most regions now.”
Laura highlighted the importance of the CNIO role in navigating the benefits and challenges that accompany the introduction of new technologies, bringing a clinical lens to conversations around AI. “Given the pace technology is currently moving at, I think the CNIO role could be sitting as both a challenger and a disrupter, both in a positive way bringing these new and exciting technologies in; but also bringing that caution that is necessary,” she noted. “Maybe not really a change, but just a slightly different vantage point in relation to some of these new technologies.”
We’d like to thank our panel for taking the time to join us and share these insights.
