Andy Haywood joined the Welsh Ambulance Services NHS Trust (WAST) in January 2020 as its first director of digital services, an executive CIO role on the trust board. Now a managing consultant at Channel 3 Consulting, he discusses the lessons he learned in two and a half years as a new NHS CIO during the COVID-19 pandemic.

The Welsh Ambulance Services NHS Trust (WAST) covers a population of 3.1 million people and 8,000 square miles. It provides national 111 services, including the 111.wales website; 999 call handling and telephony; emergency medical service (EMS) response and non-emergency patient transport services (NEPTS) nationally across Wales.

As you read on, I’ll share some experiences, observations and thoughts about what it actually feels like to step up to being a CIO for the first time.

The step up to an executive role was bigger than I thought

The move from assistant director to executive director is huge and I didn’t fully appreciate it until I was in the role. You move from your boss being a digital executive, to a boss who’s a CEO and the relationship is different. I was lucky to have a fantastic CEO at WAST, but as a CIO, the buck stops with you for all things digital and informatics. Your boss still charts the intent, but you have to define the way to achieve it and bring everyone with you along the way. Don’t underestimate how the change of line management from CIO, or similar, to CEO will change things for you.

It can be lonely, but only if you let it

I wasn’t new to leadership roles before this one, but the CIO position put a new spin on it for me. What I hadn’t fully appreciated was that, even though the ‘loneliness of command’ is real, how lonely you allow yourself to be is very much a personal choice. Over the two and a half years, I learned to lean less on the CIO title as a badge to get things done and use it more as a tool to build support networks. Internally, the digital directorate and my leadership team were hugely important, along with my executive colleagues. However, it was in this role that I fully realised the benefit of peer networks.

NHS Wales didn’t have a peer group for CIOs when I started, but after the initial waves of the pandemic, a group of us were in touch informally and collectively felt a gap. Together, we set up a formal peer group within NHS Wales that included all board level digital execs, the CEO of Digital Health and Care Wales (the national digital provider) and the Welsh Government. The value of being able to discuss common challenges with peers was immeasurable and something I wouldn’t be without again.

Embrace the glitterball of governance

I’m naturally a reactive person and, as such, I like challenging situations where the need presents itself. Traditionally, committees and highlight reports were something that I only tended to lean on when I needed them to achieve something. However, what I rapidly learned as an exec was how much more this is required at board level and how it can assist you to gain broader support.

If you’re not on the minutes, you’re not in the game. If you want to celebrate a win, highlight a risk, issue or opportunity – it’s on you to bring it to the table. Likewise, if your organisation is early in its digital journey and the right table doesn’t exist, you need to build one. No one else is going to do it for you.

Strive for improvement over perfection

Delivering improvement over perfection isn’t a new concept. However, it can be challenging to remember when you’re trying to make your mark in a new role. That’s where an effective digital and organisational strategy is essential. If you set the desired outcome first, you can tailor the approach to get there as different priorities arise. This is particularly important if you have a small team that has to jointly carry the load of delivering live service versus delivering transformation. As the lead exec you have to stand up and prioritise the digital work that needs doing against the push for transformation.

Accept when you need help

I need to reiterate at this point that I now work for a consulting firm that provides this kind of help; however, what I learned here is common sense. No matter how experienced and capable you and your team are, there are certain things that you’ll do once, such as strategies, operating models and major systems rollouts that other partners have done multiple times. They also tend to require specialist skills that you may not need in your team on a permanent basis. Whilst it shouldn’t be a default, it should always be worth considering whether short term support on one-off big pieces of work can help to make it a success.

Digital transformation is a team sport

Despite being the digital lead in your organisation, don’t expect people to listen to you. You have to earn the right to be heard, and where you’re dealing with other professions, there are people that already have that right, along with a far better understanding of how digital tools are needed than you. It can feel counter-intuitive, but success often comes from knowing when to step back and let others take the lead.

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‘Clinically led’ is a well-used phrase, but it’s crucial to live it when you’re delivering new digital-clinical systems. This was repeatedly apparent during our electronic patient clinical record rollout, where having our medical director act as senior responsible owner and a consultant paramedic as project executive was absolutely invaluable. If you are delivering digital services to enable another group of people do their job, make sure they lead the delivery of the outcome.

You might be a figurehead, but you’re nothing without your team

Your directorate will make or break you. If they feel unable to raise challenges and critique your thinking, you won’t know what’s going wrong before it materialises. As a CIO, your reach spans every digital system and data processing capability across your organisation. You can’t be an expert in everything and you’ll probably find you’re more effective in areas initially where your expertise is least and you’re required to lean on the knowledge in your team.

Looking after your team often presents one of the major conflicts you’re likely to face. The organisation will take what it can to satisfy the need for rapid digital transformation and it’s on you to decide how much it can take. If it needs more, then you need to explain why and how much.Even minor things can make a big difference. You’ll get requests for laptops, phones and other items from all over the organisation and you’ll want to help where you can, but if you say yes to all of them, you’ll completely undermine the processes that allow your service and end user teams to function effectively. It’s a tightrope that you’ll be required to walk constantly.

There are gaps everywhere and you’ll need a toolkit to fill them

There will be gaps in your own expertise, the expertise of your team and your organisational capability. You will need a plan to fill them. This is another area where building a support network of peers, and professional bodies such as BCS are essential. This is particularly relevant with big areas, such as recognition of the digital profession and qualifications, where the change required is huge and your voice alone won’t be enough.

You're not alone

Challenges and ideas are rarely new. Technology may change, but the people that deliver it and adopt it don’t. Lean on any experience you can find and, more importantly, share the experience you gain. We’re all in it together!