Questions for boards

We have suggested a short list of questions that board members – both executives and non-executives – may find useful to evaluate their trust's digital strategy. The answers should prompt discussion and help those board members less involved to assure that the strategy is on track.

1. How integrated are your digital and business strategies?
   You should have a clear vision for how digital will help to realise your clinical and operational objectives. Trusts with less experience of digital transformation may benefit from a separate digital strategy to focus on getting the basics right. Over time, trusts should aim for a more embedded approach to digital.
   
   
2. Does your digital strategy have a succinct mission that is understood across the trust?
   For your digital strategy to succeed, you'll need to engage your entire organisation in new ways of working. Having a simple, clear and consistent message about your digital aspirations will help. Everyone on the board should recognise this mission and understand what sits behind it. For example, Cumbria, Northumberland Tyne and Wear NHS Foundation Trust is known as the "work from anywhere trust" which is repeated throughout their work.
   
   
3. Do you understand your users and their biggest needs?
   Your digital strategy should focus on fixing your biggest problems. All trust boards seek the views of their patients and service users, from patient stories at board meetings to floor walks across the organisation. Digital should be no different. Many boards are now looking at how they incorporate feedback about digital services – from both staff and service users – to identify the pain points and problems their digital strategy needs to solve. This will require boards to put equality, diversity and inclusion at the heart of their approach.
   
   
4. Do you know what digital services you are operating and how they are performing?
   It is important for the board to understand where the trust is on its digital journey. This requires an awareness of existing digital services, what volumes they are operating, how they are performing, how they relate. This will help give you a clear view on what you need to fix, and – crucially – where to start.
   
   
5. What are you not prioritising in your digital strategy?
   The NHS is facing huge challenges over the coming years, and many trusts lack the funds to make large investments in digital transformation. Your digital strategy will need to be clear about the trust's priorities and any trade-offs. Board members will want assurance that the strategy's ambitions are achievable and understand what has been de-prioritised to free up capacity to deliver on its priorities.
   
   
6. Have you committed to realistic and tangible actions?
   The best strategies turn ambitions into firm commitments with clear ownership. Chief digital officers/chief information officers and chief clinical information officers have an important coordinating role to play, but successful digital transformation requires ownership by clinical and operational leaders.
   
   
7. How will you know if your digital strategy is working?
   Effective strategy relies on strong feedback loops. It will be important to set up the right checkpoints and identify some indicators that will help you understand whether your strategy is working, and where you need to change course.
   
   
8. Can you explain how your organisation's digital strategy aligns with your system strategy?
   NHS England and NHS Improvement has placed digital at the heart of system working. Each trust board will need to collaborate with system partners to set a shared vision for digital and agree how to deliver joint initiatives like the shared care record that will help drive the best outcomes for the population. 
   
   
9. How will your organisation change to enable digital transformation?
   Digital ways of working can run against the grain of how large organisations operate. Think about how your planning cycles, incentives, finance and governance processes may need to change to enable a more agile way of working.
   
   
10. What could go wrong?
    From project failure to cyber security incidents and outages, it is inevitable that some things will go wrong. Board leaders should make sure the right systems are in place to reduce these risks and promote a culture of learning, not blame. As digital becomes more important to the delivery of care, this is a patient safety issue.
    

My advice to other chairs is threefold. Firstly, you need to understand your starting position, but in a pragmatic way. Don't get pulled down particular rabbit holes. You can only understand your future position if you are aware of your tether.

Secondly, you need to keep things simple. Focus on doing the basics well, and don't get side-tracked by shiny new things, or lots of bespoking. Finally, and most importantly, make sure the strategy focuses on improving the most things for the most amount of people.

Liam Coleman    Chair, Great Western Hospitals NHS Foundation Trust