18 July 2019
Before I knew anything about digital health, health informatics or the NHS, I worked on a national project implementing software and coordinating data collection from Children and Young People’s mental health services for the CYP-IAPT project. To say it felt like being thrown in at the deep end is a massive understatement. I was in my early twenties and the project was during my first job out of university where I got a degree in English with Creative writing - which has nothing to do with anything unless anyone wants to produce a play I wrote about Chernobyl.
Back then, the NHS was to me as mystifying as it was romanticised – a well-oiled machine with many parts and components that all worked together in unison. Except there were more parts and components to it than I ever could have imagined and not one vast machine but many, many smaller ones amassed together, some with the same purpose but working in different ways, some which should be working together but weren’t. There I stood in the long shadow of the NHS, nervously approaching to get patient questionnaires electronically recorded so the data could be analysed and used in research to develop and improve mental health services for young people. No pressure.
Nerves played a large part of my experience at the first Residential for Cohort 2 of the NHS Digital Academy. I was surrounded by titans of the digital health scene. CIOs, CCIOs, Data Analysts, Heads of departments, Digital Leads, Clinicians in primary and secondary care of all kinds, combinations of all of them. Most people were older than me and 60% were men. I wasn’t too preoccupied about fitting in with this crowd, but did I belong in it?
During the day, we had a series of ice breakers, interactive sessions to learn more about the programme and breaks to mingle with each other. What struck me was how many times I heard sentiments echoing my own. I was stunned, because these were the people who I thought would feel confident and secure but were incredibly humble. Talking to people in the room never felt like formal networking – we were all genuinely rooting for each other and making friends from the very start.
Dr Kathrin Cresswell is a Chief Scientist Office Chancellor’s Fellow and Director of Innovation at the Usher Institute of Population Health Sciences and Informatics, University of Edinburgh. Kathrin also co-leads Module 3 of the Digital Academy with Professor Robin Williams and is responsible for everything from planning to content development and delivery. I asked her about what she thought of the Imposter Syndrome hanging in the room like a morning fog. “I couldn’t believe that this was an issue when I first heard it. Actually it really assured me that people who are clearly at the top of their game have this. Only the inexperienced believe that they are infallible!”
Kathrin has a BSc in Psychology and I was curious if she saw this as a stepping-stone to her current career or if she originally had different plans, much like myself. “I had completely different plans with my life!” she explains. “I was always interested in psychology and wanted to become a clinical psychologist. It’s difficult to say whether it’s my interest in psychology or my training, but I think the angle of trying to understand where people are coming from, their motivations, emotions, ambitions and experiences is pretty closely related to the type of social science I do today. So, I think it has helped me quite a lot in trying to understand why and how people from different backgrounds plan, use, implement, develop, and optimise different technologies in healthcare settings and how their needs can be aligned.”
What I am learning is that The Perfect Digital Health Leader doesn’t exist, simply because one person cannot possibly encompass all the skills, experiences and characteristics the ultimate leader would have, especially when you consider the variations in qualities depending on who you ask to list attributes. One of the biggest takeaway messages from the Digital Academy is that it doesn’t matter if you’re not this or that, what matters is you – your knowledge, your impact, your initiative. More and more it becomes clear to me that we shouldn’t be comparing ourselves to each other to see how we can match our peers, but how our jigsaw pieces fit together.
As my self-confidence grows and my skills and understanding develops, I decided to re-visit my first taste of a digital project in the NHS to explore how I’d progressed in my development as a Digital Health Leader so far. Dr Andi Fugard is a Senior Lecturer in Social Science Research Methods and Director of Postgraduate Programmes in Social Research at Birkbeck, University of London. We worked together on the CYP-IAPT project, me on the software development and implementation side, Andi on the research and analysis side, though their involvement extended beyond this during the initial project scoping. “I was quite involved in […] trying to ensure data was collected and transported safely, analysed in a timely manner - and useful,” they explain. “That was interesting in all kinds of ways. How do we safely get data out of the NHS? And where to start?”
It's an imposing question faced by many when embarking on a project requiring NHS data, especially when multiple sites are involved in different patches. Information governance can feel like an ever-descending staircase towards a seemingly inescapable labyrinth. “There were lots of different people in lots of different places,” Andi continues. “Part of the struggle was finding out who really knew the answer to the questions about data security and ethics. I think using NHS data - a lot of it is practical stuff about just getting at it and using it, and ensuring senior managers don’t wildly over-interpret poor quality data.”
Navigating a project pathway within the NHS often starts small and straightforward enough but will usually rapidly proliferate. Knowing who to include, who to go to – that’s half the challenge. The final assignment for Module One of the Digital Academy (Essentials of Health Systems) gave me the opportunity to roll up my sleeves and get stuck into a detailed process map. Its focus was on the adoption of digital innovation in primary care sites (primary care encompasses GP surgeries, pharmacists, dentists etc. at Wessex AHSN). It’s a procedure I know well but someone starting brand new wouldn’t know to the same level of detail. The more I worked on the map and thought about it and considered the steps from stakeholder perspectives, the more crucial stages I was able to capture. When I finished, I was kind of surprised with the depth of my knowledge. I started with an innovator and created a journey spanning across the AHSN, into primary care, through a CCG, dipping into secondary care and, crucially, where the impact is felt by a patient.
It has taken a long time to understand each stage of this map. With every implementation, I learn something new, something valuable to share with my colleagues to help them prepare for important and potentially time-consuming tasks (looking at you, ethics approval). I’ve learned it’s crucial in adoption and spread projects, the fundamental value to consider at the very start is adaption, because no two sites are the same, even if on paper they are. Best of all, I’m not the only one who can use this resource. Everyone in my organisation can benefit from it. Everyone.
Now, I’m not saying the Digital Academy taught me how to make a process map. I knew that already. But there was a lot of research and learning that went into that map. I didn’t just have an idea and smash it out in one afternoon. Everything Module 1 taught me about considering my strategic position in my health eco-system got me thinking about the bigger picture of not just the innovation adoption but the alignment to the wider purpose of digital innovation adoption – for services and for patients. I will admit I sometimes lose sight of the bigger picture of why I’m doing something and have benefitted from re-visiting and re-learning what the purpose of an innovation implementation project is and what it is in response to.
No stranger to digital innovation adoption having been involved in the ePrescribing Toolkit, I asked Kathrin Cresswell what her what her advice would be to me as someone who project manages innovation implementation and evaluation. “Difficult question. I could go on forever answering this...I think the key is humility, reflexivity and maturity. The rest can be learned”. Learning can take many forms and is something that should be encouraged and embraced. I’ve come a long way from that first NHS project and every day - at my job, at the Academy – is an opportunity to gain more insight. The Digital Academy particularly is a critical arena to develop my skills and expand my knowledge through either first-hand experience or learning from others, enhancing the influence I have in Wessex when it comes to implementing new technologies into the eco-system and how this can develop and improve services for patients.
Follow Nadia’s Journey on Twitter
With thanks to Dr Kathrin
Cresswell and Dr Andi Fugard for their time