All aboard.

As a chief clinical information officer, it can sometimes feel as if your board is just another group of people demanding things of you. But the reality is that board members can also be your biggest allies, and help you to deliver your vision. Quite simply, you and your projects will not succeed without them.

So how do you go about building this support? This chapter gives an insight into what board members are collectively and individually looking for from you as a CCIO – and how to provide it.

What do boards want from a CCIO?

What a board wants from its CCIO will inevitably depend on the current status of electronic health records within the organisation.

If you are drafting a business case, clearly your approach - and the board’s expectations - will be different from when you are implementing a large scale change project, realising the benefits of that change, or when you are in a steady state phase.

There is one need that remains constant, however: the board will always demand a clear and consistent vision. You will need the ability to articulate the rationale and purpose of a project to different audiences, and must be seen to listen and respond to issues and concerns.

This does not necessarily mean giving in to the views and objections of others, but requires you to explain why things do have to change.

What keeps boards happy?

Electronic records are becoming ever-more central to the running of all organisation. They are expensive; and even the smoothest of implementations has a high propensity to cause problems.

Clearly the overarching responsibility of any board is to provide safe, high quality and efficient patient care. It is therefore entirely reasonable of your board to seek assurances about the projects on which you are working. It can also be useful if it identifies the resources you need to ensure a smooth implementation.

Boards do not want bland reassurances and they loathe unexpected shocks. It is imperative that you set realistic expectations and are clear about what you will be delivering. Whatever you do, you must not over-promise.

If you are wondering whether or not to tell your board about a potential issue, my advice would be to do so. Sometimes it might feel as though you have to “feed the beast” but in the long run it will help you deliver your project. It is much better that members find out directly from you if there are any problems.

If you and your team cannot provide them with assurance, they will inevitably start asking for reassurance. This is essentially a whole lot more work for everybody and can be the first sign that the board is getting nervous.

This reassurance may even include seeking external people to come in to assess your project. This is not necessarily a bad thing, nor should you interpret this as a sign of lack of confidence in you and your project.

What do individual directors want?

As well as having collective needs, your board members will have individual demands.

Chief executive

If a project doesn’t work, the chief executive is ultimately responsible, and is accountable to the board. So he or she needs assurance and regular updates about your work.

Medical director

Your medical director is a key ally and you need him/her to share your vision. Doctors are critical to the effective implementation of any informatics project. Their ability to derail any project is immense and they will not be shy in letting you know if you get it wrong.

Some doctors will embrace the opportunities on offer but some will either actively and/or passively act as barriers to change.

It is a clichéd truism that these are not IT projects but rather massive clinical change programmes, based around IT systems. You must work as one with your medical director.

He or she will probably know where potential support and opposition will come from and jointly you will need a strategy to sell your shared vision to these individuals and departments.

Your medical director will need to be reassured that there will be no clinical safety issues at any point in the implementation of your project. Part of this process will be to ensure that there is a process to ensure that the Health and Social Care Information Centre’s clinical risk management standards are met.

Nurse director

It is critical to keep doctors engaged in the project; but it is equally essential to seek the input of all other clinician staff groups, including nursing staff and allied health professionals.

Your nurse director will be particularly interested in how nurses interact at the bedside with IT devices whilst providing personalised care to the patient. It is vital that these interactions are efficient and that technology does not get between the nurse and the patient.

Chief operating officer

Your chief operating officer has day-to-day responsibility for the smooth running of your organisation and for the delivery of performance/activity measures and targets. So he or she will be interested in your project from this perspective.

Finance director

Finance directors have a tough job in the current NHS climate. Balancing the books is nigh on impossible. They will want you to stick to your project budget. Ideally they would like you to be successful in securing external funding from, for example, the various NHS tech funds.

Any business case you made to justify your project will have had a number of proposed cash-releasing benefits, and your finance director will expect to measure how successful you have been in delivering these.

In addition, the finance director will take a forensic interest in the way your IT systems and changes in working might affect the way activity is counted, coded and billed. Failures in any of these could have a dramatic effect upon your organisation’s income or result in penalties from commissioners with serious consequences.

Chair and other non-executive directors

Your non-executive directors need well-drafted reports that tell them what they need to know. They also need to be comfortable that there will be a timely escalation to them if there is any issue that cannot be addressed within your project.

Other key players

The following are just some of the other key parties you will need to deal with:

Human resources director:

If your plans involve hiring new people or losing staff, your HR director is the person who can help you, but you really do need to get them involved at the earliest stage. If there are new people needed in your project then you must play an active part in the whole recruitment process.

Director of information technology

As CCIO, you are a clinician leading on the clinical aspects of informatics. You are not an IT person. You need to work as closely together with a shared vision as to what you are both seeking to achieve. There is another chapter of this book dealing specifically with this issue.

Director of communications:

If you are implementing a major project you will need your communications team to help you spread your message internally, and to communicate with other, key external players such as GPs, local media and patient groups. You need to be aware of and allay patients’ fears about the risks of data being lost, stolen or inappropriately shared.

Director of transformation:

It is inevitable that there will be considerable overlap between what you are seeking to achieve and the aims of your trust’s transformation team. So it is essential that you coordinate efforts and avoid potential conflicts, duplication and double-counting of any anticipated savings.

Conclusion

Building the support of your board isn’t always easy. But if you can convince the people sitting on it of your vision and of the need to change, they will give you the air-cover and delegated authority to lead and embark upon one of the biggest, most exciting and scary clinical change projects that your organisation will ever take on. Good luck.

About the author: Dermot O’Riordan, chief clinical information officer at West Suffolk NHS Foundation Trust. He is a past interim chief executive and medical director for the organisation.