By Mark Chillingworth
Senior leaders of organisations are required to have a professional qualification and to be member of a professional organisation. Your peer, the Chief Financial Officer (CFO) couldn’t hold their role without being a certified accountant. Yet in technology that situation does not exist. The chasm is ever more noticeable in healthcare where CIOs share the leadership table with doctors who have spent a considerable amount of their career developing their professional qualifications as well as in practice.
“At some point in the future it will be standard practice for a board of an NHS organisation to require appropriately qualified CIOs who are members of a professional body in a way that a Finance Director couldn’t be appointed unless they are a qualified accountant,” says Andy Kinnear Director of Digital Transformation at NHS South, Central and West CSU.
A need for healthcare CIOs to be qualified and recognised in a manner that secures their position as peers to doctors and CFOs has arisen of late.
“When you look at organisations that are achieving less or are struggling with the digital agenda you may well find a CIO that has not been invested in; in terms of of their digital capabilities,” Kinnear says. “So I am really keen to that we have a formal programme to drive up the level of professionalisation across the board,” the Bristol based CIO says.
“If we are going to put digital at the front of the agenda…then it needs a different type of person and a different set of skills that is augmented from the traditional IT as an enabler that some of us have come from,” says Nick Hopkinson, Devon Partnership NHS Trust CIO.
“The professionalisation agenda makes most sense to me when you look at some of our non-clinical colleagues in HR and finance where there is already a professional structure and career path for people to come through.
“If we took away those away from finance and HR people would think it is a bizarre idea and I think it is bizarre that we don’t have that ourselves,” Hopkinson adds.
The Wachter Review, published in September 2016 is helping drive the professionalisation agenda, the government commissioned review outlined 10 recommendations for inform the approach to IT in healthcare, one of which was the introduction of the Clinical CIO role (CCIO). CIO for NHS England Will Smart told the Horizon Business Innovation podcast that the approach of Wachter is beneficial to the professionalisation agenda as it recognises the need for teams to work together, which has driven healthcare IT success in the USA, Smart says.
“Wachter will prove to be a seminal moment and history will judge it well,” Kinnear says. “Ten to 15 years ago getting a board interested in digital was hard work as they could run a well functioning organisation without investing in digital. Now you look at the way the world works and it is entirely based on digital platforms and the ability to share and exchange information and the Wachter Review reflects that,” Kinnear says.
Societal change means that the NHS has to change the way it operates. “We have real challenges around skills and maturity,” says Smart of why new training needs to be made available.
The three CIOs see professionalisation being crucial not only to CIOs in healthcare, but also their CCIO cousins.
“The role of the CCIO coming to the fore is going to drive change because you have clinicians coming from a professional background moving into digital roles with an expectation that there is some accreditation,” Smart says of clinical staff joining the ranks of technology who are used to each step of their career requiring learning and some level of assessment.
The Horizon Business Innovation podcast was recorded at the Digital Health Leadership Summit, produced by Digital Health Intelligence.
“We have heard examples of some really exciting examples of technology adoption that has been driven by a CCIO with energy and imagination to make things happen and we have heard examples of clinical resistance,” Kinnear says. The Local Delivery Advisor to NHS Digital (which gains CIO Sarah Wilkinson as CEO soon) says clinical resistance will lose its effectiveness with CCIOs able to move conversations “to a different position” and he says the role is “a game changer”.
Of a number of professionalisation options open to CIOs in healthcare is the College of Healthcare Information Management Executive qualification (CHIME) which CIOs such as Rachel Dunscombe at Salfords NHS is an embassador for in the UK.
“CHIME should be truly commended for what they have done in the US, it is an exceptional piece of work,” Kinnear says. “At the British Computer Society (BCS) we’ve had some interesting conversations with colleagues in Canada and Australia who have done similar work and we are keen to learn from their experience,” Kinnear says wearing his BCS hat as chair of the organisation’s Health & Care Executive.
“There’s a lot of work going on around FedIP and professional standards. The CIO community is beginning to think about what the accreditation looks like for them,” Smart says of the digital academy his organisation NHS England is creating for CIOs and CCIOs. The CIOs also salute the Skills Framework for the Information Age (SFIA).
When asked if the rise of professionalisation will be harmful to existing CIOs who’ve done the hard yards Smart says: “There are many CIOs with great experience of doing the job, we must not get too uptight with professionalism by examination. People who have been at the coal face, have the scars and who do the work with a clear sense of what the capabilities and competencies..we must bring that whole group into the fold.”
“For me the balance between experience and qualification is very pertinent,” Hopkinson says. The experienced CIO who has done his entire career within the NHS describes honestly reaching the point in a career where a CIO wonders if they should get an MBA or other qualification. The conversation is reminiscent of the recent podcast on using the Apprentice Levy to train existing team members.
“What the Digital Academy is to begin is the creation of a cohort of qualified informaticians within the NHS.”
“There are lots of aspects of this job that you can only learn by doing the job,” Kinnear says of his career that began in 1991. “I look across our colleagues see people that have genuinely invested in their own development and have taken the time to go to the summer schools and I see people that have been far more passive, yet have the experience under their belt and I’m keen to see the professionalisation piece drive out some of the passive behaviour, that is not to say I think it is all about an academic qualification.”
Like the apprentice debate, Kinnear and peers admit the issue is not only with individuals but also organisations.
“If you think about Malcolm Gladwell’s 10,000 hours of learning to become an expert, that is 10,000 hours of professional learning, not just doing the role for five years. If you are doing the same thing, then you are not four times more experienced, you’ve just been going around the same circuit four times longer,” Hopkinson observes.
“Continual learning is critical,” Smart adds. “What the Digital Academy is to begin is the creation of a cohort of qualified informaticians within the NHS.” Smart believes professionalisation will also help rebrand the NHS as a great place for a technology leadership career. “We are good at celebrating failure in the NHS, we are really poor at celebrating some of the remarkable things that we are doing with data like the genome project and some of the remarkable change that is going on to enable clinical practice that will have the ability to match drugs to a patient based on genomics. It is the most exciting form of information to be getting involved in,” the CIO of NHS England says.
There are those that criticise professionalisation and professional organisations for restricting innovation and perhaps becoming inhibitors to entry for CIOs not from healthcare. But none of the panel members see this as becoming an issue. Nick Hopkinson raises the point that professionalisation should encourage greater collaboration amongst trusts so that a smaller trust like his can enable the career development of talent by encouraging secondments to other organisations.
“Our role as CIOs is to give them the skills and experience to move on and move out of your organisation by recognising that nine out of 10 times they will stay somewhere in the care sector,” the Devon CIO says.
“This is about getting to the heart of what are true leadership skills. In my 20s I focused on the core informatics, in my 30s I focused on what it meant to be a CIO. As I have got older the skills I have sought are more subtle, behavioural, influencing, how to cajole execs to support initiatives and how to get people to do things when they don’t want to and how to deliver a sense of passion,” Kinnear says of the arc of different education needs a business technology leader requires.
Hopkinson says: “Our business is not IT, it is not technology, our business is care.”