NHS England - Transformation Directorate

Guidance for Nursing on ‘What Good Looks Like’

Published 15 March 2022


Foreword

Sonia Patel, System CIO, NHS England

What Good Looks Like (WGLL) is powered by cohesive, interdisciplinary teams. It presents a unique opportunity for the nursing profession in driving digital transformation.

This guidance for board level nurse leaders accountable for digital transformation will work alongside and support the WGLL framework, through practically applying its success measures to nursing practice. By applying WGLL to nursing, we can showcase the importance of system-wide collaboration and community, with people and teams working together to achieve the overall WGLL aims.

Ruth May, Chief Nursing Officer for England
Natasha Phillips, Chief Nursing Information Officer, NHS England

As nurses, we are deeply connected to delivering high quality care for all people. Through shifts large and small in health systems, nurses are the constant and direct connection with people. It is hard to ignore the rapidly evolving landscape around us – from the opportunities to improve care in better connected systems and data sharing to our population becoming more digitally fluent. What Good Looks Like (WGLL) sets out an ambitious, common vision across seven success measures for digital transformation. We see a unique place for nurses and nursing practice to support the realisation of this vision. This Guidance for Nursing on WGLL aims to support strong nursing leadership and the practical application of WGLL to the nursing profession, enabling us to have a key role in delivering transformation.

We ask questions such as how can we support people to become more active participants in their care? How do we represent the unique needs of the nursing profession in the requirements for new digital solutions? How can population health data inform nursing practice? Equally, how can nurses contribute to smarter data collection to help us learn more about population health inequalities and create more equitable services?

The nursing profession has an active role to play in the digital culture shift that can improve care outcomes right across the NHS. Nursing is well placed to lead and work collaboratively across the health and social care system. This guidance will provide assistance in implementing the key principles of WGLL.

Through our collective effort in delivering WGLL, we will create a future-proofed digitally enabled nursing workforce and ultimately, better, more resilient and more sustainable care for our patients.

What is What Good Looks Like?

The What Good Looks Like (WGLL) framework was first published in 2021 and is aimed at all NHS leaders. It outlines how integrated care systems (ICSs) and organisations can work to best support care through digital transformation. Digital transformation or digitally enabled care can take many forms. Most simply, it is where digital solutions are used to support and improve care. For nursing, this could range from having citizen data available at your fingertips, from the moment they enter your care to a rising early warning score automatically notifying a specialist team for support.

The seven success measures of What Good Looks Like

WGLL outlines seven success measures that set an established measure of best practice for the ICS and organisations to accelerate their digital transformation. To support WGLL and the nursing profession, we are providing this guidance for nursing on WGLL. While developing this guidance, we sought the views of a broad range of stakeholders who represent the breadth of the nursing profession. This involved exploratory discussions about the future of nursing practice, as well as specific input on the success measures.

Who is this guidance for?

Guidance for nursing on WGLL is directed at board level nurse leaders who have accountability for digital transformation in either their ICS or organisation. Throughout this guidance we refer to this role as ‘nurse leaders’, however in your work, you may have a different title, such as (but not limited to) Chief Nurse or Director of Nursing. The accountability and influence at this level, where you may also sit on the integrated care board (ICB), creates the opportunity to drive digitally enabled nursing. These roles are often supported by Chief Nursing Information Officers (CNIO) and/or Chief Clinical Information Officers (CCIO), with the CNIO role referred to in this guidance as ‘digital nurse leader’1.

We recognise there is no one-size-fits-all leadership structure across the many organisations that make up each ICS. The ‘nurse leader’ role may be called, or look like many different things, depending on where you work, such as in community or primary care.

This is also useful for those who are part of the team supporting the nurse leader or nurses who are interested in and want to get more involved in digital transformation. This provides them with a shared understanding of WGLL and how it applies to nursing.

This guidance has been primarily developed by nurses, with a view that it could be adapted for use by midwives, AHPs and other clinical professional groups.

A unified vision for digitally enabled nursing

WGLL builds on the numerous recent publications which identify the ongoing digital transformation across health and social care. The NHS Long Term Plan, the Topol Review and the independent report Putting data, digital and tech at the heart of transforming the NHS all call out the fast pace of technological innovation and the need to support digital leadership to drive system-wide change.

Various nursing practice areas have identified the advances digital and data solutions can bring to the care they provide, particularly during the COVID-19 pandemic. This has been outlined for primary care in the King’s Fund report Understanding factors that enabled digital service change in general practice during the COVID-19 pandemic. The National Community Nursing Plan Engagement Document2 includes the increased use of digital and data as a key action area, along with an emphasis on joined up care and capacity building across the integrated care system (ICS). Mental health services also recognised the ability of digitally enabled care to provide continued services during the pandemic and the COVID-19 mental health and wellbeing recovery action plan discusses this and other aspects to consider such as information provision and the digital divide.

