NB – Slightly longer article than normal, with massive inspiration from Michael Jary and his wirtting on this subject. An article written together with the superb Sarah Moorhead.
During the first month in my new job, my first role not being a CIO for over a decade, my new boss handed me a slightly terrifying article (Nine reasons why you are not really a digital retailer By Michael Jary), an article that seems to say that the ‘Plan A’ that everyone was working towards was already a failing plan for the new sector that I am now part of, retail. The amazing article goes on to say that the ‘system’ needs to think again about how to become a digital retail organisation, one that survives the impending and much advertised doom on the high street.
I took the opinion piece home with me and reflected on it with an old colleague and friend who has stayed in the health sector as a digital leader. Her immediate observation was clear, the race to become a business that adopts a transformation agenda is the only way for any business to become efficient and competitive and that it is the same in so many verticals. It doesn’t matter if its health, retail, automotive or the finance sector the challenges of the digital agenda can be mapped in very similar ways and there could (should) be a great deal we can learn from each other.
The reflections we had together though also considered the new roles that are being created to ensure that digital, innovation and transformation, buzz words in both of our sectors, are something that can be achieved by all of us. Does the title matter anymore, was the question we posed to ourselves as we thought this through?
I am sad to no longer be a CIO I must admit, and my co-author of this piece is ambitious to one day be a CIO, but why, when the agendas we ‘dance towards’ are changing so much? Will the badge CIO still be the direction new aspiring leaders head towards when they are looking at the top job in technology in the future.
The Jary article started with…
“… a simple truth has emerged. The successful (Transformation Programmes) ones brace themselves for a breakneck pace of change – to move at digital speed. And they see transformation not as a programme but as a continuously accelerating commitment to stay ahead of the customer.”
Transformation is achieved through the adoption of new innovations, not specifically digital, new ways of working, new attitudes to communications, new processes for delivery; all the different ways to change need to be considered. But transformation can only be achieved with an open mind and when the organisation, in its widest definition, is truly ready to change.
Is healthcare ready? Yes, it is! In fact, very much like retail on the high street if it doesn’t transform then the death of the healthcare system we love so much is nigh and that’s why the article by Jary is so important, not just to the retail sector but to all sectors that wish (need) to still be here in a less than a decade.
Jary’s article went on to offer why you are not (yet) a digital retailer, in the piece below we (me, Richard Corbridge outgoing CDIO of Leeds Teaching Hospitals Trust (and newly appointed director of innovation at Boots) and Sarah Moorhead the Associate Director of Digital at Leeds Teaching Hospitals Trust) consider each of the nine issues he raises from our two perspectives as leaders but also with the ‘hat’ of our own area.
One – You have a head of digital
Digital is not a channel, nor a project, nor a capability. It is where your customers already live. Who is Amazon’s head of digital, or Apple’s? It’s Jeff Bezos and Tim Cook. The chief executive should take charge.
SM – It has been questioned since the inception of the CIO role in the NHS. What are the right roles to achieve a digital transformation and is a CIO needed when you have an engaged CEO or well-placed CCIO’s (Chief Clinical Information Officers), are they enough to lead a digital team, therefore, making the role of CIO redundant?
In Healthcare we have conflicting priorities; the upkeep of estates, vital equipment, staffing levels, reducing budgets and after all the business we are here to deliver, making people well. All of which apply in slightly different ways in other sectors.
These types of priorities are well-known issues in every sector whether private, public or retail but then we introduce the word Digital suddenly we want our CEO’s to become experts overnight to what really is a new sector in its own right. A sector that is growing at such an exponential rate even someone dedicating 100% of their time to would struggle to keep up. The concept of taking charge as a CEO is correct but you take charge of the experts not trying to become the expert. Any organisation without an expert in digital is destined for failure no matter what the sector.
Digital can, and will, and needs to transform every sector soon to ensure sustainability and affordability and therefore the expert needs to lead the way with a very tight ‘army’ right behind him or her!
RC – Every business is a digital business in 2019, or so the analysts would have us all reflect on and apply to the transformation we are making. Moving from the role that had responsibility for all technology in a large healthcare system to one that ‘just’ has responsibility for innovation has been an eye opener to the attitudes and aptitudes of the business, I am now in.
The role of transformation is a business role, its more clearly articulated than I have seen anywhere else as the responsibility of the business to achieve, it’s a shared goal, even a passion. In healthcare, the Wachter report inspired a ‘business’ ownership of the agenda less than a decade ago, but, Wachter only inspires the delivery part of the business, not the customer, the patient. In just a short period of time, one thing I have learnt quickly from my changed role is that the NHS could (maybe should) appoint more patient power to the decision making and influencing forum that are in place to truly inspire the new digital transformation.
