One of the very first things I ever did in clinical informatics was to build a team of outstanding people.
In 2015, shortly after becoming director of development at Barts Health, an informal steering group of nurses who – like me – wanted to make sure the nursing voice was heard in digital projects was formed.
A few years later, I’d formally add the chief nursing information officer role to my responsibilities. But the importance of teamwork has never changed.
Getting a clinical informatics project off the ground, and then running effectively, can never involve only one person. It needs involvement across all clinical user groups (each of which may have slightly different needs and priorities) as well as across the IT side (both the internal IT staff and those working vendor-side). It needs, in short, teamwork.
Negotiation and trust
For me, that means that personal leadership style is key to success in the CNIO role. I’m very committed to collaboration, participation, and facilitation that enables an understanding of where everyone’s coming from. I like to build on the strengths of a team and create a strong user voice, bringing people together through engagement and towards a shared goal. Helping teams to be truly empowered in their digital development and journey is also important to sustained outcomes, growth of talent, and the satisfaction of team members.
That probably sounds like it’s straight out of a textbook. But all I’m really saying is that success in the CNIO role is about how you negotiate with people and how you build collaborative trust. It’s about making sure that teamwork is inclusive and builds understanding across all domains of the health informatics world. That way, you get the best out of the technical and clinical aspects of people’s skills and responsibilities.
I have expertise in, and a strong passion for, the development of outstanding care, nursing practice, the NHS, and organisational development and transformation. I’m not an IT technical expert but the NHS Digital Pioneer Fellowship and further training and development have really helped to expand my skills, critical thinking and system knowledge. The Digital Health CNIO Network, Summer Schools and regional CNIO groups have also been fabulous sources of rich information. So over the years I’ve developed skills in health informatics and recognise the opportunity to bring together a multi-professional team and enable a shared perspective on the digital solution. It makes a real difference to adoption if the patient and user voice are part of the team and early co-design – bringing in creative ideas and positive momentum and a satisfaction in the work. Really understanding what matters to everyone as part of the programme team is essential. By working and learning together, we get the best possible outcome.
The importance of identity
We have built an excellent clinical informatics team at Barts Health as part of a programme we call “We Connect”. Having a brand and team identity has been a positive motivator. The progamme is recognised across our group of hospitals, not just for digital transformation but for an energising approach to teamwork and change implementation methods.
The CNIO role is a lovely combination of clinical insight, health informatics and the ability to enable people to want to come on board. It’s about the ability to collaborate to enable often large-scale change and digital transformation, to reduce unwarranted variation and simultaneously achieve positive quality improvement. The core is engaging people at the heart of the development and raising the profile of health informatics, as well as bolstering digital competence and capability among fellow clinicians.
Negotiation skills are important in working with the team and wider workforce. Making sure the changes and developments really reflect excellence in the clinical workflow and are clinically led is crucial. Listening to teams, understanding what they need and then helping them to get it is important. Getting people involved early helps get a good balance between generic and specialist requirements and enables a seamless design. Building a wider team including super-users, digital champions and ambassadors does much to extend knowledge, skills and involvement and they are a fabulous positive energy and resource for wards and services. When people are part of the solution and can share in the improvement it all changes for the good.
That informal steering group created back in 2015 has grown to become a formal nursing informatics infrastructure. We have a nursing informatics officer at each of our four main hospital sites, a deputy and a lead informatics nurse, and then hundreds of super users. I report into the chief nursing officer, meaning informatics is central to nursing at the trust and have a close working relationship with the CIO and CCIO. The collective clinical informatics leadership team has a strong bond and the support has been truly amazing.
Our teams played a huge part in successful implementation of the electronic prescribing and medicines administration (EPMA) project back in 2021 and designed new functions and workflows right through the complexities of covid waves. This has built on our earlier implementation work, enabling digital development in nursing across the whole Barts Health Group. We have EPMA pharmacists and digital midwives, a growing allied health professionals informatics group, and medical clinical informatics leads too. We’re all continuously working together with our clinical systems and IT colleagues to enhance outcomes for our patients and our communities.
Build your rope team
During the We Connect nursing programme, I was reminded of a presentation I’d heard several years before. When we were implementing our Cerner EPR, we went as a team over to their headquarters in Kansas for a conference. One of the speakers was Erik Weihenmayer, the first blind person to reach the summit of Mount Everest.
His inspiring presentation introduced us to the idea of a rope team – the people who are with you as you adventure; who will save you from falling. It was an idea that really stuck with us as a nursing informatics team. Any time we implement a new digital project, we’re really clear about who is on our rope team. As we began to implement the EPMA project, I received a postcard from one of the teams involved. It was a picture of climbers on a rope team. There was something really nice about that – about people feeling they were part of a team in which everyone had one another’s backs and sharing that same adventure.
Our team has expanded over time and there is a strong core of people who have really developed nursing informatics. We continue to integrate health informatics in everyone’s day, helping others to take their careers forward through the likes of fellowships, mentorship, coaching, our What Good Looks Like Strategy, and shared decision-making councils. They are true health informatics ambassadors and signal the very best of nursing and its impact. I am proud to work with such an amazing team of professionals.
Louise Hicks is CNIO and director of development at Barts Health Trust, one of the largest NHS trusts in England, and a visiting professor at City University of London. She became CNIO at Barts in 2019, having initially joined the trust as an improvement and transformation programme director. Louise previously worked in higher education and in clinical practice, of which she has over 40 years’ experience.