One year at BHT, reflections on interim Board CDIO and why the NHS needs you

I’ve just passed my one year anniversary at Buckinghamshire Healthcare NHS Trust (BHT) and I thought a little reflection would be useful! I’m putting some thoughts down I think for three reasons

• To reflect on my experience as Interim CDIO and to offer some views as to how a Board level CDIO can balance Exec/Board responsibilities with operational/team responsibilities
• To encourage staff who do not have a 20 year background in the NHS to apply for senior (and all other) roles — we need your perspective, and your impetus to drive change in the NHS. You can be successful, in the small way that I have
• To reflect that a Digital voice and Agile thinking can help Exec and Board working

Reflections on being an interim Board level CDIO

Starting at BHT in January 2022 for the first 3 months it was a whirlwind of TIF/ERF and UTF spend (apologies for the acronyms, but hey this is the NHS 😉). And then in March I applied for and became Interim CDIO. The Trust was on a journey to appointing their first Board level CDIO (as advised by Andy at https://andy-callow.medium.com/why-you-need-a-cio-on-your-nhs-trust-board-ced67ddb6c98) and so between March and July I became that Board level Executive colleague.

This meant I lived through a cycle of full Board level meetings — Executive Management Committee every week, and then the cycle of Audit, Finance and Business Performance (F&BP) and Private and Public Board meetings.

So what do I look back on in my time as Interim CDIO? Well fortunately I had a debrief with the CEO so I have some notes! Neil asked me to evidence three things

1. What have you done with digital teams — structures/staffing/wellbeing
2. Major projects (e.g. pathway to EPR)
3. Interaction with Exec and Board

In terms of teams and people I was pleased to report we’d developed a ‘go high’ and ‘go low’ strategy — meaning if others advertised a role at 8C then we’d go for 8D — alongside grow apprenticeships/people earlier in their career. We’re also investing in the people we have — and I was pleased to secure a £50k training budget for Knowledge Academy (and I’m not sure there had been any external training pot before).

I’d also set in train some substantive appointments that have been handled as perennial secondments before, identified budget for some FTC posts and appointed some brilliant colleagues to work in Digital in the form of Daniela Valdes as Assistant Director Digital Transformation & Innovation, and Jemima Stewart as EPR Programme Director.

I’m next on the hunt for a Head of Delivery and a Head of Clinical Systems so watch this space!

I also think I’ve demonstrated personal leadership in values I want to see in others, namely:

• Openness
• Transparency
• Approachability
• Challenging without being chippy!
• Being open to feedback (yes, I did another survey!)

In terms of major projects I:

• shaped/appointed an agency to lead on our EPR business case
• contributed to the BOB ICS digital strategy
• led/influenced/shaped/enabled significant projects (Digital ICU, eConsent and Pre-Op, System C Hardware refresh timeline, case for scanning of paper records, Cyber security, TPX Impact ‘communications discovery’) etc.

In reality we took on too much in the first half of 2022 and that’s something I want to avoid in 2023.

In terms of Interaction with Exec and Board I:

• participated fully in Exec meetings (EMC, F&BP, Audit etc)
• attended 2 Exec Away Days including talking about my ‘Manual for Me’ and White fragility (and continued my journey of trying to get people not to use the term ‘guys’ — see https://www.theatlantic.com/family/archive/2018/08/guys-gender-neutral/568231/)
• challenged other privileges in a way that straddled the line of ‘being challenging but not chippy’ (Neil’s words)
• attended two Execs + Divisional leaders’ meetings and ingrained folks with the view that ‘we don’t do digital to you, we do it with you’

My experience also chimed with my time at Kettering where I thought as an Exec and a CDIO there were three key aspects to the role, namely:

• Being an Executive and a Board member — being a ‘fit and proper person’!
• Being a leader of a team of 200+ colleagues
• Understanding how a hospital works and having deep empathy with its staff and patients

None of these are easy!

