SCW's Aasha Cowey shares her journey of turning frustration and confusion into culture change and optimism for health informatics career pathways.
Today marks quite a special day for me. It is a day filled with excitement and a sense of achievement. It is also a day filled with quite a lot of anxiety and dread!
The Health Informatics career pathways project reports are going public, and I quite literally feel like I have put my heart and soul into this work. I’m not going to talk about the content of the reports in detail itself as I would like you to read them. Instead here are mainly some reflections on the drivers behind this work and what next.
Many of you likely know my story but in a nutshell, I probably grapple with three key challenges in my own working life. In recent months that has been how to manage flexible working as a new (ish… she’s nearly 3 now!) parent, how to manage anxiety and realise I can still do a good job, and finally how to manage expectations about my career.
I have previously spoken about a mismatched expectation. I joined ‘health informatics’ because I was interested in transforming how ambulance services could utilise data and technology to keep patients at home when appropriate rather than an automatic convey to hospital ‘just in case’, but, and this has happened to me twice now, because of that umbrella and skillset, I’ve ended up in roles which are very much feeding the beast and managing datasets for the sake of managing data.
Part of me does reflect that over time I probably could have turned those roles into something more ‘me’ – but spending months in a back-office fighting with Microsoft Access pretty much finished me off. Twice! Please feel free take a look at a guest blog I did for the Association of Professional Healthcare Analysts APHA around this.
Ever since those early graduate scheme experiences I have been fascinated with the ontology (or lack of it!) around careers in health informatics. I chucked myself into networking (not my comfort zone) and over time, met this small group of individuals who were doing so much to try and get this right.
Wendy Dearing and Julie Andrews at British Computer Society (BCS) hosted a session for my graduate scheme cohort in 2014 and we were joined by individuals, including Anne Cooper and Emma Doyle, who were able to present a different perspective. As my network grew, I could see the fight that people like Andy Kinnear and James Freed, in their respective roles, were having about the need to professionalise and get this right for the informatics workforce.
Launching the project
During my temporary career break in 2018, I started to develop a business case to do a piece of research in this area working with James. James linked me up with Di Bullman (who leads the professionalism workstream on the Building a Digital Ready Workforce (BDRW) Programme for Health Education England, NHS England and NHS Digital), and around the same time, I started to work at NHS South, Central and West (SCW). The project was born.
The project started as the pathway from ‘graduate to Chief Information Officer (CIO) but expanded as we rapidly realised it was hard to even quantify that. I developed a survey working with the University College London (UCL) Institute of Health Informatics which explored four areas: contextual information, an attempt to map career pathways at scale, reflections on the past, and looking to the future in order to understand key themes around retention, recruitment and progression.
This was meant to be a small piece of work, and we hoped perhaps 50-100 responses would be a useful start to understand this area better. We had 507 individual responses which include information on 855 job titles and over 300 different definitions of what Health Informatics is. It exploded, partly thanks to some very high profile tweeters, and led to an awful lot more work than initially expected.
I don’t however regret it one bit.
For those who are familiar with the area, I suspect there will not be loads of surprises. However what this now does is provide an evidence base; both to support the national BDRW programme in designing some of its next steps, but also key messages we can start to take out to different groups such as CEOs, Chairs, Directors of Workforce. We can preach to the 'unconverted' on career development, with evidence. We can make a case for change in that we must break down silos between different professional groups.
We must get better at treating our staff. We believe this was the first attempt to capture both longitudinal views, but also collecting views at scale, rather than one individual's anecdotal story, to pool into a strong evidence base.
What happens next?
We will be releasing a number of documents today. There will be a short 3-page executive summary which I’d please encourage all individuals to share and read as a taster. There is then the main report which explores five themes in turn and draws from the evidence base. These five themes are:
- Articulating health informatics career pathways across the NHS
- Nationally supported recruitment and retention
- Defining the professional body offer and understanding health informatics network opportunities
- Regional / System approaches to developing an informatics workforce
- What can senior leaders do now?
The themes are not mutually exclusive but enabled us to present the findings in a way that lends itself to ownership and action at both national and local levels. There is also a third report which presents the results, anonymised of course, at a much more granular level.
While we couldn’t fit everything in, and it became obvious we had a wealth of information, this felt like the right thing to do. So even if the findings from my report do not directly pull out everything from the survey, that evidence base is there and should be used by the wider community as they need. We will also share a PDF of the wonderful career pathways heatmap (which when I present it, is usually met with a mixture of horror, amusement and agreement).
I hope you find it interesting and helpful. It is a short discovery piece and there is so much more we could do. I thought I would end this blog with two main reflections.
Over the last 12 months or so, I’ve gone from having quit the NHS altogether (for many reasons, being in the wrong job was just one), to getting a seat at the table in some really important groups. This includes the CIO advisory panel (which is nationally elected), the South East Regional Talent Board and I am a co-founder of @FlexNHS.
I am often involved in conversations with individuals much more senior and experienced than myself but I think this is really positive. I’m not trying to blow my own trumpet.
Hopefully the message I’m getting across here is I feel proud I have the opportunity to shape some of this stuff and represent people at a different stage of their career and potentially life, from someone who is really in the thick of it. I am living and breathing the things I am being vocal about requiring change. This feels really positive.
I probably won’t be able to retire for another 40 years, so it’s in my interest to get this right. In the summer, just before my presentation at Digital Health Summer Schools, I threw up in a toilet. I was so nervous. Last week I felt like someone who was fighting for what they believe in.
I will continue to try and do the right thing because it can lead to change. I also feel like there is quite a lot of power in the groups above as an interface between both informatics/digital and workforce – and the opportunity to bridge some gaps. So much of this is about story-telling and building up shared community messages. There is a lot of power in realising that you are not alone in the struggles or frustrations you face. Thank you to everyone who participated and shared their stories to make this piece of work a reality.
I couldn’t end this blog without reflecting on my own career pathway. Ironically, this work has led me to a point for the first time in my life probably where I have two potential routes to explore that I am really interested in.
I’ve spent the last 15 months doing programme management in digital transformation in primary care, and of course through this piece of work and all the @FlexNHS work I am gaining a real interest in the workforce space. I attended a brilliant workshop last week led by Nicola Calder who is the workstream lead for Supply & Capacity; as many of the recommendations I have made map to that workstream.
I really look forward to seeing what happens here, and it was like a lovely reunion seeing so many individuals who I know have shaped this area over the years – often relying on passion and goodwill.
So perhaps I’m not sure what’s next for me – but I think that’s the beauty of one of the things I hope will change though and perhaps I will continue to do both – or even find a way to combine the two areas.
It’s not about having a linear career path, no one will follow something that’s A to B. But without that exposure to different things and understanding what you could do, it becomes very difficult to not bounce and stumble around the system aimlessly.