CCIO Handbook

CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
James Reed, CCIO, Birmingham & Solihull Mental Health Foundation Trust

History of the CCIO – who, what, why, and where?

The rise of the Chief Clinical Information Officer (‘CCIO’) as a recognised role within the NHS has been the most influential change in how technology is applied to healthcare in the last 20 years.

As recently as the early 2010s, it was rare to find practising doctors who also pioneered digital healthcare. Developing and improving the use of technology was often seen as eccentric by NHS colleagues, who viewed the doctors pursuing it as harmless cranks.

However, such doctors were also often seen as “good with computers” and rapidly became familiar with colleagues asking them for advice.

The forerunners of CCIOs

There were formal opportunities in the NHS and some clinicians found it simpler than others. GPs, for example, found it relatively easy to trial new technology because their practices were small and they owned the business.

The major primary care systems, such as EMIS’ Electronic Patient Record (EPR), were all coded by pioneering GPs. Doctors working in secondary care with similar skills, however, didn’t have the same opportunities.

‘Computerisation’ in hospitals often consisted of putting large mainframe computers in the basement to process administrative data. Although some trusts succeeded in this wasn’t recognised at the regional or national level.

Nonetheless, these pioneering individuals were the forerunners of the modern ‘CCIO’.

The National Programme

The digital maturity gap between primary and secondary care worried the Blair Labour government who, in 2002, launched the National Programme for IT (NPfIT). This was, at the time, the largest public sector IT programme ever attempted in the UK, and had the aim to bring NHS information technology into the 21st century.

Much has been written about how local innovation largely halted in the face of such a large-scale national programme. A few heroic figures tried to avert disaster but, in retrospect, too much emphasis was placed on big technology companies, and the role of clinical experts was overlooked.

As the NPfIT drew to a close, most health care providers had made little progress, and the idea of digital transformation was largely discredited.

The CCIO role emerges

However, at grassroots level, change was brewing. People who disappointed by the National Programme nonetheless felt it was a missed opportunity, not a bad idea, and were keen to take the good ideas forward.

They latched onto a small, but vocal, website known as ‘e-Health Insider’ (now Digital Health), who had begun to socialise the US concept of a ‘Chief Medical Information Officer’ (CMIO). This was a senior doctor responsible for overseeing the design and operation of clinical technology.

The term ‘Chief Clinical Information Officer’ was soon coined and the EHI CCIO Campaign to lobby for “every NHS provider organisation to appoint a CCIO to provide clinical leadership on IM&T projects.” Unlike CMIOs, who were senior medical staff, the CCIO was intended as a role anyone with a clinical background could fulfil.

The rise of the CCIO

The campaign proved successful. People began to turn away from the NPfIT’s failures to look ahead. The promise of CCIOs was to bring clinical leadership to the fore and, through doing so, ensure every aspect of technology applied to clinical work was driven by those with a clear understanding of need.

Moreover, the CCIO could use their clinical understanding to engage staff at large. And, thus, improve engagement compared to the NPfIT.

While an interest in technical matters was clearly desirable to the new CCIO role, it wasn’t essential. The most important skills were in communication and managing change. Some described the CCIO as akin to a translator, responsible for explaining clinical requirements to IT staff, and articulating IT concepts back to clinicians.

The CCIO Network forms

This new group of CCIOs began to naturally join networks, which were nurtured by eHI. An active discussion group sprang up on Google Groups which, over time, matured into a mature web forum.

These communities were further bolstered by conferences and day events, with the first Summer Schools held in 2012. These have continued to the present day.

eHI also mounted a formal campaign for every NHS Trust to appoint a CCIO and, as part of this, the Secretary of State for Health formally launched the CCIO Network in March 2012. As interest grew, more NHS organisations launched large implementation projects and appointed clinical staff into leadership roles.

The Wachter Report

An important milestone was the 2016 publication of ‘Making IT Work’, popularly known as The Wachter Report. Bob Wachter, an American physician and internationally-recognised expert in digital healthcare, was invited by the Secretary of State to review NHS IT and make recommendations for further change.

Three of his recommendations relate directly to the workforce, recommending a national CCIO be appointed, as well as developing a workforce of clinician-informaticians, and investing in digital literacy among the broader workforce.

