The balance of fantasy and reality in assignments

Assignments are a highly specific form of written communication. They are often set by one person who may also be the primary audience. There will be concomitant constraints such as word limits, prescribed structures and writing styles.

Part 1 of the Technical and Digital Leadership Assignment asks us to produce a 'Business Case' for our organisation.

The implicit underlying requirement is to demonstrate an understanding of the material covered in the course. For this the ideal might be to recognise and promote a disruptive digital technology or platform which would yield competitive advantage to the organisation.

The type of organisation we work for, its level of digital  maturity, the nature of its products and services, its regulatory context, and other factors will have a major impact on the ease with which a suitable  digital business case can be defined. So there is an element of 'luck of the draw' in how well the organisation we work for fits.

Similarly, our individual job roles and hierarchical positions will greatly affect our ability to produce a substantive business case. We may have the intellectual understanding and knowledge to produce such a business case. But that does not mean that it would ever be asked of  us in our normal jobs. In our normal jobs, we may well have to argue a 'case'. Such bids and negotiations are probably quite frequent.  But the form of these transactions and their subject area are usually going to make them a poor choice for demonstrating the range of features that will dazzle in an assignment.

One of the by-products of doing a course is to create opportunities to break out of the perceived constraints of our current job roles. This allows us to be creative in opening up opportunities. The same possibilities might be also be able to be negotiated in our work personal development plans.

How far we might be allowed to stretch will depend on the perceived size of the leap we are proposing and whether there is a shared, and agreed,  vision for our future career direction.

For example, if I were to propose that as part of a course in leadership, I would like to take on the role of Acting Chief Executive for a trial period, it would be greeted with little more than mild amusement, and perhaps a referral to occupational health. But if an Executive Director colleague asked to gain comparable experience for personal development, there  might be a good chance of success, perhaps tempered by the extent to which this posed a potential threat.

There is an inverse relationship between how useful the proposal is to us and how likely we would be allowed to do it

There is also an element of the catch-22 type paradox

'How can I get any experience until I get a job that gives me experience?'

(a line spoken by the character Brantley Foster in the 1987 film 'The Secret of My Success').

One of the main purposes in enrolling on the course of which the assignment forms a part of is to gain the experience and qualification that would lead us step closer to being likely to be able to do these things.

If we already produced our organisation's Digital Strategy as part of our normal job role, we would quite likely be a lot less interested in enrolling on this particular course. 

I work for the NHS, which is a very large, complex public sector service organisation lagging somewhat behind in digital infrastructure investment and innovation. The part of the NHS I work in, North Cumbria suffers from a similar long term lack of investment and has a legacy of old applications supporting pre-digital ways of working. For example, when I joined my current organisation in 2014, it was still using as its main patient administration system (PAS)  a system implemented in 1993. In a previous NHS organisation, we had replaced this same system in 1997, regarding it as inadequate. 

The NHS nationally has a succession of digital plans and strategies together with emergent strategy, almost Agile strategy production,  being announced by Health Ministers and gradually assimilated into subsequent plan documents. COVID has injected fresh  momentum into this.

My employing organisation, North Cumbria Integrated Care NHS Foundation Trust has very recently (March 2021) produced a Digital Strategy covering the period to 2024. The existence of this document makes it almost impossible for anybody, let alone me, to produce any kind of digital strategy for the organisation for several years. 

One of my observations of NHS culture is that process is regularly mistaken for product. So having a document, or a committee, or a designated individual  can often be seen as an end point in its own right. The familiar elements of paraphernalia have structures which can be followed without too much thought. Achieving the goal takes a lot more imagination. The journey, wherever it eventually leads, is accompanied by documents. 

Usually such documents are very light on analysis and reflection. So, if in 2016 the NHS announces that it will be 'paperless' by 2020, what happens when limited progress has been made? The answer  seems to be that in 2020 the NHS simply announces that it will be 'paperless' by 2024. It is staggering. What is needed is some deep reflection around why limited progress has been made. Surely this is essential to prevent the same thing happening - or in this case not happening - all over again? Instead we simply reset the clock. This pattern can be tracked right back to the early 1990s where NHS Trusts were asked to define their progress to achieving EPR Level 6 - electronic patient records which would have dispensed with paper. 

It  seems there is already a significant issue with the balance of fantasy and reality in 'real life' even before we look at this dynamic in writing in assignments.

