Major transformation programmes are a formidable undertaking for NHS organisations. As Trusts strive to adapt to the digital age, effective board-level engagement has emerged as a pivotal element in ensuring the success of such transformative initiatives. In a candid conversation with Mandy Griffin, an award-winning ex-NHS CIO and Luminary member, with a wealth of experience in healthcare leadership, we delve into the importance of senior engagement and the critical role it plays in the realisation of transformation programmes.

The Crucial Trio: Chief Operating Officer, Chief Nurse, and a Senior Executive

In the realm of healthcare transformation, the term "trio" takes on a unique significance. It refers to the collective wisdom and decision-making capabilities of the Chief Operating Officer (COO), the Chief Nurse, and a senior executive team member. These key figures are entrusted with shaping the priorities following the deployment of an Electronic Patient Record (EPR) system.

However, Mandy highlights, there is often a disconnect in these leadership discussions. The stabilisation and transition phases of EPR implementation can be tumultuous, causing doctors and nurses to feel overwhelmed. They are suddenly asked to adapt to an unfamiliar system while grappling with existing pressures.

What becomes evident is that many healthcare organisations falter when it comes to engaging the right range of senior leadership in the decision-making process. It is at this critical juncture that their input is needed most.

Mandy emphasises that senior leadership involvement should extend beyond the programme level, which often includes a CIO and a CNIO. While these roles are crucial, the need for the next layer of leadership cannot be overstated. They are the ones who can help determine priorities and, in essence, calm the turbulent waters.

The Path to Improvement: Governance and Leadership

To address this issue, Mandy suggests a multifaceted approach that begins from the very start of the transformation journey. First and foremost, she advocates for the appointment of a Chief Executive Officer (CEO) as the senior responsible officer. This choice of leadership is paramount and sets the tone for the entire initiative.

Moreover, establishing robust governance structures from the outset is crucial. Regular senior-level meetings to discuss the programme’s progress can alleviate pressure on the programme team. It is at this level that key stakeholders can effectively win the hearts and minds of clinicians and staff.

One critical aspect often underestimated is the time commitment of key individuals, such as the Chief Clinical Information Officer (CCIO) and CNIO. For their influence to be felt, they must be fully dedicated to the task. When, for example, a CCIO works only one day a week, their capacity to engage effectively is severely restricted.

In essence, it is the leadership's responsibility to understand the impact of technical issues on healthcare delivery. They must prioritise issues based on their clinical implications. The role of the COO is particularly vital in comprehending the operational consequences of technical challenges. Their expertise helps in harmonising the technology's implementation with the organisation's operational needs.

Leadership: The Bedrock of Success

Mandy’s experiences have shown the importance of leadership in navigating transformational projects. At her previous organisation, Calderdale and Huddersfield NHS Foundation Trust (CHFT), she enjoyed the support of her executive team, which included CEO Dr Owen Williams OBE, and Helen Barker, the Chief Operating Officer. Their unwavering commitment to the project and ability to gain the trust and support of staff ensured that challenges were addressed, while Mandy could focus on problem solving.
This support from senior leadership in "calming the waters" is emblematic of effective healthcare transformation. The board's role is pivotal in setting the stage for success.

Early Governance and Leadership: A Foundation for Excellence

The governance structure within an organisation must be established from the beginning of a transformation project. As Mandy notes, these initiatives should be viewed as transformation rather than mere IT projects. The focus must be on the people involved, and this necessitates strong leadership from the outset.

Success stories like those of Milton Keynes University Hospital NHS Foundation Trust and East Lancashire Hospitals NHS Trust underscore the importance of early governance and leadership. These organisations made substantial investments in senior engagement, which paid off in the long run. These initiatives did not make headlines for the wrong reasons because of their robust senior engagement and leadership.

East Lancashire, for example, remained open to learning and engaged its executive team in the decision-making process. They encountered challenges, but their proactive approach and willingness to adapt to change ensured a safe transition.

The Role of the Chief Digital Information Officer (CDIO)

A pivotal aspect of senior engagement in transformation programmes is the presence of a Chief Digital Information Officer (CDIO) within the boardroom. Mandy underscores the importance of having a CDIO directly involved in the decision-making process. This direct engagement facilitates more effective communication between technical experts and the board. In contrast, when the CDIO is absent from the boardroom, discussions often occur second-hand, which can lead to misunderstandings and miscommunication.

Moreover, CDIOs play a crucial role in post-implementation phases. They help the board realise that the investment doesn't stop with the core programme. Continued investments are necessary to digitally adapt and grow in response to evolving needs. The CDIO's role is to present evidence, advocate for additional investments, and help the board make informed decisions about where to allocate resources.

Prioritising Transformation Needs: Clinical Safety, Operational Impact, and Financial Recovery

To prioritise the multifaceted needs of a hospital, and decide where to invest first, Mandy suggests considering whether any of the potential investments sit within these three key categories:

1. **Clinical Safety: ** Ensuring patient safety is paramount, does this programme affect the well-being of patients.
2. Operational Impact: Does this issue disrupt the seamless functioning of healthcare services.
3. **Financial Recovery: ** Could it lead to significant financial impact either now or in the future.

These categories offer a structured framework to help leaders prioritise project work and can guide collaborative discussions and decision-making at Board-level.

Extra Advice: Be Honest and Transparent

Mandy Griffin offers a piece of valuable advice for anyone embarking on a transformation programme: be honest! Transparency is key when dealing with challenges or uncertainties. If a setback occurs, don't hide it; communicate it to the board openly.

Furthermore, Mandy acknowledges that you won't always have all the answers, and it's okay not to be the expert in every facet of the transformation. The journey is a learning process, and admitting when you are out of your depth can be an essential part of navigating the complexities of healthcare transformation.

In conclusion, Mandy's insights shed light on the vital role that senior leadership and engagement play in healthcare transformation. These leaders serve as the linchpin for making informed decisions, prioritising needs, and ensuring the success of these monumental initiatives. By heeding her advice and having the right leadership structure and engagement from the outset, healthcare organisations can navigate the challenges of digital transformation with greater ease and effectiveness.