If the NHS were to truly back transformation may be what is needed is not a CCIO as a leader but a Chief Digital Patient as a leader, or maybe go one even more radical and ‘simply’ appoint a Chief Patient to every board, that would put the transformation in the hands of the payer, the receiver of the service and perhaps the most influential element of the NHS today, the voter.
Two – You’re talking customer segments
You do so because you lack the data and insight to understand individual customers or to offer them a unique experience. Segments are OK for marketing. True digital businesses integrate into each customer’s life.
SM – Integration can only come from an understanding of each of your stakeholders, this requires them to be segmented or themed. Once we have a clear understanding of each group what they want and need and how that can be achieved only when this is complete can we truly begin to integrate? Integrated healthcare is the panacea for efficient, safe and patient centred health and care, therefore we strive for this in the NHS and we understand the route to it, even if no one has achieved it yet!
In Healthcare we prioritise by the impact a development can provide for. The functionality for 10,000 nurses will be prioritised ahead of a bespoke offering for 3 expert clinicians. Using this as the matrix for prioritisation though will not enable a culture of innovation to land and comes with risks that we simply keep replacing paper for glass-based processes.
In retail, I would see this as the equivalent to ‘pandering’ transformation towards the biggest customer sector and the spend they can make. As with healthcare through the different customer sectors will forever raise the problem and concern that they are more important than the focus group, being able to individualise the retail experience in the same way as we try to personalise the healthcare experience must really be the transformation goal.
RC – The proliferation of digital into what we do every day never ceases to amaze me and I think of myself as a person who gets this stuff. Empowering a kid of now with a phone is like delivering them a supercharged ‘skin’ on Fortnite (and if this reference is lost on you then therein lies part of the problem)!
As SM says we need to understand the segments that exist to integrate and that does not matter whether that is retail or healthcare that we are trying to achieve that understanding. The ability to enable innovation to come from any part of the market is one of my new challenges. I need to find ways to support innovation happening but then ensure that it can replay across segments, the purest definition of Omnichannel I guess? And that phrase is something I would love to push back into healthcare from retail, the ability to create an Omnichannel experience of the NHS would be so powerful for the patient who sees the brand of the NHS as ubiquitous, a single organisation across the UK and yet integration, interoperability and messaging standards; ways to ensure information is available across the system, have been our focus, maybe even our obsession for the last 20 years, and still we are trying to make this happen.
The Great North Care Record is maybe the single place really trying to create this experience today, what Joe McDonald (The leader, the voice and the Chief Clinical Information Officer of the North) and the team have done up there where all things are ‘great’ and ‘north’ is a true early stage Omnichannel innovation, one that should be supersized to achieve a new digital paradigm in healthcare innovation.
Three – You have an ‘agile team’
Agile teams get frustrated when their innovations need to be scaled up through operational functions. The principles of agile – distributed governance, rapid prototyping and fast feedback – are relevant everywhere.
SM – If we remove the word agile and replace it with dynamic, fast-paced, quick learning the stigma seems to disappear, and this is all it means. People and technology are moving so fast they expect technology introduced in retail to be available in healthcare, for example, appointment booking in healthcare should be just as easy as flight booking in travel. When it comes to the exchanging of data from GP to pharmacists then why isn’t it available overnight or quicker.
The only way this can be achieved is by us working smarter and quicker and changing that historic mentality that big and slow is good. We must listen to our customer and react quickly to the required change so whether we use Agile or another buzz word it is the principle of delivery that matters.
RC – Surely this must be more than buzz word bingo for IT geeks. A game that turns off everyone else. Service Management created ITIL (IT Infrastructure Library) because the words stopped making sense and an obsession with what the words meant took over from the benefit that could be gleaned from them. The same is landing with the Agile methodologies. SM taught me what happens when Agile really is used in the delivery of benefit in healthcare in her organisation. Where I am now Agile is new, it’s exciting and it’s delivering because the engagement is significant at a people level. I draw parallels to ITIL back in the late 90s to where Agile is now, a theory, a theme, a way of working that needs to be taught at the most basic and rudimentary level to a width of the organisation way beyond the IT team for it to make a difference.
Building rapid feedback must play out to all customers, SM has that through digital engagement with the ‘elite’ of healthcare but, to truly make a difference we need to apply the same as we have said earlier, we need the customer level of our organisations to be part of the story if we are to be ultimately successful.
Four – You’re launching a ‘store of the future’
Digital requires many touchpoints – ship from store, pick-ups, showroom, brand experience, service, pop-ups, et cetera. Most retailers try to cram all these ideas into one repurposed, compromised space. The key is to intercept each customer journey with the relevant offer.
