Archive April 2019

NHS Digital Academy – The journey has just begun

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The first ever NHS Digital Academy Cohort has just finished – but this marks only the start for participants who have new skills and networks to enable the digital transformation needed in our NHS.
It also marks the start for those who got prized places on Cohort 2.

So, what did we learn on Cohort 1 and will it make a difference?
If you talk to anyone from Cohort 1 and you’ll see them come alive as they talk about the their experiences, learning, friendships and how it’s opened new opportunities and broadened their thinking.

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Module 1 : Essentials of Health Systems

Module one dropped everyone straight into learning mode and taught us so much about the complexity of healthcare. In most businesses you create a model and repeat it to generate consistent results but in the NHS there are no single interventions that can be guaranteed to have exactly the same outcomes for everyone. In complicated circumstances you can break the problem into smaller chunks. With the complex issues encountered in the NHS this is challenging because of the dependancies and uncertainties. But if you and me are able to reduce complexity in what we do we’ll improve success rates and reduce the risk of error.

I learnt about the impact of population health on the UK’s GDP and how the two are inextricably linked. We reviewed the Global Burden of Disease and the determinants of health. We looked at the purpose and process of regulation. It was interesting to gain deeper insights into the history of the NHS and investigate the apparent disparity in spending on health preventative initiatives – just 5% of NHS funding is spend on prevention. It was clear in my mind this needs to change – but it’s an impossible task to decide what you stop funding in order to invest into helping people avoid illness.

Teens in Crisis + logo

I’ve been asked to become a trustee at Teens in Crisis Plus and love their work because of the innovative way they help children (9-21) cope with life’s struggles. I believe this will result in stronger healthier happier adults and is something I wholeheartedly believe will change the future.

Gaining insights into the impact of asymmetries of information was fascinating and will help me think about how I work with others to build trust and relationships built for mutual success.

We took a look at how much the NHS spends on technology and whether it always provides the intended value – post project reviews are essential to understand benefits and develop learning – it’s something we can all help to improve. Looking at the NASSS framework was very interesting – a piece of work by Professor Trisha Greenhalgh which I compiled into a poster for my office wall.

The module looked at governance in relation to cyber security via a case study – I enjoyed this although I know some of my colleagues found it very technical. I’ve worked hard in my day job to achieve Cyber Essentials Plus and continue to champion the cyber cause recently joining an NHS Digital pilot of some new tools to provide improved external security assurance for NHS networks.

We finished module one with a look at system redesign and process mapping tools and techniques. I now have a big list of different tools which I can pick up to help me present and review systems and projects.

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Module 2 : Implementing Transformational Change

Module 2 continued the significant learning with advice from not just NHS experts but also external third parties who brought insights and experience in how to bring about transformation in our organisations with new approaches.

We learnt about organisation buying behaviour and why suppliers can have a hard time partnering and working with the NHS. We all have a responsibility to support relationships with parters because they bring experience and capabilities the NHS desperately needs.

We looked at project delivery methodologies and benefits of each. We also learnt more about risk management and innovative financing arrangements. I’m keen that future development programmes I run will be agile and iterative giving more flexibility than the traditional PRINCE2 waterfall we are all indoctrinated into. We need a hybrid that brings the best of both together.

One of my favourite items of learning was using lean canvas to present a project on a page and I can recommend giving it a try at

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Module 3 : Technology Strategy and Health Information Systems Implementation

Module 3 introduced Health Information Infrastructures which can be very complex and are created from systems of systems. Managing these and the data flows between them requires clear strategies and depends on long term relationships with stakeholders and vendors.

In the module introduction Kathryn Cresswell summed up the challenges brilliantly:

“Studies show that, when healthcare staff are pressed for time, they often do not consult technological systems (e.g. records or decision support) and they may also delay data entry till they have time to do this. Delayed record keeping may impair quality of care with potentially safety critical consequences. In these situations, systems do not function as intended by designers and implementers.  Systems design needs to be mindful of the social and organisational pressures on users.” 

We learnt about data driven research and the ethics of using information for research purposes. It was also useful to reflect on the significant trust the NHS has from the general population and this comes with responsibility on us to protect and use data with wisdom within the legal frameworks that exist.

We looked at integrating and improving care by sharing data across organisational boundaries. This is now working in some areas via shared care records but will become national via the LHCRE programme. This will require increased use of open standards and interoperability such as SMART on FHIR and standardised use of SNOWMED CT.

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I enjoyed learning more about workarounds – what I thought was simple subject proved to be very interesting. It would seem not all workarounds are as bad as I might have assumed and there is a lot we can learn from studying workarounds. This paper on Theory of workarounds was a great read.

We concluded Module 3 by studying some disruptive technologies which seek to improve and radically change health and care – this is future we’re all called to create in our organisations.

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Module 4 : User-Centred Design and Citizen-Driven Informatics

Module 4 introduced us to techniques which can enable improved user engagement. We investigated what user centred design really meant and looked at some of the national standards that have been published recently.