The hard reality,  for me,  is that I am not the person who will be asked to write the Business Case for implementing a full Electronic Patient Record (EPR)  in the place I work. I can have all the passion,  belief and vision - I do - but I will not be asked to write the business case. In fact, it seems nobody from my organisation is going to be entrusted with writing this important document. I am told we will be paying £250,000 to a consultancy to produce the document!

So if I produce a 'business case' for an EPR as part of my assignment, what is the status of this? At best it can be seen as a kind of role playing exercise. But if I want to take my own 'business case' into any real work forum, it  risks being simply dismissed as irrelevant fantasy. I may be lucky in getting constructive feedback from one or two colleagues. But in doing this they would be consciously joining in the role play. Yes, I would hope to have some influence on the real life business case, whenever that turns out to be, but that is no use to me in producing an assignment for 12th April 2021

My dilemma is that those horizons in which I currently have influence provide relatively weak opportunities for demonstrating all the requisite features covered in  the course. Those horizons where  areas where the best impact could be seen are the ones where I have negligible impact.

It seems the main intention - to set out a plan for the next two years in which I propose and propel a case which could actually be adopted where I work - is pretty nigh impossible in reality. The question then becomes about the value of fantasy.

Edgar Bolton. 

31/03/2021

Any views expressed above are purely mine and should not be mistaken for those of any organisations or individuals I have been associated with

The NHS Leadership Academy self-assessment tool

The NHS Leadership Academy was moved to NHS England/NHS Improvement in April 2019. This was to align it more directly in support of the leadership initiatives set out in the NHS Long Term Plan

Most leadership development has been postponed over the course of the COVID pandemic.

Prior to these recent changes, the NHS Leadership Academy developed the NHS Leadership Model and accompanying online self assessment test.

https://www.leadershipacademy.nhs.uk/resources/healthcare-leadership-model/supporting-tools-resources/healthcare-leadership-model-self-assessment-tool/

To be able to take the test, it is necessary to register. My Academy ID (AID) number is 1000278428

The test is taken online. There are nine dimensions in the leadership model. Each is assigned an identifying colour. For each dimension you need to rate yourself as one of five proficiency levels

• I – Insufficient 
• E – Essential 
• P – Proficient
• S – Strong 
• X – Exemplary

A second strand is to rate how essential the leadership dimension is to your job role. The processed output is emailed in a 25 page Adobe pdf document

There is also an additional section which applies  if you line manage any staff. This section applied to me. There are three statements for each dimension and you are asked to score on a six point agree-disagree scale. The focus is on how well you feel your team feels supported and enabled in each of the 27 aspects

The results are presented in a series of charts. The first is the following radar plot showing the self rating for each dimension:

The same data is also presented as a kind of hybrid table/bar chart. This time the  'how important is it' measure is paired with the self-rating

This summary suffers a little from having five graduations in one measure compared with four in the other. But it does allow some sense of prioritising

The same data is presented again in a kind .of heat map plot showing three types of 'heat':

 This chart looks quite 'scientific' until you realise that it is really just a 5 x 4 grid. Most of my scores sit in the 'balanced zone'

The scores are then presented again as a table showing the scores you give for the two ratings for each of the nine dimensions

Next, in my report, is the summary of impact scores. I have limited the screenshot below to the first six statements (covering two of the nine dimensions). It is really just a simple table 

The remainder of the pdf document is largely space for you to write on reflections and personal development plan actions.

So how useful is this tool?

Overall, it uses the nine-dimension NHS Leadership model (for which further material exits). So part of the answer to 'how useful is it' depends on the extent to which you buy into the model. Nine is quite a lot of dimensions. It introduces a question of how well balanced all the elements and statements are across both the model and the assessment. There is a bit of a control on this in that you are asked to rate the importance of each dimension to your job role. So there is a kind of self-weighting.

Unlike quite a lot of assessment tools with online renderings (Honey and Mumford, Enneagram, Myers-Briggs etc) there is no complex algorithm behind the scenes, The tool simply presents back to you your own ratings. It does this through a slightly repetitious set of neat, alternative renderings in tables and charts. But you could easily set up the same scores in Excel and produce similar, and better, summary tables and charts.

The whole thing is dependent on how you perceive and score yourself. So it exists largely within one side of  the Johari window. It may be influenced by your mood and level of self-confidence at the time you take the test. I will be interested to see how it looks if I retake the test in a few weeks time

There is a logical progression into a '360 degree' feedback exercise in which you would ask people who work with you how they rate you along all the same strands of the same nine dimensions. This excursion into another part of the Johari window might produce some surprises. But to be honest, reflecting even for a short while on the incongruity between my own self-ratings gives plenty of areas to work on. Basically my somewhat strident starting point - yes, I'm quite good at that'  would sit awkwardly with 'how would they see me'

Edgar Bolton. 