SM – The store of the future is the equivalent to having a Digital Hospital rolled out ward by ward and wing by wing. Done in such a way as to give you a demonstration of what the future holds to create engagement and buy-in. As you roll out store by store you apply the lessons learnt and get better and better at making it work best. It’s not the case of cramming in functionality and making it fit, it’s making a suite of offerings available for each customer to choose from, once you put all of this under one roof (ward, wing or indeed department or store) it enables the ‘businesses’ to educate themselves and make the right decision for them on what transformation is needed next and how it can be applied. It will not matter whether it is the adoption of a new digital form or a huddle around a whiteboard; engagement through example and learning works best. There is no one size fits all in digital but with the right principles in place everyone can embrace adoption.
RC – The learnings from healthcare really teach retail something here. As SM says above, “It’s not the case of cramming in functionality and making it fit”, it must be about journeys and healthcare has been able to do that so well in the most recent times and I think SMs organisation better than most. Seven years ago, the city-wide leadership coined a phrase that has become ubiquitous across digital, ‘the platform businesses’. Dylan Roberts (The Leeds City CIO and one of the foremost innovators in the UK CIO peer group) and colleagues at the time hadn’t realised that they were just less than a decade ahead of the new trend. Retail, in fact, any business that is to be successful beyond 2025 is a platform business now, we all are learning that we can’t cram functionality in but need to deliver journeys for customers to follow so that they are delighted by the experience and return to it, that’s how innovation becomes ‘sticky’ and how we delight the customer.
Five – You’re measuring online customer behaviour
Good, but if you’re not capturing the same experience and engagement data in stores, you’re missing the whole customer view. You should monitor value to the brand irrespective of which channel the customer chooses.
SM – The comparison I make in Healthcare is carrying out assessments through the global advisory organisations like HIMMS, KLAS, and Digital maturity user groups. We must realise that the people that contribute to these know what they want and how they want it which is why they are happy to give feedback. It’s when you walk the Theatres, the Wards and head out on the corridors that we truly get the feedback we need to learn and improve. But the assessments still need to be done because these are tangible outcomes that can be used to send the message out to users to improve everyone’s experience and influence behaviours.
RC – Is this where the way we work diverges the most? I hope it isn’t, the NHS has Friends and Family analysis and the reviews that SM mentions above, in retail we can gauge customer experience by standing in a busy store and simply seeing the vote with the feet that happens. I believe the divergence is the appetite for risk, in retail we can try and fail fast more easily we can pivot and try again at speed and on a small scale. The NHS has yet to really learn how to do this, it has a DNA that is built on ‘do no harm’ and that extends into the ability to innovate easily and transform the system.
Six – Your org chart has added new roles and titles
You’ve renamed your marketing chief as “customer director” and added a role or two such as chief data officer. But structurally the organisation has not changed. To be fully digital, you need to organise around the new functions of customer experience design and ecosystem partnership development. Meanwhile, AI is eliminating whole swathes of the organisation.
SM – I would have to agree with this one but say we have done the opposite in my organisation but know many NHS organisations have taken this approach and not really changed. Our central bodies like NHS Digital have been the perpetual culprit. It’s not about shuffling the cards, the NHS needs the whole deck to be thrown in the air to ensure a future proof digital organisational structure can exist breaking rules of old, but alas many organisations keep shuffling. The one hope on the horizon for this must be NHS eXperience (NHS X) though, something that feels more like a new deck than a deck reshuffle and even the name ‘should’ place it with the right agenda.
RC – Could this be the one area where the NHS has the answer it has been looking for? The creation of NHS X has been seen by so many ‘lifers’ to the cause as the white knight on the charger, at last, way more than the promise of NPfIT or the Wanless Report or StBOP ever was (just pause and consider how many more daft acronyms and phrases we have had in our common parlance over the years that haven’t actually changed very much at all.) New minds are coming into the NHS and old ones (me included) are heading elsewhere, maybe this is what is needed, empower more people like SM, digital leaders who went to school with digital and not learnt it after their first pint had been consumed.
Seven – You are hiring more retailers
The scarce skills needed to be competitive in the future do not include retail experience. You already have plenty of that. You need data scientists, technologists, machine learning specialists and above all people who bring challenge and creativity. Hiring more retailers is only going to reduce your chance of survival.
SM – In Healthcare I would make the comparison of people with retail experience with our ‘administrative doers’; medical record teams, service desk analysts, switchboard operators and project managers; we need to bring or upskill to have the new (and right) skill for the future digital team. We need data scientists to feed and teach the advancements of AI. We need to drive decision making for better patient care through expert information analysts and we need to have architects to drive our Cloud future; these things will help the chance of survival for the NHS and see transformation become normal, ensuring the priority is thought through in the hiring of these staff ‘against’ the hiring of the much needed ‘doers’ is a huge challenge for a new leader in digital.