A national CCIO was appointed, and there followed a rapid series of reorganisations, including the brief existence of NHSX as a central organisation leading digital transformation. The national CCIO role continues to exist, but is currently vacant.

Education and Training

Wachter’s recommendation to develop a digital workforce has been pursued more unevenly, although the NHS Digital Academy was established and offers a few training places on a Digital Health Leadership programme.

Other schemes, such as the Topol Fellowship, also offer a training programme but, again, places are limited. The main requirement for working in digital health remains enthusiasm for the subject, with informal help and support available through the Digital Health networks for those at all stages of their careers.

The CCIO role today

The role of CCIO has become increasingly well established. While not every organisation has a formal CCIO position, it is now increasingly rare to find NHS Trusts without clinical leadership of systems and technology in some form.

For those with a passion for digital healthcare, now is a time of opportunity for developing a career, as the CCIO develops into one of the most important clinical leadership roles.

CHAPTER 2

Ramandeep Kaur, CCIO, NHS University Hospitals of Northamptonshire & Sarah Thompson, CCIO (Pharmacy and Medicines), Wirral University Teaching Hospital NHS Foundation Trust

First 100 Days in the Life of a CCIO

Sarah Thompson and Ramandeep Kaur are amongst the first pharmacists in the country to become Chief Clinical Information Officers (CCIOs).

Sarah was recognised by the Pharmaceutical Journal in 2022 as a Woman to Watch, and Ramandeep was Highly Commended for the Dedication award for the NHS Year of the Digital Profession Awards 2022.

Both pharmacists have known each other for over eight years, having first become acquainted in 2014 after communicating about electronic prescribing and medicines administration. Their friendship has since grown and now they are determined to raise the profile of digital pharmacy, while embracing a concept of multidisciplinary working within digital teams.

They are passionate about inspiring the next generation of digital leaders and, after appointments to new roles during 2022, here they share their guide to the first 100 days of life as a CCIO through poetry and art.

“Sarah and I opted to do something a little bit different and fun,” explains Ramandeep. “I love writing poetry and Sarah has recently started sketchnoting, so this is a great opportunity to showcase our views through creative media.”

Poem

First hundred days: the ingredients for the CCIO cake

F irst CCIO role or a seasoned pro, each adventure a rollercoaster

I n at the deep end, new Trust and role, battling the feeling of an imposter

R unning to never ending meetings, tip 1, diary management is key

S eek out time in first 3 months to determine where your attendance is truly a must- see

T ip 2, complete your mandatory, systems, and clinical training, it will pay off

H andover from a predecessor is vital, if possible, tip 3 will save you

U nder your frantic glaze or bewildered stare your digital handover will be your cue

N ew beginnings means rest and reflection is a must, tip 4 plan and book leave within first hundred days

D etermine your line management responsibilities and eroster access as tip 5 amongst the newbie haze

R olling to tip 6, book in your 1:1s, team meetings and your no-meetings time

E mbrace your inner child and plan a team bonding activity for tip 7, with a dash of soda and lime

D igital, clinical and operational team engagement for tip 8 is fundamental

 

D on't pigeonhole yourself in the digital shell

A las tip 9, take time to listen to others and their stories

Y our time will come to fix the world but, right now, people will just want to share their worries

S eek out the positives for tip 10 in their tales so you can share their joyous moments too

T ip 11 don't forget your own personal development, with everything else being so new

I nvest time in getting to know your seniors and peers, face to face meetings is up there at tip 12

P eople, positivity, priority and passion for me are essential ingredients to the initial CCIO role delve

S o take mine and Sarah's tips, add your own flavour and icing and take a bite of the CCIO cake!

CHAPTER 3

Dr Ayesha Rahim, Clinical Lead for Digital Mental Health, NHS England

Everything you ever wanted to know about clinical safety by Dr Ayesha Rahim, Clinical Lead for Digital Mental Health, NHS England

As clinicians, we take clinical safety very seriously – it’s baked into our ways of working, but what about in our digital roles? Digitising workflow can eliminate certain errors within analogue processes, but it can also introduce new ones too.

For example, introducing electronic prescribing eliminates the risk of manual transcription. But what if the electronic prescribing system crashes, or suffers an outrage? This just doesn’t happen with paper and pens…

This is where clinical safety processes come in. By undertaking a robust assurance process on a digital product or service, we can plan for what might go wrong before going live.

