Chris Fleming

Tag: leadership

  • What good looks like for digital transformation in health

    As part of our work with NHS Providers (supported by HEE and NHSX) on running digital board sessions for trusts, we often get asked, “Can you tell us what good looks like?”. So it was great to see that NHSX is working on this very question, and even better talking about it openly on social media.

    When Trust leaders ask us this question they usually are coming from a place of “tell us what the latest technology is” or “paint us a picture of the modern digital hospital”. My response is always the same. We could do that, but is that really what you need?

    Historically, digital advancement in health settings has been taken through a predominantly technological lens. The most obvious example of this is HIMMS. But I worry this approach has been pretty unhelpful overall, because as anyone with experience at the sharp end of digital transformation will tell you, it’s not just the technology but the culture, processes and operating model you need to worry about if you want to genuinely change. The risk of painting the picture of an internet-era clinic is that you are not giving a trust any tools to help them get there.

    With that in mind, here are some thoughts about what good looks like

    1. Having a clear mission everyone understands. Digital strategies that are 40pages of shopping lists are hard to remember. Make it clear to people what you are trying to do, or they wont come on the journey with you.
    2. Relentlessly focus on your users’ needs. If you aren’t actively focussed on understanding and addressing the clinical, practical, or emotional needs (Ht Janet) of either patients, clinicians, or other staff people won’t use your services and you will never see any benefit.
    3. Talk about services not projects. Services start at go live, projects end at go live. Your digital services should be seen in the same way as any other service you offer- to be supported ongoing, iterated, improved. The NHS Service Standardhas all the advice you need.
    4. Invest in skilled teams – with internet era capability covering not only engineering but product and design, and pair these with clinical and operational staff. Work together, don’t chuck requirements over the fence. And please please try not to design things without some design expertise!
    5. Use modern cloud based technology. Don’t lock into long contracts. Work with suppliers who want to collaborate with you as one team. Stop putting tin in the basement.
    6. Be agile. Focus on the minimum viable product based on valued delivered and iterate when you learn more. Minimum viable governance that is proportionate to the need. Show the thing, don’t hide meaning in 2″ inch-thick board packs.

    As a board, be servant leaders. Take collective responsibility for your digital transformation, put it at the top of your agenda. Ensure you have the right technical knowledge in the room where it happens. Unblock things for your teams. Move authority to information not information to authority.

    The title of this blog post is ‘What good looks like for digital transformation in health’ but the same principles apply in every sector. None of this is news. It’s all already in the Public Digital book, blog, and in other places like the digital maturity scale my colleagues developed with Harvard Kennedy School. Many of my formercolleaguesand others all around in the health and care system have been saying similar things. 

    A common picture for what good looks like is beginning to emerge across the NHS. In some places, it is already more than just words – you can see it, and so can patients. But that’s not true everywhere. What comes next must be the harder discussion about what makes good so difficult to achieve, and so hard to scale. Because the answers are likely to be rooted in the topics that all too often fall into the ‘too hard to fix’ category: money and power, legislation and legacy, the rules and tools of the game. 

    If you’re interested in this work and want to continue this conversation you can find me @e17chrisfleming.

    This post was originally published on the Public Digital website.

  • Building digital organisations, creating great teams and enabling transformation

    I’ve spent a good portion of my career working in digital teams in the NHS. You’ll have to trust me when I say it’s the most satisfying work you could do.

    The ingredients are pretty compelling. Done well, it brings you close to the people you are trying to help. You understand their backgrounds, stories, hopes and fears and live it with them. A minute saved, a question answered, a reassurance given; incremental tweaks making a small difference to the world. Over time these can scale up to something rather powerful. Even better if the team is empowered by leadership to solve the problems the business and users have set them. There is no further level to ascend in Maslow’s hierarchy.

    Most inspiring though, is operating in a multidisciplinary environment. The satisfaction of charting a course through what’s safe, what’s possible technically, what the business wants to achieve, and what experience will meet the user need. It requires technologists, designers, researchers, clinicians and operational staff. They each bring expertise from their alien worlds to alight on the thing that will make the service better by next Friday. And the Friday after that.

    As part of the Digital Board’s programme we recently helped NHS Providers produce a guide on Building and enabling digital teams. It may sound obvious when you say it out loud but the secret to digital transformation is not magic. It’s teams. While leadership and a window of opportunity are important, all the words and slides in the world won’t save you without a team in place to deliver. Teams are the start, middle and end of your transformation.

    The board of any organisation plays a huge role in creating great teams. It also sets the conditions to enable them to thrive. In the guide we propose 8 questions for boards to ask about progress building a digital organisation.

    1. Do you talk about digital services or IT projects?
      Projects imply a one-off thing to be ticked off a list. Services imply a need to understand the people who will use them and help them complete a task. Projects end on launch day. Services start on launch day.
    2. Who designs your services and how?
      Digital is not just a rebrand of your IT department. True transformation happens when the edges of traditional and new disciplines meet. You will design the best services and meet the needs of your users when you bring together multidisciplinary teams.
    3. Is specialist digital knowledge represented at the top table when key technology decisions are made? Digital is about rethinking operating models as much as delivering new technology. Making those decisions in the absence of specialist expertise is risky.
    4. Are you applying new hiring strategies to hire new skills? Senior product leaders or interaction designers are not typically going to be looking on NHS Jobs. If you look in the same places, you will get the same people.
    5. Does your team look like who you are trying to reach? The best way to build services that work for everyone is to make sure that your team, at any level, reflects the people who will be using them. Diverse teams are more productive and innovative, and have been shown to improve patient care and outcomes.
    6. Are digital teams coming to you with problems to solve? As a board, are you servant leaders having an open conversation, or are you trying to decipher the hidden problems obscured in the papers?
    7. Does information flow to authority, or does authority flow to information? There is no argument that good governance is critical to good service delivery. But ‘good governance’ is often confused with extra process, hierarchy and paperwork. There is a better way.
    8. When was your last blog post about your digital transformation published? One of the most powerful ways an institution can differentiate itself and attract a new type of skillset or leader is to interact with the outside world in a different way. The best digital organisations show their working out.

    This post was originally published on the NHS Providers website.