RC – Transformation is not to be considered code for carving the wage bill lower in any organisation or the reaction will be akin to that of the printing press, a Hulk-like, ‘Smash!’ Transformation and innovation have keys in local knowledge, system intelligence and loyalty being maintained which is achieved through a fully human connection being made. Reduction in budget for digital, for innovation, in times of crisis is the first sign of desperation, but as a CIO I have been asked to make the decision; fire alarm or desktop refresh, and when that happens you can no longer be a transformational leader, all you can do is manage the IT operations, and as long as the organisation realises what they have ‘just’ done then that is ok, kind of!
A CIO must be able to manage operations and have a vision of the future. A CIO needs the budget for both, a leader with a focus on innovation needs to find the right buttons to press to get buy in to innovation, I think this may be an easier job in reality than that of a CIO, because how can you argue at board level that we might have to wait for a fire alarm because Cyber Security risks are larger when the board are unsure what Cyber Security means.
Sadly the CIO role is still the three Ps to many healthcare boards; Passwords, PowerPoint and Projectors.
Eight – You have few millennials and Gen Zs in positions of influence
Globally, millennials outnumbered baby boomers more than a quarter of a century ago, and yet who is making your strategic decisions? Generation Z is the first truly digitally native generation: its oldest members are just turning 21. If you’re struggling to hire them, perhaps the problem is…
SM – The observation between healthcare and other sectors here is that we have the same problem but for different reasons. Healthcare and the digital part of it can’t attract Gen Z people because it struggles to compete with other opportunities. A Gen Z has an amazing expectation of self-worth, they have and want more than what the NHS can offer ‘out of the box’; be it status, opportunity or salary, and when we do attract them they are seldom here for the ‘long haul’, lost to bigger things too soon.
The mindset of someone not being experienced or able to be a decision maker from Gen Zs is an ingrained mindset in the top tier of the NHS. That it would not be possible for them to play this role as they don’t have enough ‘experience’ only gained through age is one of the last bastions of discrimination. We have seen that when we empower our Gen Zs their ideas can drive the biggest of changes. The baby boomer generation must be educated that this new fast-paced, people and culture aware and collegiate generation is the solution to the speed of which we can deliver Digital.
RC – Pause and look, we can hire the right people in the retail sector if we accept that the new and brightest are here to make the instant difference and then will be on to the next difference they can make soon. Once the CIO role was for the IT leader who didn’t mind becoming a bit famous, now the ‘gig-economy’ delivery agent wants the fame for the immediate project being delivered, and why not, we are all becoming our LinkedIn profiles when we look for the next job.
SM predicts it’s an NHS issue, it’s not, it’s a large corporation issue, to be innovative we need to empower disruption and a start-up mentality, we need to let loose the knowledge, capability and passion of the next generation of leaders, and we as ‘old timers’ need to find new ways to accept the temporary nature of the roles we are now appointing into.
Nine – You can’t articulate your purpose
Societal purpose is a core motive for millennials and Gen Z selecting a brand or an employer. But this goes beyond ethical compliance, it means finding a unique, genuine and meaningful role in the world.
SM – The NHS is a purpose job, my Mum told me it was a job for life, I wanted it to be a job for life. But in 2019 we have seen some of the most inspirational and forward-thinking leaders move on, for the first time this year’s Digital Health Summer School (#DHSS19) felt like a new school for so many. Where I work today needs to play on its brand more than it does. The #LeedsDigitalWay has become a calling card for openness to ways of working but there is a risk, a brand can be too inspired by a person or space in time. As we move into 2020 with new leaders all over the NHS taking up the reigns of large business change programmes how do we, as the ‘middle management’, ensure we help the new leaders learn from the past and bring our teams along with us on the journey.
RC – And here again, sorry SM but I must disagree a tiny little bit, I always had the same mantra as you until seeing it from the outside. As public servants we need to be careful not to believe our own press too much, the private sector is not full of ‘gas guzzling, profit-making, cats’. The public servant mentality is that of higher plane existence and after a few short weeks outside of this ‘higher place’ I no longer agree. Great digital leaders see innovation as almost a religion, a way of making the world a better place, sometimes that may make a profit for a corporation and sometimes it may simply be for good, but a focus on doing good is just as there in retail innovation and digital as it is in the public sector.
And that is the nine points reflected on, agreed with, disagreed with and generally applied from the point of view of learning more for the business we are all in, interestingly we don’t even settle on a name for ‘that’ business, so here is a proposal. Maybe all we are here to do is actually focus on longevity. Principled and ethical longevity that serves, no elights, the customer. The defintion of customer can also be argued over and it clealry isnt ‘just’ the person that pays the bill… But lets put them at the centre of the next thing we want to do and make sure it meets their needs to the best of our collective ability.
The continued existence of what we are doing at a macro level (because we believe in it) supported, sponsored and made possible by a digital agenda, an agenda that is the catalyst for innovation which in turn is the engine of transformation.
We all have skills that we can bring to the ‘mix’ lets do that in collaboration with each other.