My experience helped me understand how a Board level CDIO can balance Exec/ Board responsibilities with team responsibilities, and the sketch below is my attempt to show how I think the CDIO role is a T-shaped role — the ‘top’ of the T is the Exec- the ‘down’ of the T is the team of 200+ people.

An overview of the CDIO role

Noting:

• Not all Exec roles have direct management responsibility for a large team — for example the Medical Director and the Chief Nurse may be responsible for the activities of thousands of staff, but not by close management of those folks.
• Equally some of the other roles such as Finance Director and Chief People Officer have massive responsibilities, but manage teams of usually less than 50 staff.
• Some roles such as Director of Governance are very specialist, and carry a lot of risk, but again may line manage a small team of 20–30 colleagues.

I now have a much better feel for what you need to do in such a T-shaped role, and being conscious that you have at least two teams you’re a part of — the Exec Team, and the Digital team (or ICT as it’s still labelled at BHT).

The two Exec teams I’ve been a part of have been a collection of brilliant individuals, making them a team that gels is quite difficult, given all have slightly different T-shaped responsibilities!

Why the NHS needs you

Reflecting on my time in the NHS from when I joined NHS Digital in 2017, but more pertinently when I joined Kettering in March 2020 and BHT in Jan 2022 I have been an Executive team member for approximately 20 months, and a full Board member for 4 months (at KGH I was a part of the Executive, but not Board).

Why does that matter? Because I think it shows you don’t have to be a 20 year veteran of the NHS to be successful at the highest levels — if you’re thinking of joining the NHS and particularly Acutes (and Community) from another sector don’t hold back. If you have the skills and more importantly the right attitude to make change happen the NHS is a great space to work in — very challenging, but very rewarding (and I previously wrote about the challenges but also the reward here Why come to Buckinghamshire and do digital stuff in an Acute hospital?)

Why the Board needs Digital and Agile thinking

This echoes some of Andy’s post but adds a bit more from my own lived experience of two Exec teams. Being a Digital Director and trying to work in an Agile fashion brings with it some characteristics which I think help an Executive team, and probably the Board. From my point of view working in a Digital fashion in the NHS:

• is democratic (aim for the lowest level of decision making)
• is inquisitive (user research, appreciative inquiry etc)
• is accessible (open to all, inclusive, diverse)
• is a team sport and all about collaboration
• is Digital natch, not technology or IT! (Do I need to quote Tom’s definition of Digital? “Applying the culture, processes, business models and technologies of the internet era to respond to people’s raised expectations” — just as relevant in a hospital as anywhere else)
• is challenging of privilege
• uses data in a smart way to give insight (user experience, performance, managing demand)
• is Agile, releasing value early, learning and iterating, going where the need is
• influences ideas and policies early on so Digital isn’t an after thought
• helps sort complex problems by using hypotheses-based design ideas or user stories
• uses a prioritised backlog to manage epics and features, not 2-year waterfall plans

All of which is as relevant at the highest level of a hospital as much as it is in a squad building a small feature for a digital product.

And to end with my greatest success

Well of course it’s the blue gilets, and I’ll explain why…

Me and Ash and Kris and Olly

At Kettering I couldn’t quite get the gilets in place, we even spent Exec time talking about them! But the cost of embroidery (“well everyone would want embroidered stuff Ian”) and the fact that gilets weren’t covered in the uniform policy meant the friction was just a lil too tough, even for me

But Joe Rouse summed up beautifully why this is my greatest success at BHT. He’s a Paediatric Nurse, and he described a feeling he gets when he’s nursing a sick child, and they turn the corner and he sees in the parents eyes a sign of hope. He said he felt that when a blue gilet turns up in A&E or a ward, he sees a similar look of hope. Now the parallel isn’t the same in terms of care, but helping clinical teams do their job is what it’s all about — and you can’t buy hope.

Now onwards in my Digital Director role. We have an EPR to build, and a team to support and grow, and an ICS to make fly.