31/03/2021

Any views expressed above are purely mine and should not be mistaken for those of any organisations or individuals I have been associated with

The Insights Discovery tool

Insights Discovery is a widely used psychometric test. It is usually sold as part of a package intended to be used by whole teams.

As I cannot justify buying this for myself and my current employers show no interest in it, my current learning about it will be somewhat indirect and limited. 

For example, I cannot assess the structure and mechanism of the 20-minute online 'multiple choice' test that is used to generate all the outputs. I would be interested to compare it with the two-option forced choice structure of the Enneagram

But I am lucky in that a few years ago a colleague gave me a copy of his own generated report, illustrations from which I am reproducing below. In addition, I can still remember a conversation at the time with the senior manager who commissioned the Insights Discovery exercise for this whole team, at no little expense. Both these colleagues seemed to enjoy the experience and both reflected to me that it had given them new insight. But I could not, and did not over the subsequent years, see any sign of what any of the participants really did with these insights and what, if anything, changed as a result of using it.

The context in which this Insight Discovery exercise was carried out was organisational change. In essence two previously separate and largely autonomous technical teams had been brought together. There was a lot of resistance to change. People whose 'expert power' had previously insulated them from challenge by their wider organisations were lined up against similar colleagues who did things differently. To make things worse, neither of the two heads of the precursor organisations had been appointed to be overall in charge, but they were kept on in the new structure. The grape pH reading was well below 7. So the new head of this service was making valiant efforts at team-building and  unification in the face of some typical public sector bad behaviour.

So, in this situation, it probably did not matter whether or not the Insight Discovery had any actual validity, the exercise had immediate benefits in getting people away from their day to day work and talking about themselves and talking to each other.

The output from the Insights Discovery 20 minute test is a personalised report with a lot of information in it. Production of this must be entirely automated, using elaborate algorithms. The output I have available to study is several years old. So it may be that the processes have been modified subsequently.

Edgar Bolton. 

31/03/2021

Any views expressed above are purely mine and should not be mistaken for those of any organisations or individuals I have been associated with

The NHS long-term plan

Published January 2019,  the 'NHS Long Term Plan' is the latest iteration of what previously might have described as a ten year plan. 

https://www.longtermplan.nhs.uk/

The main report is 136 pages. There is also a 2 page summary, a 24 page 'easy read' version and a 12 track audio version (total running time: 08:56:52)

The document outlines intentions which are very significant for digital transformation, not least the aspiration to 'develop digitally enabled primary and outpatient care, which will become mainstream across the NHS'.

By  2020/21 (so by 31/03/2021) the NHS app will allow people to see their careplan and 'communications from health professionals'. I have the NHS app installed on my phone. I cannot tell how much of my information is nominally available as I have not experienced any ill-health recently. But I was impressed to see that the NHS App allowed me to see details of my two COVID vaccinations

From 2024, people will be able to use the NHS app to access 'digital primary care services' i.e. to have online appointments. This means to be able to see their GP remotely rather than have to trail into GP surgeries. COVID has already accelerated the availability of telephone appointments. What is new is that in addition to being able to consult their own GP, there will be an option for people to access the 'emerging digital-first providers' instead. This is the game-changer, the disruptive innovation which will transform the NHS and the way people use it. We already have NHS Direct / NHS 111 providing a general telephone triage service supported by online health information. This  new direction will break the role of GPs as gatekeepers to further services.

By 2029 (i.e. by the end of the period covered by the plan) it is envisaged that wearable devices will enable people to stay more at home rather than be moved to NHS locations. Diagnostic services,  such as images and pathology, will be able to be delivered differently, as will Secondary Care Outpatient appointments.

During 2019, new controls will ensure that technology suppliers comply with agreed standards for interoperability. Anybody who has worked in and around NHS patient systems will be familiar with the ease with many suppliers shake off commitments. So it remains to be seen how much impact, how quickly, there will be on supplied systems. Also, the cost is likely to be transferred back to the customer i.e. NHS organisations 

Reminding us that the NHS is a predominantly role-based culture, there is a requirement for the Boards of all NHS organisations to have a Chief Clinical Information Officer (CCIO) or Chief Information Officer (CIO) by 2021/22

These directions are not new, having already been set out in the Wachter Review (2016) and the Future of Healthcare strategy (2018).

