Based on their experience of working in governments and business around the world, Public Digital has compiled a set of questions board members can ask themselves about teams and governance in their organisations. We believe much of this can apply to the NHS. It is not an exhaustive list but these questions are intended to kickstart wider discussions that can engage and focus whole boards on the organisation's digital capability.
- Does information flow to authority, or does authority flow to information?
Good governance for digital transformation should be simple and supportive. It should trust and empower, giving decision-making authority to teams so they can focus on delivering.
Good digital governance is about outcomes and behaviours over deliverables and documents, and doing away with hierarchies that add layers of process and drag. Instead teams should be encouraged to make their work open and transparent.
There will always be a role for leaders to guide and set goals or context, but good digital governance acknowledges that the team has the best knowledge of the problem it's trying to solve, and therefore the best chance of coming up with the right answer. - 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.
If the answer to this question is 'no' then the follow up is, what's your plan? Are you looking at your recruitment practices and checking job adverts for language that is biased towards particular genders for instance? Are you actively finding and working with new networks (such as the Shuri network) who are helping connect under-represented groups? What are you learning from other trusts? - Is specialist digital knowledge represented at the top table when key technology decisions are made?
During board discussion, the combination of clinical leadership, executive roles and non-execs provides for well rounded, collective decision making on key issues. The same should be true for digital. If digital is fundamentally about rethinking operating models as much as delivering new technology or services, then the vision and drive for that change needs to come from the top as much as it does from a ground-up movement.
Making decisions about technology without having access to specialist expertise is risky. Creating the right environment for digital teams to flourish is almost impossible unless there is some understanding at board level of what is required.
As well as leading to more informed board discussions, the benefit flows in the other direction too. Ensuring you have specialist digital knowledge at the top table when key technology decisions are made, helps senior digital leadership more closely align their strategy aims and objectives with that of the organisation at large.
- Do you talk about digital services, or IT projects?
Organisations that are further along their digital journey understand that at heart they deliver services to users. The NHS is advanced in this area compared to other public sector bodies, but does the concept of service delivery rather than project delivery also apply to digital? Is the same user oriented, outcome based, iterative approach one you would apply to delivering a clinical service the same as you would for a digital one?
The language used to describe digital initiatives reveals much about an organisation. IT or digital 'projects' are one-offs; things to be done and then forgotten, move on to the next thing, and require the completion of a list of tasks. Digital services aren't one-offs, they live on, evolve. Digital services are actively designed, with due care and attention to what people think of them, whether they are used, and whether they work.
The digital mindset combines the disciplines of user-centred design, agility, and the use of modern internet technologies. Having staff or representatives on the board who are able to talk about products and digital services rather than projects will help move your organisation in the right direction. - Who designs your services and how?
Examining how your new services are designed, by whom, and where the discussion takes place, will tell you a lot about how digital your organisation is.
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 most effectively when you bring together multidisciplinary teams. This means bridging traditional silos between digital experts with internet era skills, and clinical operations, and support staff. Digital and technology should not be an afterthought but at the core of any forthcoming change. - How are you hiring people?
Repeating the same approaches for bringing new skills into the organisation will lead to the same results. Senior product leaders are not simply going to be looking on NHS Jobs, or probably any other job site. If you truly want to start to diversify ways of thinking and skills it may require you to look in some non traditional places.
This might mean leveraging networks, going to conferences or advertising in different places. It may also mean bending some of your normal rules, as the reality of hiring new and sought-after skills means that by default you may need to do different things.
It's also about thinking about your offer. Working in digital healthcare is one of the most intellectually challenging and rewarding sectors out there. Use this to your advantage.
- Are your board papers and meetings really telling you what’s going on?
Board members are used to lots of information flowing to them (often in the form of papers), and extracting real knowledge remains a key challenge. The job of a board director is to balance what they read with what they're told and what they see.
But digital transformation means re-examining all processes and ensuring that they add value. It's about instituting new forms of governance that prioritise seeing servant leadership from board members, working prototypes over documentation, and a leadership culture of going to see delivery for themselves or asking for a demonstration rather than waiting for risks to be escalated through a report or committee.
If you are getting the sense that you are not getting value out of a particular governance process, rethink it along these lines. - 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 or the attention of other stakeholders, is to interact with the outside world in a different way. Building digital organisations therefore means changing the way you communicate, and moving away from classic broadcast type communications to show your working out.
Openness is a key attribute of digital organisations. Your public communications should be as much about clarifying strategy, attracting people, engaging suppliers and sharing knowledge. Your blog is where you put your news and successes but also what you've learned and mistakes you've made. It is your brain on the internet over time and needs to be authentic. Many trusts have blogs but do they explain the thinking that's going on above simply the facts? Do they talk about digital at all?
Things that will change if you're doing communications well may include things like how many people are sending CVs that show they have different experiences, how often are members of your team being invited to speak at conferences, and how well recognised you are as an employer of digital people.