Royal Free London NHS Foundation Trust

Glenn Winteringham

Glenn Winteringham is the Chief Digital Officer for the Royal Free London NHS Foundation Trust (RFL) and he has 35 years’ experience working in NHS Information Management and Technology (IM&T). Glenn started his career working as an information analyst at various London hospitals before becoming the Director of IM&T at Whittington Health in 1999. Glenn joined RFL in 2017 to lead the delivery of the Trust’s Global Digital Exemplar (GDE) programme, which culminated in Chase Farm Hospital achieving HIMSS EMRAM stage 7*, which makes it one of the most digitally advanced hospitals in the world.   

* = Healthcare Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Mode (EMRAM)

Below is the conversation that we had with Glenn Winteringham.

As the Chief Digital Officer, what are some of your key roles and responsibilities that you have on a daily basis?

I am responsible for all Digital Services across the Royal Free London NHS FoundationTrust (RFL), which comprises of three main hospitals with 70 satellite sites and we support 11,000 staff. The post covers a wide range of responsibilities from strategic supporting the delivery of national, regional, and local digital transformation programmes through to the daily operational management of Patient Systems, IT and End User infrastructure, Cyber Security and Telecommunications. A key part of the role is to provide professional leadership to the Group Executive team and to lead on the development of business cases and approval of investment plans in Digital Services. Another key part of the role is to be a conduit between understanding the clinical and operational user requirements and ensuring Digital Services deliver fit for purpose solutions to meet those demands. It is a very challenging but enormously rewarding role because we can really make a difference to improving the care and experience of our staff and patients.

What are some of the biggest challenges facing organizations when it comes to digital transformation, and how do you work to address them?

There are many challenges facing healthcare organisations regarding digital transformation. We have been on amazing digital transformation journey over the last 5 years at RFL since we were selected to be an NHS Global Digital Exemplar (GDE). I think there are seven key lessons we’ve learnt:

Executive sponsorship and alignment to the Trust Strategy and priorities

When we embarked on our Electronic Patient Record (EPR) digital transformation journey we held an executive team alignment session with our EPR supplier to define our digital vision and goals. This established it as a change programmeled by the Group Chief Executive Officer (CEO) as the Senior Responsible Officer (SRO) and it became the responsibility of the entire executive team.  

Clinical Informatics Leadership

As part of our GDE we established a Clinical Informatics team to provide the leadership with frontline clinicians and over the years we have enhanced this where we now have a CCIO, 3 x Consultant CMIOs, 3 x Junior Doctor CMIOs, CNIO, 5 x NIOs, 4 x EPMA, 2x AHP, 10 x Change Managers, 3 x Hospital Digital Leads. We are appointing Divisional Digital leads to try and embed digital leadership at a ward and outpatient clinic level.

Talent

Delivering digital transformation at scale in healthcare is incredibly hard. It’s essential to identify, recruit and nurture talent so they get the opportunity to use their skills and experience to deliver success. I have been extremely fortunate to stand on the shoulders of giants and work with some exceptional executive, medical, nursing, operational, digital and partner colleagues. 

Culture

We have worked hard to develop a culture to support digital transformation, which has matured over the years to the point our mantra is now encapsulated in our strapline of “clinically led, operationally delivered, digitally enabled”. We are on a continuous improvement journey around our EPR adoption and optimisation which does require a relentless focus and energy on changing ways of working and delivering benefits.

Governance

We have completed two major re-designs to our digital governance in the last 5 years. Firstly, we replaced the legacy IT led technology groups and established hospital based digital transformation boards chaired by their respective CEOS, who were responsible for implementing the EPR. They then reported into a Group wide Digital Board, chaired by the Group CEO, which meant we had very senior sponsorship and able to make decisions quickly. Following the go-live of the EPR and the publishing of our Digital Strategy last year, we completely changed our digital governance structure to align to and deliver the five core themes of EPR, Digital Hospital, Culture, Innovation and Data.

Resources

We know from various national reports like Wanless (2002), Wachter (2016) and the National Audit Office (NAO 2020) that to deliver sustained digital transformation you need to prioritise on-going capital and revenue investments in :IT Infrastructure ; Cyber Security ; Frontline Digitisation / EPR ; Clinical Informatics ; Testing ; Development ;  Training ; Business as Usual (BAU) Support, Programme Management, Change Management, Benefits Realisation etc. As a GDE, we received £10m government funding, which we match funded locally, and have subsequently continued to make very significant capital investments to advance our digital maturity. In 2022, this culminated in Chase Farm Hospital achieving HIMSS EMRAM stage 7 status, one of only four hospitals in the NHS and seven in Europe with this level of digital maturity.

Partnerships

No matter how good or comprehensive your EPR solution is, there will always be a complex ecosystem of different solutions and suppliers in an acute hospital setting which we need to interoperate and work seamlessly for our clinicians. We have a number of strategic suppliers, who we value as long term partners and endeavour to foster a very positive relationship so we are aligned going forward. 

What steps is your organization taking to enhance the overall customer experience through digital technology and innovation, and what are some examples of recent initiatives or projects in this area?

We are constantly striving to improve the patient care, outcomes, and experience. some recent examples include:

We now have over 300,000 patients registered on our Patient Engagement Portal (PEP) which allows them to view their medical record including appointments, clinical letters, test results, as well as re-book appointments and complete on-line forms e.g. pre-operative assessments which reduces the need to come to hospital to complete.

Provide access to virtual consultations through Attend Anywhere to reduce the need to come to hospital.

Establish virtual wards to monitor patients remotely and prevent unnecessary visits to the hospital.

Provide access to free wi-fi and on-line resources for patients and carers whilst in hospital.

What advice would you give to someone who is interested in pursuing a career in digital leadership, and what skills or experience do you think are most important for success in this field?

I would strongly encourage them as it is an incredibly rewarding role where you can have a significant impact on the care of patients and the work experience of colleagues. It is a role that is very complex, challenging and constantly changing, especially with the ever-increasing pace of innovation and demands for digital solutions.

I think you need to be passionate about the NHS and healthcare and want to make a difference for patients. You need to be able to operate at Executive and Board level as the professional lead for Digital as well as have sufficient knowledge and experience to manage the operational delivery of digital services that meet the organisationalneeds. I think you also need a lot of personal skills and qualities such as leadership, resilience, talent management, empathy and compassion, transparency, pragmatism and relentless positivity and energy to keep delivering improvements. 

How do you measure the success of digital initiatives, and what metrics do you use to track progress and ensure ROI?

It very much depends on the digital initiative, but thekey performance indicators (KPIs)and ROI are normally identified in the business case. Some recent examples include:

To achieve HIMSS EMRAM stage 7 we had to evidence attainment of criteria such as full closed loop electronic prescribing and medicines administration (EPMA) and 95percentscanning of patient ID wristbands and prescribed medicationswhich reduces adverse drug events.

Reduced length of stay and cost of diagnostic tests through the adoption of standardised care pathways, which are coded into our EPR, to reduce unwarranted clinical variation and improve patient care and outcomes.

When we opened the new Chase Farm Hospital, we saved over £1m recurrent per annum as we no longer operated a medical records library or any Outpatient Clinic receptions. Similarly, when we went live with shared instance of our EPR with a neighbouring Trust we saved £800K per annum due to the shared hosting and support costs.

We have reduced our carbon footprint through refreshing our data centre and end user device infrastructure, which are 40percent more energy efficient, and we have reduced hospital visits through virtual consultations and virtual wards.