Achieving this vision will require significant upgrading and extension of the technical infrastructure. This will require money. It also assumes a higher degree of digital literacy amongst both patients and NHS staff than exists at present. Whether this evolves naturally or has to be nurtured remains to be seen

The plan passes responsibility for working out the details of its implementation to ICSs (Integrated Care Systems) and STPs (Sustainability and Transformation Partnerships)

Apprenticeship Standards

 Core Technical Skills

Is able to:

Core Technical Knowledge

Knows and understands:

Identify, document, review and design complex IT enabled business processes that define a set of activities that will accomplish specific organisational goals and provides a systematic approach to improving those processes;•

Design and develop technology roadmaps, implementation strategies and transformation plans focused on digital technologies to achieve improved productivity, functionality and end user experience in an area of technology specialism;•

Deliver workplace transformations through planning and implementing technology based business change programmes including setting objectives, priorities and responsibilities with others in an area of technology specialism;•

Negotiate and agree digital and technology specialism delivery budgets with those with decision-making responsibility;•

Develop and deliver management level presentations which resonate with senior stakeholders, both business and technical;•

Professionally present digital and technology solution specialism plans and solutions in a well-structured business report;•

Demonstrate self-direction and originality in solving problems, and act autonomously in planning and implementing digital and technology solutions specialist tasks at a professional level;•

Be competent at negotiating and closing techniques in a range of interactions and engagements, both with senior internal and external stakeholders;•

Evaluate the significance of human factors to leadership in the effective implementation and management of technology enabled business processes;•

Develop own leadership style and professional values that contributes to building high performing teams;•

Apply broader technical knowledge combined with an understanding of the business context, and how it is changing, to deliver to the company’s business strategy;•

Demonstrate effective technology leadership and change management skills for managing technology driven change and continuous improvement;•

Create and implement innovative technological strategies to support the development of new products, processes and services that align with the company’s business strategy, and develop and communicate compelling business proposals to support these.•

The strategic importance of technology enabled business processes, and how they are designed and managed to determine a firm’s ability to compete effectively;•

The principles of business transformation and how organisations integrate different management functions in the context of technological change;•

The role of leadership in contemporary technologywn employer’s business objectives and strategy, its position in the market and how own employer adds value to its clients through the services and/or products they provide;•

How to justify the value of technology investments and apply benefits management and realisation;•

How to monitor technology related market trends and research and collect competitive intelligence;•

The personal leadership qualities that are required to establish and maintain an organisations technical reputation.•

The role of leaders as change agents and identify contributors to successful implementation;•

Technology road-mapping concepts and methods and how to apply them;•

The role of learning and talent management in successful business operations.•

Inspire and motivate others to deliver excellent technical solutions and outcomes•

Establish high levels of performance in digital and technology solutions activities•

Be results and outcomes driven to achieve high key performance outcomes for digital and technology solutions objectives•

Promote a high level of cooperation between own work group and other groups to establish a technology change led culture•

Develop and support others in developing an appropriate balance of leadership and technical skills•

Create strong positive relationships with team members to produce high performing technical teams•

Inspire and motivate others to deliver excellent technical solutions and outcomes•

Establish high levels of performance in digital and technology solutions activities•

Be results and outcomes driven to achieve high key performance outcomes for digital and technology solutions objectives•

Promote a high level of cooperation between own work group and other groups to establish a technology change led culture•

Develop and support others in developing an appropriate balance of leadership and technical skills•

Create strong positive relationships with team members to produce high performing technical teamsTechnical knowledge for Software Engineering Specialist - knows and understands:

Data Analytics Specialist

A data analytics specialist investigates business data requirements, and applies data selection, data curation, data quality assurance and data investigation and engineering techniques. This will help the business to most effectively organise their data and they will provide advice and guidance to database designers and others in using the data structures and associated data components efficiently. They will undertake data processing to produce data sets for study and will perform investigations using techniques including machine learning to reveal new business opportunities. They also present data and investigation results along with compelling business opportunities reports to senior stakeholders.Job roles: Big data analyst, data and insight analyst, data science specialist, data management specialist, analytics lead.

