How to implement change: the crucial role of the digital clinical lead

In the second of our four-part series on effective NMAHP teams, Elaine Tustian explains how the digital clinical lead can be a “golden thread”  running through projects and ensuring successful implementation

Successful implementation and sustenance of change requires a team of people to address the changes to process and workflow, as well as the human factor elements associated with change. When the change involves the use of digital equipment and applications, digital literacy and digital competence are also influencing factors.

I am a nurse with clinical experience on adult surgical wards, as well as experience in change management through my role as lead nurse for Enhanced Recovery After Surgery. My transition to the digital nursing team has enabled me to use my skills and experience in digitally enabled projects and implementation of organisation-wide change. As deputy head of nursing informatics, I provide digital clinical support and advice to two clinical divisions. Alongside my deputy CNIO colleague, I support trust-wide digital transformation initiatives, ensuring patient care and patient safety remain at the heart of what we do.

A clinical informatics lead role requires clinical experience and technical knowledge to understand where digital health technology can increase efficiency, reduce duplication, and enhance clinical workflows.

It requires a passion for improvement and investment in the workforce to support clinicians through digital transformation; it is important to ensure clinically experienced, but digitally immature, staff are not disenfranchised during the process. These key skills can prove invaluable within a project team to provide a link between the technical teams and the clinical workforce.

Deciding factors in success or failure

A project team should contain individuals (or teams) with: managerial responsibility; competent project management skills; technical knowledge; and clinical experience to successfully implement and sustain change.

Change affecting clinical processes, workflows, and patient care must be owned by the clinical services to ensure the digital solutions offered align with the operational workflow.

Change projects within healthcare organisations should strive to be clinically led, operationally driven, and digitally enabled.

Effective stakeholder engagement and involvement can be a deciding factor in the success or failure of projects. This can be challenging in healthcare organisations where identified stakeholders are clinicians with commitments that limit their ability to contribute.

In the absence of clinical stakeholders, there should be at least one individual on the project team with awareness and knowledge of the clinical workflows, who can advocate for the clinicians ensuring proposed solutions support clinical processes. A digital clinical lead can fulfil that role, providing a bridge between technical and clinical, aligning system design with operational workflows.

Not the driver of change

The role of a digital clinical lead in projects is to understand clinical workflows and support appropriate digitally enabled change. They are not the drivers of change – this needs to be the clinical teams.  However, they should provide direction and clinical context to digital solutions to ensure they will work in practice.

The digital clinical lead should seek to understand the end-to-end workflow and identify the services and teams involved in the whole process. Gaining a full understanding of the impact of the proposed change, including implications on the workflow if specific elements are not followed, is crucial for successful adoption of change.

If teams and individuals have not been previously identified by the project team as stakeholders, it is the digital clinical lead’s role to ensure they are included, especially when the proposed change will affect their workflow and/or processes.

An objective view

It is important for the digital clinical lead to have clinical experience and knowledge of the proposed change but, ideally, they should not be directly affected by the change. This detachment from the workflow allows the digital clinical lead to objectively review the technical solution in the context of the clinical processes and make recommendations that ensure successful sustenance of the change. A digital clinical lead who is directly affected by the change may not be able to maintain an objective view as they may have a vested interest in the process, especially if the change involves their colleagues.

A digital clinical lead who is embedded within the clinical informatics team is far enough removed from the process but has clinical credibility amongst their professional peers to influence the implementation and adoption of change. Being seen as part of both clinical and digital teams provides a sense of impartiality that may not be achieved by other roles in the project.

You could say that the digital clinical lead role in projects is the golden thread that pulls the different parts of the workflow together, aligning technical solutions with clinical workflows, ensuring stakeholders are identified, included, and involved in change. Without this role, parts of the workflow may be missed, stakeholders may not be recognised and digitally enabled, and clinically led transformation may miss the opportunity to realise identified benefits.

Elaine Tustian is a deputy CNIO at Oxford University Hospitals NHS Foundation Trust. A registered nurse with over 20 years clinical experience, her role involves collaboration with clinical services to use digital technology for the benefit of patients and staff.

Read the first in the series: What makes an effective digital team?

Explore nursing, midwifery and AHP roles in digital leadership at Digital Health’s Summer Schools 2024, 18-19 July. Find out more and register here.