“A user interface is like a joke. If you have to explain it, its not that good”.

@kimunertlphd (Twitter 04/04/19)

At Residential 3 we were treated to a visit to the Empathy Museum to experience ‘In Their Shoes’. Skeptical to begin with I put on someones actual shoes and a headset and listened to the story of the experiences of an ambulance driver who had move to the UK from Australia to work for the NHS. Hearing his empathy (and at times distress) for the people who he encountered each day was difficult to take on board. I would treat him with massive respect if I ever met him having understood what he has to experience everyday.

Perhaps we could all assume the best intentions in others and treat them with respect and value – then the world would be a better place. We shouldn’t need telling about the stresses in others lives – we can be sure they have had struggles like we have – being a helping hand rather than adding to their problems should be everyones aspiration.

The role of the citizens in health service transformation is essential as expectations increase. Evidence shows health ownership (and outcomes) improve when patients are more involved in their care, so it is essential to co design and prototype with our service users more than ever to improve inclusion, engagement and self-care.

The best learning for me was that if I really want to learn about a situation rather than getting someone to come and explain to me I need to get myself into the user environment. 90% of what you learn is indirect from just being there in the users situation. When I make someone visit me to discuss a project they learn more about me from my office and surroundings than I actually learn about them.

So from now on – I go to where you are to learn about you because that’s what I’m interested in and its the only way to ensure systems are designed using your perspective, experience and needs.

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Module 5 : Decision Support Knowledge Management and Actionable Data Analytics

Module 5 taught us about clinical decision support systems and analytics. We learnt about the learning health system which takes data, uses the data to generate knowledge and then applies that knowledge by taking actions to change processes or systems to make improvements. These improvements feed new data to keep the cycle going – generating a learning health system.

The Learning Cycle

We looked at some quite complex statistical modelling and mapping which definitely made my head hurt! I even decided to have a go at learning the statistical research software R – in the end I reverted to Excel and SQL for my assignment!

We learnt about the need to use appropriate sample sizes, frequency and segmentation to provide robust basis for analysis and generating an evidence base. We also learnt about ontologies, benchmarking, data collection techniques, complexity and governance.

I found the learning about type 1 and type 2 thinking interesting, with the former being reactive and intuitive and the latter being slower and more analytical. We thought about benefits of both and where they are best suited. We also thought about artificial intelligence and how systems that can provide additional data in terms of diagnosis suggestions are likely to become common place in the future – we just need to find ways to integrate them at the point of care seamlessly.

Developments in the areas of AI and machine learning are exponential and will need critical appraisal and analysis and we reviewed academic papers that had investigating approaches to this. We also looked at some new and emerging systems.

Module 5 was the most challenging but I was able to use data gathered for my work place project and gain new insights and understanding using techniques I’d learnt.

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Module 6 : Leadership and Transformational Change

If you think Digital Academy was mostly about technology I’d have to let you down lightly and explain it was mostly about people.

People are who will enable change and transformation to be successful (or not) and how we engage and work with one-another will be essential to making our NHS sustainable in the future.

For Module 6 we carried out a number of practical exercises at residentials helping us develop negotiating and pitching skills. The rest of the module was to develop a work place project through which we could use our learning and assess how we’d grown in our leadership skills.

The main learning points for me were:

  • I can’t lead without engaging and listening to properly understand
  • I must spend more time with clinical services
  • I should actually show empathy – just thinking it won’t show it
  • I’ll continue to inspire and release innovation at all levels
  • I need to keep finding new ways to influence
  • Keep discovering language that makes sense to the listener
  • Simplify strategy so everyone gets it – keep evolving it
  • Relstionships are critical – keep buiding them
  • Diarise more reflection time to feed the learning health system in me
  • Keep reading – knowledge is growing rapidly I need to keep up with some of it!
  • Automate and democratise – don’t be scared of giving more ‘power’ to a wider audience. Empowerment = engagement = productivity

This week I was accredited by Federation of Informatics Professionals (FedIP) which is a small but growing group of people who are recognised as being professionally qualified in informatics. I’m proud to have achieved this and recognise the NHS Digital Academy played a huge part in developing me to achieve this.

I feel very privileged to have been part of Cohort 1 and now move on the the MSc final year from May 2019 onwards.

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The DA has an active Alumni which will grow as more cohorts complete this world class learning experience helping to share learning and build relationships. Best wishes to Cohort 2 as they start on the NHSDA journey next week.

Thank you NHS England for having the courage to commission such an innovative ground breaking course.

I committed at the start of the Digital Academy to share my learning. This blog is a part of that commitment. I hope you’ve found it interesting to read.


Rob Blagden works for 2gether NHS Foundation Trust in Gloucestershire as Deputy Director of IT, he is also the Trust’s Lead Governor. Rob was recently elected to sit on the first Alumni Committee for the Digital Academy.