It’s fair to say I’ve had a varied nursing career. I qualified in 1994 and have held clinical roles and management ones. I started taking an interest in digitally-supported healthcare over 10 years ago when I discovered a love for data and how it can drive improvements for patients and staff.
I moved into my first chief nursing informatics officer post in 2019, when the trust I was working for at the time was procuring an electronic patient record. Since then, I have completed the Florence Nightingale Foundation’s Digital Leadership Scholars programme and started an MSc in data analytics and artificial intelligence. I tell you that to prove that as a new or potential CNIO you already have a set of skills to bring to the role – and those you don’t have you can learn!
One key area in which you will have pre-existing skills, though ones that may need developing further in the context of the CNIO role, is clinical safety.
Essentially this is risk management, and as clinicians we do this daily. The design of systems, how they are applied into practice and how data can be used to drive clinical safety are all components of the CNIO role. At times there will be a need to say no to an idea that has been deemed safe on a formal risk assessment but which would be a risk if applied to a certain department or patient group.
I experienced this when rolling out a task-based system. The functionality was sound but when it was used by the on-call team it posed a patient risk of duplicate tasks due to not having a scheduling function. It was however suitable for the hospital at night team. The understanding of how areas work and how certain systems impact on those areas is a critical skill to develop.
Top tip: Learning about general risk management is beneficial if this is a gap in your knowledge. (The aviation industry has some great examples – which is always good to hear!)
Digital clinical safety
So how do we define clinical safety in the context of digital? This is covered in the Digital Clinical Safety Strategy, published in September 2021. It is an essential and insightful read and aligns well with the The NHS Patient Safety Strategy.
I particularly like this simple definition:
“Digital clinical safety is about making sure the technologies used in health and care are safe, and then using those technologies to improve patient safety.”
Technology is changing patient safety by moving healthcare from a reporting culture to one of prevention. Personalised medicine, predictive medicine, and technology-supported diagnostics are just some of the domains working to prevent negative outcomes.
The relationship between digital innovation and clinical safety is well documented. Improving sepsis detection, alerting to patient deterioration, and improved access to specialist teams are a few I have personally seen improve patient outcomes.
Shared care records help to improve communication between healthcare communities and remote monitoring is helping keep more patients at home during the pandemic.
It is essential to understand technology alone is not responsible for these improvements. People, processes, and organisational culture are all equally important. The role of the CNIO in my opinion is to ensure the systems are fit for purpose, do not increase patient safety risks, and are successfully implemented so as to gain full benefits in practice.
Digitisation however can present some risks. Access to electronic data can lead to concerns about data breeches and confidentially. An essential part of the CNIO role is to support a culture of information safety through training, audit and learning lessons. Another area is data quality: does the information in different systems match up, can we trust it and how do we use this to improve patient outcomes?
Occasionally there need to be workarounds, the concept of deviating from the intended use, that may need a full risk assessment and logging on the risk register. It is important to understand clinical safety to ensure the impact and likelihood of potential harms. Workarounds can also lead to positive outcomes in the form of enhancement requests to the developers.
Top tip: I would recommend setting 30 minutes aside each week to read or learn a new digital skill (so that equates to 21 hours of learning per year). You will soon become an expert and understand the digital language.
Clinical safety standards and clinical safety officers
There are formal clinical safety standards that apply to digital systems. The one that applies to the use of health systems is DCB0160: Clinical Risk Management – its application in the deployment and use of health IT systems. (It is supported by the related standard for the application of clinical risk management in the manufacture of health IT systems, DCB0129.)
Evaluating the use of a system against DCB0160 is the job of the trust’s clinical safety officer (CSO). This is a named individual who is responsible for ensuring the safety of a Health IT System in that organisation through the application of clinical risk management.
The individual has to be a suitably qualified and experienced clinician who holds a current registration with a professional body; has to be knowledgeable in risk management; and is responsible for ensuring clinical risk management processes are followed.
Top tip: Arrange to spend some time with a clinical safety officer from your organisation or form elsewhere. It is always good to see the practical application.
To CSO or not to CSO?
So do you need to qualify as a clinical safety officer if you are a CNIO? There is no definitive answer to this currently. The Faculty of Clinical Informatics has produced recommendations for a CCIO which states this should be a desirable qualification.
There is not a CNIO standard at present. Some employers would like to combine the role and others have a separate CSO. I am not currently a qualified CSO – however, becoming one is on my personal development plan. Traditionally organisations have one or two CSOs but there can be more. Some organisations outsource the role to skilled professionals.
Being the CSO as the CNIO has a risk of becoming so time consuming the other elements of the role may be compromised. So it may be best that it is not seen as the duty of the CNIO, but that the skills of a CSO are useful for a CNIO to have.
Top tip: If you’re applying for a CNIO role, check whether the CSO aspect is also part of it. If it is, discuss the percentage of the role that will be allocated to safety sign off.
Becoming a CSO
There are currently two parts to becoming a CSO. The first is to complete the eight e-learning modules, which can be accessed for free by anyone with an NHS email address. Once someone has passed these modules, he or she can move onto what is called the foundation course. This involves direct teaching.
Once complete, you are a certified CSO. You also receive 14 continuing professional development (CPD) points.
You can find out more about the training on the course’s page on the NHS Digital website.
Top tip: Spaces on the course are limited so agree whether being a CSO is a part of your CNIO role and, if it is, include it in your personal development plan as an essential course. Then apply for funding and book a place in plenty of time. Remember too to book out time to complete the e-learning at a pace you are comfortable with.
About the author: Dione Rogers is chief nursing informatics officer at Kettering General Hospital NHS Foundation Trust (to March 2022) and at Barking, Havering and Redbridge University Hospitals NHS Trust from April 2022. She qualified as a nurse in 1994 and has held clinical roles in stroke, haematology, respiratory, rehabilitation and acute care as well as general, operational and project management roles.