Skills for Data Analytics Specialist

Be able to:

following company standard processes (code reviews, unit testing, source code management etc.).The rationale for software platform and solution development, including the organisational context;•

The various inputs, statements of requirements, security considerations and constraints that guide solution architecture and the development of logical and physical systems' designs;•

The methodologies designed to help create approaches for organizing the software engineering process, the activities that need to be undertaken at different stages in the life-cycle and techniques for managing risks in delivering software solutions;•

The approaches used to modularise the internal structure of an application and describe the structure and behaviour of applications used in a business, with a focus on how they interact with each other and with business users;•

How to design, develop and deploy software solutions that are secure and effective in delivering the requirements of stakeholders and the factors that affect the design of a successful code;•

The range of metrics which might be used to evaluate a delivered software product.•

Identify and select the business data that needs to be collected and transitioned from a range of data systems; acquire, manage and process complex data sets, including large-scale and real-time data;•

Undertake analytical investigations of data to understand the nature, utility and quality of data, and developing data quality rule sets and guidelines for database designers;•

Formulate analysis questions and hypotheses which are answerable given the data available and come to statistically sound conclusions;•

Technical knowledge for Data Analytics Specialist

Knows and understands:

Digital Business and Enterprise Systems Architecture Specialist

A digital business and enterprise systems architecture specialist designs, documents and maintains technical architectures that describes the best approach to provision the business technical infrastructure. This typically involves the interpretation of business goals and drivers into an operating model and the description of inter-relationships between the people, organisation, processes, data, and technology with the external environment. They implement an information technology systems architecture to support or accomplish the strategy of the enterprise.Job roles: Business and enterprise architecture specialist, enterprise architect, business architect, systems architect.Skills for Digital Business and Enterprise Systems Architecture Specialist - be able to:Conduct high-quality complex investigations, employing a range of analytical software, statistical modelling & machine learning techniques to make data driven decisions solve live commercial problems;•

Document and describe the data architecture and structures using appropriate data modelling tools, and select appropriate methods to present data and results that support human understanding of complex data sets;•Scope and deliver data analysis projects, in response to business priorities, create compelling business opportunities reports on outcomes suitable for a variety of stakeholders including senior clients and management.•How key algorithms and models are applied in developing analytical solutions and how analytical solutions can deliver benefits to organisations;•The information governance requirements that exist in the UK, and the relevant organisational and legislative data protection and data security standards that exist. The legal, social and ethical concerns involved in data management and analysis;•The principles of data driven analysis and how to apply these. Including the approach, the selected data, the fitted models and evaluations used to solve data problems;•The properties of different data storage solutions, and the transmission, processing and analytics of data from an enterprise system perspective. Including the platform choices available for designing and implementing solutions for data storage, processing and analytics in different data scenarios;•How relevant data hierarchies or taxonomies are identified and properly documented;•The concepts, tools and techniques for data visualisation, including how this provides a qualitative understanding of the information on which decisions can be based. based wn employer’s business objectives and strategy, its position in the market and how own

employer adds value to its clients through the services and/or products they provide;•How to justify the value of technology investments and apply benefits management and realisation;•How to monitor technology related market trends and research and collect competitive intelligence;•The personal leadership qualities that are required to establish and maintain an organisations technical reputation.•The role of leaders as change agents and identify contributors to successful implementation;•Technology road-mapping concepts and methods and how to apply them;•The role of learning and talent management in successful business operations.•Inspire and motivate others to deliver excellent technical solutions and outcomes•Establish high levels of performance in digital and technology solutions activities•Be results and outcomes driven to achieve high key performance outcomes for digital and technology solutions objectives•Promote a high level of cooperation between own work group and other groups to establish a technology change led culture•Develop and support others in developing an appropriate balance of leadership and technical skills•Create strong positive relationships with team members to produce high performing technical teams•Inspire and motivate others to deliver excellent technical solutions and outcomes•Establish high levels of performance in digital and technology solutions activities•Be results and outcomes driven to achieve high key performance outcomes for digital and technology solutions objectives•Promote a high level of cooperation between own work group and other groups to establish a technology change led culture•Develop and support others in developing an appropriate balance of leadership and technical skills•Create strong positive relationships with team members to produce high performing technical teams

North East & North Cumbria ICS Digital Strategy 2020-2024

 Published 18/12/2020  24 pages

Our digital strategy is fundamentally about delivery and transformation,

January 2019 NHS England published the NHS Long Term Plan that sets out how the NHS should invest to deliver the best results for patients and citizens The NHS in England was asked to

Develop digitally enabled primary and outpatient care, which will become mainstream across the NHS.