Undertaking comprehensive clinical safety assessments can also help reassure frontline colleagues that a new digital innovation is as safe as existing analogue workflows.

What is clinical safety?

As CCIOs, we must ensure the technologies we roll out are safe for patients and reduce risks in the delivery of care. “Clinical Safety” simply refers to all standards, guidelines and practices relating to the safety of health technologies.

How do I know if something requires a clinical safety process?

Any application/digital platform that impacts on clinical care delivery or decision-making requires adherence to a Clinical Safety Standard.

There are two main standards to be aware of:

  • DCB0129, which is the standard that software manufacturers must adhere to; and,
  • DCB0160 which is the standard that healthcare providers must adhere to when they deploy products for clinical use.
  • Working with Digital Health, provide platforms for innovative ideas to be shared and exchanged.

As a CCIO in an NHS Trust, you’ll mostly need to familiarise yourself with DCB0160. Persuading suppliers to undertake an DCB0129 isn’t always easy. My advice would always be to err on the side of caution and undertake a DCB0160, at least. More on this later…

Handily, as well as the existence of these national standards, there’s also plenty of training and guidance for Clinical Safety Officers (CSO), who are tasked with overseeing these processes.

So, who should the CSO be?

This is a thornier issue than it appears…

According to national guidance, the CSO must be a “suitably qualified and experienced clinician”, which makes it easy to see why this often ends up tagged on to the CCIO role. After all, CCIOs are generally experienced senior clinicians, familiar with digital systems, who work closely with digital teams.

However, there are a couple of disadvantages. If you are both the clinical informatics lead and CSO for a digital project, this can smack a little of “marking your own homework”.

There’s also the issue of workload. Most clinical informatics teams are under-resourced. Having a separate CSO not only spreads the workload, but also increases clinical leadership with the digital department – no bad thing at all.

So, if you are a CCIO and have also been asked to be the CSO for your organisation, it may be worth considering whether separating the two roles is beneficial.

How do you “do” clinical safety?

The NHS England website has information on the process, but to summarise – once you’ve identified that a product/service needs to be compliant, the following steps should take place before the system goes live:

Beginning the process

  • Someone should be identified to lead the Clinical Safety process

Supplier documentation

  • You should scrutinise the supplier’s DCB0129 Hazard Log and Clinical Safety Case Report. If you’re concerned that they don’t have this documentation, the CSO should enter a dialogue. I’ve found the national clinical safety team helpful in mediating, where necessary.

Hazard Workshop

  • You should convene a Hazard Workshop(s) with end users to identify potential clinical risks. These should be recorded in a Hazard Log and mitigations identified for each. Mitigations may require, for example, a change to the system design, or the provision of training.
  • Next, ensure these mitigations are implemented – it’s no good if you don’t act on them. It’s enormously helpful to have technical colleagues and operational managers to advise on this.

Clinical Safety Case Report

  • The person leading the Clinical Safety process must document key elements of the Hazard Log in a Clinical Safety Case Report. Crucially, the report should contain the “Clinical Safety Case Statement”, which details whether the CSO believes the system is safe to deploy.
  • The CSO must sign off the report and present it to the project board, so the Senior Responsible Officer and other decision makers have confidence clinical safety processes have been followed and can make a go/no-go decision.

Post-Implementation Hazard Log

  • The final step (often missed) is ensuring the Hazard Log can be updated post-implementation and during decommissioning, so unanticipated risks can be mitigated.

Top tips for Implementing Clinical Safety

As a former CSO, I’d recommend you:

Get Help from Colleagues

While the CSO must sign off the Clinical Safety Case Reports, other colleagues can compile Clinical Safety Case Reports or hold Hazard Workshops.

Invite a broad range of stakeholders to your Hazard workshops

Stakeholders can include administrators who will use the system; operational managers who can authorise workflow changes to mitigate risks; and technical colleagues who can advise on the feasibility of system design changes.

And, of course, bring someone to record the meeting!

Network within your Organisation

Meet with your organisation’s patient safety lead. They probably won’t be familiar with digital Clinical Safety processes but can be vital allies. The same goes for the executive colleague with responsibility for governance in your organisation. This is especially important if resourcing the Clinical Safety function is an issue.

