Ewan Davis: on new leaders and hard and soft power

Since my last column I attended two interesting events. The first was the “2nd International Symposium on Healthcare Improvement and Innovation” at the Monash University Prato Centre, Italy.

The second, just a bit closer to home, was the joint CCIO/Health CIO Summer School in Leeds organised by digitalhealth.net. Both have caused me to have further reflections on the nature of the leadership required to lead a digital enabled transformation in health and social care.

A new top team

We have had three new arrivals in the top tech team at NHS England; one we have known about for some months and two more whose appointments were announced just before the Summer School.

In general, I’m pleased, because for the first time in my memory all three appointments are of people with substantial relevant experience. This makes a change from the more usual approach of appointing a White Knight recommended by the Tooth Fairy.

All three – Matthew Swindells, NHS England’s director of operations, commissioning and information, Will Smart, its new chief information officer, and Professor Keith McNeil, its chief clinical information officer – made brief appearances at the Summer School.

So did Professor John Newton, still interim chair of the National Information Board, and our old friend Beverley Bryant, now director of digital transformation at the newly branded NHS Digital that we all knew and loved as HSCIC.

This I think is a good sign; all of these people were taking the Health CIO and CCIO networks seriously.

The event had to make do with a video from former health minister George Freeman (who for some inexplicable reason had cancelled his personal appearance in favour of remaining in walking distance of Number 10).

But shortly afterwards, it was confirmed that health secretary Jeremy Hunt was to remain as health secretary.

Love him or hate him (and from the cheer that went up on the earlier, premature news of his departure I think it’s mainly the later) the reappointment of Hunt provides continuity from someone who, I think, has some understanding of the critical part digital technology has to play in the future of the NHS.

Hard and soft power

The meeting at Prato attracted a mainly academic audience from all over the world. Among many other topics, there was much discussion about the nature of the leadership needed for improvement and innovation, which reinforced some my thinking.

Dr Helen Bevan, the chief transformation officer at the NHS Institute for Innovation and Improvement spoke about the shift from hard power to soft power.

Hard power is held by few and characterised by being closed with top-down, hierarchical command and control. Soft power, on the other hand, is held by many, is open and sharing, and pulls in ideas from all directions, with the ability to influence based on networks and relationships rather than positional power.

In an increasingly digital world we are moving in to the age of soft power and we need a new generation of leaders who now how to operate effectively in this new environment.

This style of leadership is different and my hope and prayer is that the new NHS tech team can deliver it. For some of them, at least, it will be quite a challenge; but not, I think, one beyond them.

Cultivating collaboration and ‘honourable failure’

I have said previously in this column that our community as a whole knows how to solve 95% of the problems we face. Sometimes, the answer is quite obvious; we just have to adopt proven solutions more widely.

Sometimes, we know the answer in a much more subtle way. Individually we don’t know we know the answer, but collectively we do; to move forward, we have to harness this distributed cognition – something that digital tools and social media makes much more practical than in the past. 

The job of our leaders in to create an environment and culture that values and supports collaboration, co-operation and sharing and accepts that we should celebrate and learn from “honourable failure”. To achieve the necessary transformation, the system needs to take risks and taking risks mean some failures.

The trick is to fail-fast, fail-safe and fail-cheap; and learn from the process. Swindells, in particular, has his hands on the levers of operations and commissioning that can catalyse this cultural change. Let’s hope he pulls them hard.

Stop reinventing the wheel

Our leaders also have to stop people reinventing the wheel. Sometimes, this happens because people don’t know the wheel exists, but sometimes it’s because it’s easier to solve a problem that’s already been solved.

I see this too often in NHS IT, for example when the GP Connect project reinvents – badly – work already done by GP2GP on medication.

We really can’t afford unnecessary rework that is either a result of ignorance of previous work or – worse – an unwillingness to use anything “not invented here” where the definition of “here” seems to be very narrowly parochial indeed.

As Einstein said “Insanity: doing the same thing over and over again and expecting different results.”

Previous leaders of NHS IT, digital health, or call it what you will, have not succeeded. If we want a different outcome this time we have to do leadership differently. The new team look promising, but the jury's only just started sitting.

About the author: Ewan Davis is a digital health strategist at Woodcote Consulting, with 35 years experience in digital health. He was once chair of the Primary Health Care Group of the BCS, has twice been chair of the trade association that is now techUK, and is a founder of HANDI – a not for profit venture that aims to promote openness and collaboration and which developed the Code4Health Platform for NHS England.

Ewan is also director of two open source ventures, OpenHealthHub CIC and Synapta CIC, and an erstwhile consultant to the rich and famous and NHS England. He wants to see an open digital ecosystem for health and social care before he dies; and believes that if we create one he might live longer. Follow him @WoodcoteEwan