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Obvious question, obvious answer? The Chief Information Officer is clearly the leader of digitally enabled change, no? Even if we, as CIOs, may well have a greater understanding of the role of senior leadership, as well as business ownership, in business transformation, those senior leaders may not always agree…
As a part of a healthy and candid Health CIO network in the UK, I see a risky power dynamic appearing between CIOs and Executives. I say ‘Executives’ rather that ‘other Executives’ because only about 1 in 3 CIOs sit on the board in English Health institutions, and that’s one of the symptoms of this odd relationship.
As part of our work investigating digital readiness in the health and care system in England, we conducted some interviews with Chief Executives and Chairs of health and care organisations. Many interviewees were very candid about their confidence with digital:
“There is a sense [that Digital] is one of the solutions and the NHS is not embracing the digital age… Chairs don’t understand how – it is a world of mystery.”
Others were clear that they perceived significant risks when undertaking large technology projects:
“I see a few cases where Health CEOs are lauded for their success in adopting new Health Technologies, but many more that have lost their jobs when things haven’t gone to plan”
And others who discussed the inability of the CIO to help them manage these potential opportunities and risks:
“Why can’t people working in Informatics Services just explain things more simply? …teach them to try and be ‘can do’ and to speak like a Yorkshire man to a Yorkshire man!”
"The organisation needs to have a culture of open discussion, experimentation and sharing led by visible leaders"
What became clear is that boards find Digital change scary, risky and that the one person they appoint to manage this risk and leverage this opportunity tends to speak in a language they can’t understand to explain why something can’t be done. Boards are unable to see the potential for major business change and use CIOs as a way to reassure themselves that progress is being made without having a toolset, or mindset, to provide genuine assurance. This reliance on reassurance over assurance is a weak governance model.
So, we have a board that needs to be able to understand what the future may look like and a language divide with the team who can help them. To address this, we decided to create a CIO to CEO phrase book.
We mapped descriptors of organisational digital readiness from the official NHS Digital Maturity Assessment, an unofficial model used by Salford Royal NHS Foundation Trust and the learning on Digital Leadership from a not-for-profit organisation called DotEveryone to a framework called Well Led, used by healthcare regulators in England to assess Leadership. This analysis identified eight key elements of organisational maturity that appear to be present both in NHS approved digital maturity models and in organisations most able to adapt to the accelerating rate of change across all industries.
We posit that these organisational traits are where boards should concentrate first.
Element 1: Boards need to understand the changes being brought about by use of data, information, knowledge and technology (digital) in health and care and what the opportunities and risks of these changes are. Importantly, they also need to know what the changing expectations of staff, stakeholders, patients and the public are.
Element 2:The organisation needs to have a culture of open discussion, experimentation and sharing led by visible leaders.
Element 3: Everyone in the organisation should understand users’ needs, as well as organisational performance in meeting those needs, and be empowered to act to improve them.
Element 4: The organisation has a suitably skilled and empowered workforce.
Element 5:The organisation should be supportive of cross-functional, non-hierarchical structures as well as traditional hierarchies. It needs to consider where power to affect change should be, inside and outside the organisation.
Element 6:The processes that the organisation uses to underpin its functions must be fast, integrated, light and meet users’ needs (both staff and service users). Boards should understand the impact of having poor processes on staff productivity and user satisfaction.
Element 7: Risks associated with use or adoption of digital (e.g. cyber security, GDPR and information sharing) must be understood, weighed appropriately against benefits and mitigations assured.
Element 8: The organisation should be supported by technology that is scalable, interoperable, flexible, fixable, resilient and fit-for-purpose and importantly the Board should understand how to assure themselves of this.
None of these are easy to crack. We are experimenting with board development sessions to engage boards in developing themselves and their organisations in the areas they think are most important. So far discursive and creative sessions led by independent facilitators, supported by the CIO, seem to be most successful.
What is certain is that if CIOs don’t learn to speak Digital in the native language of boards, their organisations simply won’t be able to adapt. And if organisations don’t adapt, they will fail