Trust boards are increasingly becoming "digital boards". They are growing confident in leading digital changes from the board room, and increasingly understanding that digital transformation needs to be business as usual in the NHS.
Early in the Covid-19 pandemic, we asked chief information officers if they were noticing any changing attitudes to digital at board level. One reflected how for their board, digital was no longer viewed as the "IT headache" that threw up lots of knotty questions on information governance and cyber security. Instead, board-level leaders knew that digital ways of working were fundamental to keeping their staff, patients and service users safe. Suddenly, the NHS was undergoing a crash course in digital and had given itself permission to do things differently.
Health Education England (HEE) has been working for some time to understand the drivers of digital progress, with a view to increasing the digital capabilities of the health and care workforce. For example, HEE's NHS Digital Academy programmes support the uplift of digital skills, knowledge, understanding and awareness of new ways of working, in order for our workforce to provide the best possible health and care services. A key component of this is NHS leadership.
We've worked with over 2,000 trust leaders, across 45 events and delivered almost 100 bespoke board development sessions.
Our conversations with digital leaders and observations of digitally advanced organisations suggested that while digital leadership is fundamentally no different from good digital leadership, a truly "digital ready" organisation requires board leaders – both executives and non-executives – to be both digitally willing and digitally able.
With this in mind, NHS Providers was commissioned to deliver a new leadership support offer for NHS trusts. The Digital Boards programme was launched during the first phases of the pandemic, and rode the wave of that accelerated approach to digital: we designed the programme to help busy board leaders build on this momentum. Since then, we've worked with over 2,000 trust leaders, across 45 events and delivered almost 100 bespoke board development sessions.
During this time, we've heard stories of how digital ways of working are helping transform services. At Cambridge University Hospitals NHS Foundation Trust, for example, electronic prescribing is preventing at least 850 significant adverse drug reactions and saving the trust almost £1m each year. Meanwhile at Leicestershire Partnership NHS Trust, the introduction of virtual wards in chronic obstructive pulmonary disease and heart failure contributed to a fall in the annualised death rate by 42%.
But we also came across examples of where technology is failing staff and patients. For example, at one trust we saw staff using two computer mice – one without a functioning left click and the other without a functioning right click. This clearly isn't good enough. These are the realities staff, patients and service users are facing on the ground. They represent both opportunities and challenges. We know that digital transformation requires fundamental changes to the operating model of trusts, which can only be driven by the collective leadership of the whole board.
Our programme, therefore, aimed to build board understanding of the potential and implications of the digital agenda and increase the confidence and capability of boards to harness the opportunities it provides. This has formed the basis of our theory change.
Over three years, we've helped shift the dial on this. Across our board sessions, 88% said it had increased their understanding of the conditions for successful digital transformation, while 90% felt it had increased their confidence in the board's ability to assure the delivery of digital programmes.
One trust leader said:"[The team] took the time to understand our situation at the trust and delivered two excellent sessions that have improved our collective ownership of the digital agenda. While it is still early days, I expect our changing approach will begin to deliver material benefits for both staff and patients."
And while our programme has been successful, we know there is more work to do.
There is still room to grow, and it is our ambition to provide ongoing, sustained support to help generate impactful change.
We've heard how some trusts need deeper engagement from our programme, which might involve us "running alongside the board" on their digital journey. Others want us to dive deeper on certain issues and topics, which are a bit trickier. There is still room to grow, and it is our ambition to provide ongoing, sustained support to help generate impactful change.
We also heard from trust leaders about the need to provide support for the new integrated care board (ICB) leaders. We are delighted that our Digital ICS programme, now up and running in and delivered partnership with the NHS Confederation, is helping drive similar changes at a system level.
To measure success across trust and ICB leadership, we have identified eight broad themes for good digital leadership (click on the headings below to expand). These build on the existing literature and methodologies, including NHS England's What good looks like framework. Combined, they describe digitally mature board leadership in the NHS.
Becoming "digital" should not be an end in itself. It goes without saying that digital ways of working should enable the desired goals of the trust and its overall strategies. If a board is seeing digital purely through a technology lens, it will miss the wider cultural and operating model changes required to make it a success.
Instead, the board should be aligned on a definition of digital that is broader than just IT. Digital discussions should permeate across all strategic conversations.
Too often, digital can easily be put in the "too risky to do" box. But boards should have a level of digital literacy and knowledge of working practices that will allow them to take a proportionate approach to risks and opportunities. In some instances, there will be a risk in taking no action.
Linked to the above, board members also need to be confident about how they gain assurance. More broadly, this will involve triangulating "what we read, with what we hear and see". Boards should understand what is happening beyond the milestones listed in a board paper.
All good leadership involves modelling behaviours, and digital is no different. Staff should see this leadership in action: board leaders driving engagement, enquiring about digital systems and attending focus groups or listening to conversations about digital. Visible leadership on the digital agenda will help win hearts and mind.
Collective responsibility for the agenda means all board members are asking appropriate questions on digital. It shouldn't just be the chief digital information officer or chief clinical information officer who can point to the benefits of the electronic patient record or the issues with an ePrescribing tool. Leaders should be able to articulate how digital is integral to all board portfolios.
Digital strategies can sometimes feel like long shopping lists. More digitally mature organisations will say no to projects and programmes that aren't aligned to the strategy. Board members should easily be able to recall the top three digital priorities for the trust, and how they will enable the overall trust's vision.
We know that in other sectors, digital organisations are consistently focused on the needs of their users. In the NHS, this means going beyond staff surveys and feedback forms. While the board themselves won't be organising "show and tells", leaders may want to observe staff using new tools for the first time to witness teething problems and reactions. The board should experience first-hand what users (staff and patients) are working with.
Ultimately, the board is there to empower staff and teams. Encouraging a "digital first" approach means boards have to get comfortable with experimentation. They need to unblock issues and create the space for multidisciplinary teams to work across digital, clinical and operations. This requires bold leadership – can the board point to decisions it has made that enable new digital ways of working within the organisation or across the system?
We know from this work there is no lack of appetite for digital. NHS trusts want to embrace change. With limited bandwidth and headspace at board level, it can be hard for leaders to create the space to have these conversations. From three years of delivering the Digital Boards programme, we have learned how to be adaptive, quick and responsive to the varying needs of boards. Our sessions are tailored to the different maturities and local realities facing trusts (and now ICBs). We have begun to shift the dial, but there is more work to do.
The Digital Boards programme is a free support offer available to all NHS trusts and foundation trusts. To find out more about the programme or book a free board development session please contact digital.boards@nhsproviders.org.
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