Previously responsibility for digital, data and tech was split across multiple

agencies, teams and organisations NHSX is changing this by bringing together all the

levers of policy, implementation and change for the first timeRegional

context

One

of the central ambitions of the NHS Long Term Plan is to introduce “a pragmatic and practical way of

delivering the ‘triple integration’ of primary and specialist care, physical and mental health services, and

health with social care” through the establishment of Integrated Care Systems ( The aim of an ICS is to

bring together local organisations to redesign care and improve population health, creating shared

leadership and action

The

North East and North Cumbria Integrated Care System is the largest ICS in England, serving a

population of around 3 2 million citizens Our ICS is made up of four sub regional footprints, known as

Integrated Care Partnerships (

Review of North Cumbria Digital Strategy

 

The North Cumbria Digital Strategy 2020-24 is a 30 page document available digitally as a pdf file on the Trust intranet. It is unclear if it is available publically. It is said to have been approved by the Trust’s Executives. It does not feature in public Board minutes.

Published (launched) 21^st March 2021, the timing is curious. It is 15 months into the timespan the strategy covers.

The stated scope  is  the Trust  ‘..and care partners’ . Further into the document these are identified (p.5) as 39 GP practices,  CHOC (Cumbria Health on Call), eight Primary Care Networks, eight Integrated Care Communities,  CNTW (Cumbria, Northumberland, Tyne and Wear) who provide mental health and learning disability services, Cumbria County Council, NWAS (North West Ambulance Service), community pharmacies, the third sector,  and NHS England and NHS Improvement.

The Foreward (p.2) underlines the pivotal role of ‘Digital Health’. It states that

‘This strategy sets out how in the next 4 years we will become recognised exemplar digital hospital where people seek employment and where patients receive digitally enabled best care’

The Forward ends with a quote from Darzi  (2018)

‘Digital technology has the potential to shift the balance of power between clinicians providing care to patients receiving care’

The Introduction (p.3) states that the strategy was created ‘through a series of workshops, one-to-one interviews and surveys’. It does not state who was involved in this. The Introduction then provides a description of the contents of the main sections of the document

What Does Digital Mean? (p.4)  confuses more than it illuminates. It starts saying that ‘digital should be seen less as a thing and more a way of doing things’.  The explanation of what digital is then ranges widely touching on many things that are not specifically digital at all.

 Context (p.5) provides background in the Trust and summarises the Trust’s overall vision and aims. The two graphics used look as if they have been pasted from elsewhere as the writing on both is too small to be read comfortably. Page 6 continues to state that ‘our Digital Strategy forms a key part of a wider geographical digital strategy that spans the North East and North Cumbria (NENC) Integrated Care System (ICS) ‘. It then provides some information on recent NHS national digital strategy

 Our Digital Story so far (pp.7-8) highlights a number of achievements, many of which precede the creation of the current Trust in October 2019

 Our Digital Vision (p.9)

A kind of half table, half chart is used to summarise the digital vision:

The bottom of p.9 is padded out with a meaningless, distracting semi-cartoon like graphic

 

Our future vision (p.10)  indicates that at some point in the future everything patient-related will be digital (or ‘digitised’) and that all partners will have access to it

 

Benefits (p.10)

Digitise Patient interactions and Apps Integrated with Systems indicates that patients will have the ability to interact remotely and add to their own records

 

Accessible Records Across North Cumbria and Partners  and Friction-Free Information Sharing and

Unifying Disparate Information - indicates that our information will be available ‘across the region’

 

 

 Our Guiding Principles (p.11)

 

‘A digital mind-set provides the basis for cross-functional collaboration, flattens hierarchies, and builds environments to encourage the generation of new ideas’

 

Surely the basis for collaboration is a collaboration mind-set? Flattening hierarchies would involve the removal of layers of management. There is no evidence of any inherent will to do this and consultation feedback along these lines in the most recent Digital Restructure was ignored 

 

In the middle of p.12 (‘Our Request’) the voice changes from bring that of the Trust to being that of the Digital Department. 

Supporting the Digital Strategy (p.13-4) lapses into a role based focus on the Digital Department and heralds another reorganisation

 

Making Decisions (p.15) is a disjointed mixture of statements about categorisation of initiatives, impact, prioritisation. This is the prelude to more role based thinking indicating that all proposals will go through the ‘Business Planning Group’ and outlining (p.16) a vague committee structure

Delivering the Digital Strategy (p.17) indicates that five programmes have been set up within a four-year implementation period. It refers to a supporting implementation plan

Five ‘highlights’ are set out, four of which are scheduled for 2020, so presumably either have already happened  or are already overdue

 

1. Enabling our Workforce (p.18) sets out actions which seem either role focussed or vague

2. Strengthening our Digital Infrastructure (p.19)  contains a lot a statements that are simply restating the need to strengthen the Digital Infrastructure. There are almost no precise details. One statement:

‘Converging to single Domain for North Cumbria and Partners. All North Cumbria staff will be on a single modern domain designed to be robust and resilient. This will allow the organisation to introduce innovation and flexibility through the introduction of modern systems and technology. It will remove the digital friction of our calendar and email sharing.’