Ensure your Programme Managers broadly understand Clinical Safety Processes. For example, by putting on informal training. We were able to get our PMO to embed Clinical Safety activities in all their project processes and plans, so it became an integral part of the culture.

A Note on Medical Devices

If the technology that you’re introducing is classified as a “medical device”, a different set of regulations applies. Guidance on medical devices is out of scope of this chapter, but the bar for compliance is very high – do seek specialist advice!

CHAPTER 4

Chris Day, Clinical Informatics Manager - Cyber Security directorate, NHS England

Everything a CCIO needs to know about Cyber Security

The risk of a cyber-attack in healthcare has grown dramatically over the past 20 years with many, such as WannaCry and Log4J, affecting the NHS directly. As a result, the question is now when, and not whether, a cyber-attack will ever happen to you!

Are cyber-attacks growing?

Since the introduction of Electronic Patient Records (EPR), the risk and severity of cyber-attacks has increased. Although EPRs improve transparency and patient care, they have the downside of increasing digital exposure and reliance on digital processes.

Cyber-attacks on healthcare organisations can come in a variety of guises. For example:

  • A direct cyber-attack on a specific NHS Trust, such as removing connectivity to a network or system. This may be done using malware, such as ransomware.
  • A cyber-attack that spreads across multiple organisations preventing access to devices that become infected with malware.
  • A cyber-attack on a product supplier, impacting multiple systems across multiple organisations that may include health, social care or both.
  • A cyber-attack against systems to steal data for the purpose of extorting funds.
  • Cyber-attacks that involve the hijacking of business processes to redirect funds from valid financial transactions to attacker’s accounts.

Will:

  • You know which patients are due to attend for appointments?
  • You be able to admit or discharge patients and see their previous clinical records?
  • Reporting be available to show operational pressures?
  • You be able to access diagnostic tools for critical healthcare interventions?
  • Cyber-attacks that involve the hijacking of business processes to redirect funds from valid financial transactions to attacker’s accounts.

If digital workflows become unavailable, this impacts every process – from clinical work to finance, with a major impact on patient safety. Being vigilant and aware of the threat posed by poor cyber security, and keeping systems safe, is everybody’s responsibility.

Why do attacks happen?

But why do people carry out cyber-attacks, and why attack your healthcare organisation? There are several possible reasons, with the most common being financial, or a desire to disrupt systems and core services.

The most common motivation for attackers is gaining wealth at your expense; by stealing your data, holding your systems to ransom, or hijacking your processes to divert funds. These attackers are often well-organised criminal groups with well-established ways of working, and they can act quickly.

Where funds are not the goal, the most likely motivation is disruption. Disruptive attacks can be undertaken by anyone interested in causing harm, and can include hacktivists, or anti-governmental organisations. Hacktivists tend to be less well-organised and impactful.

Cyber attacks – are you ready?

Someone will always press on a ‘dodgy link’ in an email, and we need to engage and train staff to prevent this. However, we also need to adequately fund and support robust infrastructure. It’s essential to consider clinical safety when implementing any process involving access to clinical information.

Key points that should be considered include:

  • Are staff adequately trained to reduce the chances of a cyber-attack? Ongoing awareness activities are needed to keep everyone alert to the risks they face.
  • Are staff ready to respond appropriately when a cyber-attack happens? The period where an incident is being managed is generally the worst time to try to devise new actions.
  • Are all your products up to date with patching to prevent an attack?
  • Is your desktop estate fit for purpose? There should always be a plan and a budget to replace devices. Machines can become extremely slow and along with causing frustration for staff, this potentially creates vulnerabilities.
  • Can your software update with new patches? Windows 7, for example, is no longer supported by Microsoft and can’t be patched if a vulnerability is found. This makes it easy for an attacker to get into your systems.
  • Do you have the appropriate technologies to defend your organisation, such as firewalls, anti-virus and anti-malware products?
  • Are Business Continuity Plans (BCP) in place and rigorously tested? Testing is vital to ensure your plans are functional and can support your organisation through periods of unavailability.
  • Have full timescales been considered from recovery to business as usual (BAU)? Do your plans cover up to six months of unavailability? It has happened before and will happen again.
  • Do your recovery plans account for data accumulation outside of your digital platform? If you have 6 months of data collated on paper for an entire EPR system, how long will that take to repatriate back into the system and what administrative resource would that require? The sheer volume of data created from one week of BCP means paper is not the solution. Options may include a failover data center, a simple eforms platform, or even the ability to revert to a backup.
  • Have you assessed how vulnerable your organisation is to phishing attacks? Tools are available to audit the likelihood of a staff member pressing a link by, for example, sending a deliberate phishing email.
  • Do you have your data backed up?

Taking things forward

As senior management, it’s never been more important to prevent cyber incidents and to know what actions to take if one occurs.

Whether you’re working to achieve CCIO status or an experienced CCIO already, you need to have the defence and resilience required to ensure the safety of data and – more importantly – the clinical safety of patients.

After all, in this ever-evolving digital world, patients still lie at the centre of everything we do.

CHAPTER 5

Anna Awoliyi, CNIO Nursing and AHP, Epsom and St Helier University Hospitals NHS Trust & Ronke Adejolu, National Associate CNIO, NHS England

The Audacity to Own Your Digital Transformation

Digital technologies, transformation and innovation are the golden threads that join business, operations and clinical intelligence together, to transform patient care and outcomes.

In the past, IT initiatives primarily focused on hardware and software implementation, as well on specific job responsibilities to deliver and embed digital transformation. However, in the current climate, this is no longer sufficient.

We need to move away from the nanny mindset of ‘winning hearts and minds’ because that’s about digital being done to us. Instead, we must move towards an ethos of digital ownership where diverse clinical healthcare professions work collaboratively towards a shared goal.

As leaders in digital, we have a unique opportunity to foster a culture of inclusivity and ongoing learning to increase our capacity for digital readiness both now, and in the future.

Measuring past successes

In 2002, the NHS launched its national programme for IT (NPfiT) deployment of Electronic Patient Records (EPR). Today EPRs are a crucial component of the healthcare environment, with several case studies having now described what a good EPR implementation looks like.

A critical factor for success is having not only the buy-in, but also the active involvement of EPR users, as well as the commitment of leadership and other stakeholders (Fatma Arikan et al, 2022).

Engaging stakeholders early is key as well as having sufficient resources to meet the unpredictability of an EPR implementation (Acharya and Werts, 2019).This allows the benefits of EPR use, and the legitimacy of the change, to saturate into the organisational culture (Fatma Arikan et al, 2022).

Moving beyond EPR

With the successful implementation and benefits of EPR now well documented, we need to move towards a culture where people feel they can be creative and innovative. And where they can leverage advancing technology to continuously transform their healthcare organisation.

With the digital landscape and assisted technologies moving at a rapid pace, we need to focus on how to grow and support a diverse, digitally-literate workforce in adapting to change with agility.

There’s now a renewed opportunity to, for example, use Integrated Care Systems (ICS) as a vehicle to advance the digital transformation agenda by connecting computer systems together across organisations.

We need to tap into the talent of geniuses across NHS systems’, such as Topol Digital and Digital Academy digital fellows, within the NHS and ICS. Together, we need to collectively explore powerful emerging digital-assisted technologies, such as artificial intelligence and the remote monitoring of patients.

We need healthcare professionals working hand in hand with patients, the population and diverse communities to support them in their own care, e.g. through online appointment booking, wearables and digital education.

Embracing change

Our role as system leaders is therefore to build and nurture an organisational culture that supports the workforce in embracing change. This requires us to scale and sustain this culture, through truly visionary and innovative leadership.

Gone are the days where it’s enough to simply digitalise current processes. It’s time for healthcare professionals, patients, and other staff to confidently own an equal voice and get involved in the future of digital healthcare,

To sustainably deliver seamless digitally-enabled care, everyone needs to work together in partnership. This means, for example, clinicians having the influence and power to inform and influence the scope of requirements of clinical information systems.

Broadening the conversation

We also need to overcome historical misconceptions and false notions about digital, which feed the narrative that clinicians find the language around digital too complex, need a special digital course, or don’t think digital technology is for them.

Our roles as leaders in digital is to level the playing field to make people understand that digital job titles are not necessary to do digital. Digital is for everyone, and it’s just part of how we will work now and in future. As the speed of change picks up, we all need to be agile to adapt to evolving digital capabilities.

As a leader, you need to bring the power for change back to clinicians. Instead of someone telling them what to do, they need to be thinking about the patients they serve, the problems they face, and how a digital solution might make things easier.