Could be read as implying that all North Cumbria partners (identified  on p.5 as 39 GP practices,  CHOC (Cumbria Health on Call), eight Primary Care Networks, eight Integrated Care Communities,  CNTW (Cumbria, Northumberland, Tyne and Wear), Cumbria County Council, NWAS (North West Ambulance Service), community pharmacies, the third sector,  and NHS England and NHS Improvement) would all move to a single domain. This would be a massive achievement. However it is unlikely that this is what is meant. It seems likely that the main focus is bringing the two parts of the existing Trust onto one domain – something that was not tackled in the extensive period leading up to creation of the Trust in October 2019. The inclusion of GPs  in the section The move to cloud-based Office 365 is the only hint at anything wider than the current Trust and this is not domain specific. It is hard to see how the Trust will persuade CNTW, NWAS and NHS England to migrate to its own North Cumbria domain. This is not referred to in the regional ICS digital strategy. The ‘vibrant’ third sector may also have its own ideas.

The ambition to Move towards hybrid cloud infrastructure by 2024 (p.20) is one of those vague statements which could mean anything or nothing. A move towards something could be said to have been achieved simply by taking the very first step.

Most of the Strengthening our Digital Infrastructure section could be paraphrased to say ‘we recognise that we have neglected this for several years and are way behind most peer organisations – and we did not even complete the recent merger properly -  so we will bring ourselves up to where we should already be’

3. Digital Systems (p.22) This critical section is full of vague statements, most of which are restatements of the question, not the answer, for example

From Divergence to Convergence of Clinical Applications

‘In order to move from our current silo-based system architecture, we intend to pursue and agree a robust plan for EPR development that will meet our patient, staff and collaborative needs.’

‘We will ensure that all our future clinical applications are set on the pathway to converge and interoperability will be at its core’.

4. Data Analytics (p.24) This section is a ramshackle collection of vague, grandiose statements and buzzwords padded out by two spurious graphics. The tangible action seems to focus on producing a new Data Warehouse and introducing unspecified Business intelligence tools. How these platforms will be used to create Business Intelligence is not specified. It is unclear how all the data from all the various North Cumbria partners gets into this Datawarehouse – or even if it does – or how all this data – much of which is sensitive – can be safely used

5. Data Protection by Design (p.26)

This section seems to be little more than stating that we will do the things that we are, or should,  already be doing

 

What and When? (p.28)

This section includes a bizarre graphic in which a concentric timescale with six radial sectors is overlaid with a series non radial arrows

As a data visualisation this is incompetent, not least because the lengths of the arrows do not accurately reflect the timespans. It also suggest that several of the planned actions are already overdue

Our Digital Maturity (p.29)  This section contains the rather chilling admission

‘Our Trust currently has one of the lowest digital maturity levels in the NHS of its size and is heavily reliant on the movement of paper to facilitate the provision of care’.

Rather than look to why this is  - so we can avoid repeating the same behaviours – this section simply states the obvious – that we must do something about it . It then describes the HIMSS Benchmarking framework and leaps to the conclusion that

‘As a digitally mature organisation we will be able to shorten our diagnosis and treatment times whilst simultaneously creating a more efficient and cost effective organisation due to a large scale reduction in repetitive, manual and resource intensive activities. Our digital solutions will increase safety whilst simultaneously reducing resource intensive activities.’

Strategic Risks And Financial Plans (p.30) This section sketches out some general categories of risk

Not taking the workforce with us

Not implementing well

Not achieving high value benefits

Resources being insufficient

Inertia & too slow pace of delivery

 

The first listed risk is said to be ‘Mitigated by our clinically led, technically enabled approach…’ . It could be argued that one of the main factors in the current highly fragmented, inefficient tangle of overlapping, competing half solutions this that under-informed technical people have been led by a small number of highly influential, but not necessarily representative, clinicians

The risks, apart from the obvious lack of funding,  could be re-stated as lack of clear vision, lack of strategic analysis, lack of understanding of scope, lack of recognition of the potential for disruptive innovation from competitors, lack of self-scrutiny and self-awareness.