It’s important to challenge old ways of thinking, for example, whether you’re collecting data for a purpose – or just because it exists – and whether a solution meets the needs of its users, or is just what everyone else is doing.

In any organisation, there will always be a mix of users. Some people will be digital champions or super-users who are always positively engaged with new technologies. Other users will be neutral, and just use a solution because it exists, while others will display active resistance.

It’s essential to ensure there’s a culture of continuous positive learning and innovation, to keep the digital champions and super-users engaged in digital transformation and move the neutral and negative users into the positively engaged box, so no one is left behind.

Some clinicians show nervousness towards advancing technologies, such as artificial intelligence tools, taking over their roles. While this may be the case for repetitive functions, it’s important to focus on the opportunities, and on creating a culture that dispels and demystifies these myths. For example, there will always be a role for face-to-face human interaction.

The future is here

Today the EPR is day-to-day operational technology used by professionals across most healthcare settings.

With rapid digital advancement moving in some cases faster than human intervention, it is essential that NHS organisations grow an agile and innovative culture to ensure the workorce is well equipped to adapt to change.

In short, it’s about giving people the audacity to own their organisations’ digital change and transformation.

Only by doing so, can we leverage the full potential of safe digital technologies to enhance clinical decision making and improve the quality and equity of care we deliver.

Taking things forward

About the author: Ronke Adejolu is the National Associate Chief Nursing Information Officer at NHS England, an experienced, senior healthcare and digital systems leader who specialises in systems leadership, strategy, Innovation, and partnership working. Ronke can be contacted on Twitter @ronkeadejolu or  https://www.linkedin.com/in/ronke-adejolu-212b2110/

About the author: Anna Awoliyi is the Chief Nursing Information Officer at Epsom and St Helier University Hospitals, where she focuses on improving staff digital literacy and development. Anna was a finalist for the CNIO of the year 2021 and won the “digital champion” section of the BAME Health and Care Awards 2021. She has a passion for advocating for patient and staff voices and addressing digital inequalities in healthcare. Anna can be contacted on Twitter @annatransform18 or  https://uk.linkedin.com/in/anna-awoliyi-abb4682

CHAPTER 6

Lia Ali, Clinical Advisor, NHS England

How to deliver user-centred healthcare design

‘The cure for the pain is in the pain.’

Rumi

Key to any healthcare intervention is understanding and addressing personal experience. In clinical practice this is done by taking a history, observing, testing, and examining. We manage, assess, and reassess.

The factors forming personal experience are always complex. It’s only once the ‘pain points’ within that complexity are understood that effective interventions can take place.

In technology-enabled healthcare, design-led approaches can be used in a similar way to clinical methods to understand user experience and solve complex problems, as well as considering how best to deliver solutions.

These approaches have a long history in business. Management consultants McKinsey found, for example, that companies with strong design practices increased their revenues at nearly twice the rate of industry counterparts (https://www.mckinsey.com/capabilities/mckinsey-design/our-insights/the-business-value-of-design, n.d.)

Today’s CCIO needs an understanding of these approaches to effect digital transformation.

What is User-Centred Design?

Human or user-centred design (UCD) is the creative philosophy and associated processes used to understand and address user needs, especially where problems are complex (Snowden, n.d.) (Norman, 2013).

In the ‘Design of Everyday Things’, Donald Norman describes how this complexity often manifests itself as difficulty defining the specification of a product or service.

UCD addresses this by deliberately avoiding specifying the problem at an early stage. Instead, UCD focuses on the iteration and rapid testing of ideas, allowing test results to quickly feed back into modifying the approach and the problem frame.

The design process allows us to ‘find the right problem to solve and to solve the problem the right way’. The result should be products and ‘services that achieve outcomes that solve problems for users’ (Vaananen, n.d.).

The double-diamond approach to innovation

‘Wherever there is decision there is design.’

(Grinyer, 2021)

Figure 1: Version of UK Design Council’s Double Diamond diagram (https://www.designcouncil.org.uk/our-work/skills-learning/tools-frameworks/framework-for-innovation-design-councils-evolved-double-diamond/, n.d.) (Vaananen, n.d.)


 

It’s divided into four stages, although the process is not linear and there will often be a need to return to a stage as more is learned. It’s often necessary to reframe the problem to get the best solution.