In short the people who presided for several years over the slide into  ‘one of the lowest digital maturity levels in the NHS ‘ are shamelessly putting themselves forward as those who will transform us into a ‘recognised exemplar digital hospital’

Conclusion

There is a lot of big talk, simply echoing nationally defined themes,  with a lot of vague generalities. Bold claims are made about where we are going but the document demonstrates very little understanding of what is needed to get there. A lot of the focus is simply to catch up with where we should already be.   There is too much fixation with the roles, responsibilities and processes of the Digital Department.   The document is particularly lacking in detail about how our extensive list of partners will share and access data   Overall I am left feeling short-changed and very disappointed by it. I have no confidence that the authors have the capability to lead us to the destinations they sketch out   My conclusion is that the Trust has been required to produce a Digital Strategy which means that somebody needed to create a document. Some of the obvious national themes have been echoed. But in place of strategic analysis we have boasting. And in place of a clear direction we have glib, vague statements. The implication is that if we proceed with a rag bag approach  of committees and projects, somehow  we will arrive magically at our destination.     Overall it feels more like a sales brochure than strategy. But the fact it now exists as a document labelled ‘Digital Strategy’ makes it even harder to produce an actual digital strategy   I think we are in trouble

 

Digital maturity: how digital am I?

Some days, and for some things, I can feel digitally aware and digitally sophisticated. Other days, I can feel left behind and quite technophobic. If I am to be successful as a digital leader, I need to be able to inspire people to want to be more digital. This could be hard if many of them are already far more 'digital' than me

So I need to take stock of how 'digital' I really am, leading to decisions on what things to I need to do more (or less) of.

One online tool I encountered which claims to provide a version of this is 'The Digital Competence Wheel'. ( https://digital-competence.eu/)

This is a self-assessment test in which you are asked to place yourself along a seven point scale. The site has some dubious automated analysis and presentation - and may even be primarily intended as a way of trapping email addresses - something digitally aware people should be digitally aware of. But it was, none-the-less, interesting in forcing me to look at my digital competence in the round

My results were as follows, presented in the visually soothing Digital Competence Wheel, the graphic equivalent of management speak to a data visualisation specialist:  

The results are clusters into four sub-themes: Safety (85%), Information (98%), Production (91%) and  Communication (83%) 

Further screens show  my results in relation to the range shows how respondents 'usually' score:

I seem to be at the top end of the 'normal range' or above it. An alternative presentation is shown in the following screenshot, which shows  my rating relative to the norm (norm here I think means the range of responses in total submitted to the site)

As an information analyst and data visualisation specialist, I am going to find a lot to question about how meaningful these results are and how well they are presented. But putting these  important aspects to one side: I appear to rate myself as higher than 'average' in all categories. This chimes with my observation that, outside of work where I am often surrounded by very IT savvy people, I usually have more all round confidence on the digital spectrum than the non-work people I usually mix with. That is not say I am fluent in all digital forms - my six year old granddaughter is currently knocking spots off  me.

The exercise also shows me that, in relative terms,  I think I may need to pay more attention to social awareness, identity management, collaboration, health, law, digital exploration, and 'active participation'. These, for me, are relatively weaker areas.

My overall score was 87%. This apparently puts me in the category level 7 (highly specialised) only one level off the top. Apparently

'Users on level 7 (highly specialised) are able to perform tasks and identify the most appropriate solution, even when solving complex problems, where the solution isn't easily available. They are able to adapt and integrate solutions into their professional practice.'

This is very comforting. So why do I feel so digitally 'average'?

When I first encountered computers, they literally occupied whole buildings. They really had the magnetic tape reels and flashing lights of the 1960s imaginings. They were accessed via punched card and, in the absence of monitors, sent their output direct to printers. In this era, the  people who operated computers were surely very clever people indeed. And certainly far cleverer than me. Or so it seemed.

This feeling of technical intimidation has never quite left me, in spite of all the competence I have built up over the years. My own children, in contrast, never stopped to think that computers might be difficult. They just jumped in and tried things. To them a computer - then a laptop - now a smartphone - is just a device that you get to do things for you. It has a use. It is not something you would learn about for its own sake.

Another generation on and my granddaughter (just six) has worked out for herself how to send recorded voice messages. She had been texting but some of  the spellings were a bit of a struggle so she realised that recording a message is so much easier. She just worked it all out to enable her to communicate with her grandmother during the lockdown   

A lot of this is not about intelligence, or skills, it's about seeing what might be possible using digital technology and then finding a way to make it work. That is almost digital leadership in a nutshell.