These stages are:

Discover – understand the problem as completely as possible. This might include desk and user research, such as surveys, interviews, empathy mapping and observation (Muratovski, 2016). Observation can be ‘participatory’.

The best design is usually done in the place where it’s needed

If good user research isn’t done, assumptions about the problem can generate solutions that don’t meet user need (Nuckley, 2023).

Define – take a closer look at the challenge by analysing material from the discovery stage. Specific tools can include service interaction mapping and service blueprints (Grinyer, 2021).

Develop – Once the problem is more clearly defined, brainstorming and other divergent thinking methods can be applied. This is likely to lead to creative solutions, especially if a non-hierarchical approach is encouraged to deprioritise the loudest voices in the room.

Deliver – flexible prototyping and testing are central to delivery (Agile and government services, n.d.).

Other frameworks, tools, and processes

Figure 2 Examples of tools used within the design process

There are many other frameworks, tools, and processes within the discipline of ‘design thinking’ that can help explore challenges and generate solutions. The key is to select what’s appropriate for the type of problem being worked on. (Muratovski, Research for Designers, 2016).

Continuous or quality improvement, for example, sits under the design umbrella within the field of ‘action research’. It’s well suited to systems where there is a requirement for existing practitioners to “investigate and evaluate their own work’ (Muratovski, 2016) and where there’s considerable ambiguity around how to make improvements.

Further examples of frameworks, tools and processes are shown in figure 2.

What does UCD mean for CCIOs?

“I wish people would stop trying to sell me solutions for problems that I don’t have”

NHS CCIO

UCD means being able to deliver effective digital transformation

UCD is vital to delivering digital strategy, building team capability, and encouraging a culture of innovation. The CCIO is usually at the heart of this, often acting as the interpreter for multidisciplinary teams. Adopting a UCD approach means that there’s a tried and tested philosophy alongside effective tools and processes that a CCIO can employ in pursuit of effective digital transformation; whether that’s through clinical leadership for EPR implementation or evaluating the latest artificial intelligence tool.

UCD gives CCIOs ways to deal with complexity

In healthcare, the relationship between cause and effect is often not linear, e.g. implementation of an EPR and the impact on patient safety. Key features of UCD, such as user research and iterative methods are geared towards dealing with complexity (Snowden, n.d.).

UCD means being able to deliver concurrently

Figure 3 Concurrent Development Browne, 2023

 

Well-functioning modern digital teams in any industry need to be able to develop their strategy, design, and delivery concurrently, rather than in sequence (fig 3 (Browne, 2023).

Adopting a UCD approach allows CCIOs to move away from continuous pilots towards working practices that are more likely to uncover bias and generate truly new ways of working (for example, see Royal Free London’s approach to intelligent automation – (Ali, n.d.)).

How can CCIOs implement UCD? Bring the user in

Implementation of UCD can begin simply with a commitment to making steps to bring in the user. For example, by ensuring completeness of stakeholder mapping and conducting interviews with users early in the design process.

Increase design capability

Design capability can be increased internally through education and recruitment of professional designers, as well as exploring engagement with external design specialists.

In user-centred work we did in NHS England, for example, our discoveries informed an education programme aimed at building design capability in one team. Through surveys and interviews we established a curriculum that would increase the user-centredness of our work via individual practice and team culture (figure 4.)

By adopting similar practices, CCIOs can discover how best to implement UCD in their own healthcare organisations.

Figure 4 Design Capability in the Digital Care Models Team, NHS Transformation Directorate 2022

 

 

 

 

 

 

Credits for figure 2 & 4 to Helena Traill , Healthcare Designer

Thanks to Tero  Vaananen , Tony Browne and Pete Nuckley for their help with the preparation of this article

 

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Agile and government services. (n.d.). Retrieved from https://www.gov.uk/service-manual/agile-delivery/agile-government-services-introduction

Ali, L. (n.d.). Retrieved from Innovation Collaborative Blog: https://future.nhs.uk/system/login?nextURL=%2Fconnect%2Eti%2FInnovationCollaborative%2F

Browne, T. (2023). Digital Transformation - personal communication.

Grinyer, C. (2021, October). Lecture on Service Design. MSc Healthcare and Design, Royal College of Art.

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