Digital transformation is embedded in other areas of nursing care, such as clinical safety and research. The Digital Clinical Safety Strategy is part of the wider Patient Safety Strategy which outlines the need to embed digital safety across the health and social care transformation journey. As shown by the COVID-19 pandemic, care is constantly / continually improving through nurse-led research, of which digital transformation is a key enabler.

The nursing workforce is pivotal to achieve the vision of WGLL. The use of data and digital solutions will transform nursing into a digitally enabled profession which enhances the hands-on caring role and relationship with every citizen. To achieve this, within nursing across NHS provider organisations in ICSs, requires a levelling up of digital maturity and cultural change. It will also need strong leadership and an understanding of what is required, as set out by WGLL.

This future vision for nursing, enabled by WGLL, is a vision where:

  1. Nurses are empowered to practice and lead in a digitally enabled health and social care system, now and in the future.
  2. Nursing practice is fully supported by the use of digital technology and data science.

This guidance for nursing on WGLL provides support for accountable nurse leaders, across ICSs and organisations, to achieve this ambition and enable WGLL.

How will we support you?

We've created a range of supporting material to help you achieve the WGLL success measures which includes the sharing of best practice, signposting to key resources and connecting peers across systems and regions. This support has been designed to help you to accelerate your local nursing digital and data transformation under the WGLL umbrella.

We will provide a knowledge base with real-life examples of best practice in digitally enabled nursing. This will allow you to connect with other organisations and share blueprints, templates and standards. Our goal is to support you in the best way possible to achieve digital transformation in nursing.

WGLL success measures in nursing

Success measure 1 - Well led

Integrated care systems (ICSs) span organisational boundaries and have system-wide nursing leadership that represent the diversity of the nursing workforce. Your ICS works across organisations to set the system-wide strategy for digitally enabled care, with nursing needs at its core.

Information:

“Driving a supportive culture and enabling structure from board to point of practice.”3

What good looks like for ICSs and organisations:

  • There is a digital nurse leader with accountability across the nursing workforce for digital transformation. They have digital expertise and time to lead the transformation agenda on behalf of the nurse leader.
  • The digital nurse leader in the organisation reports to both the nurse leader and a digital lead, ensuring a multidisciplinary leadership team approach.
  • Nurse leaders and their teams work together across sectors to develop a shared vision of digitally enabled care for nursing.
  • Nursing practice is fundamental and integral to the development of the ICS system-wide digital strategy that sets out a unified vision of digitally enabled care.
  • Nursing data and digital requirements are clearly articulated in the organisation and ICS data and digital strategy.
  • Nurses in all care settings, including primary, community and social care, are involved to identify future data and digital opportunities to join up care.

What good looks like for organisations:

  • Nursing needs are included in the organisation’s digital strategy, which aligns with the ICS vision to achieve digitally enabled care.
  • A specialised team of nurses, with expertise in digital transformation of nursing care. supports the implementation of digital technologies.4

Success measure 2 - Smart foundations

Organisations and sectors across your ICS are supported with system-wide data which joins up nursing care. Nursing staff are present at all stages of developing data and digital solutions, resulting in fit-for-purpose systems which reduce the documentation burden and strengthen the organisation and wider ICS.

Information:

“Building the right foundations for digitally enabled nursing practice will ensure our time is spent in the right place, at the right time, and providing the right care.”

What good looks like for ICSs and organisations:

  • Nurses with protected time are part of the multidisciplinary team working on the design, implementation, testing and evaluation of technology.
  • Nursing supports the delivery of the ICS-wide shared care record (ShCR) by developing a system-wide approach for data collection and analysis.
  • Nurses share best practice for using clinical nursing systems across regions.
  • Consistently coded and structured nursing terminologies are implemented across the ICS to enable joined up care within the system.
  • Nurses can see the impact the data they have generated has on people, supporting a system-wide culture which values robust data collection.
  • Digital systems include all required clinical documentation to support effective nursing practice.5

What good looks like for organisations:

  • Digital clinical content, which has had nursing input, is approved through the existing nursing governance structure in organisations.
  • Nurses are encouraged to increase the use, and expand the functionality, of already adopted tools, through a culture which supports safe experimentation.
  • Digitally generated data from people using the organisation’s services is used to improve nursing care and processes.

Success measure 3 - Safe practice

Consistently safe processes and systems are in place across your ICS, and its organisational boundaries, to support digitally enabled nursing care. As a result, nurses provide the best possible care with the lowest risk.

Information:

“Secure, sustainable and fit for purpose solutions are paramount in delivering safe person-centred nursing care.”

What good looks like for ICSs and organisations:

  • Nurses are trained to be knowledgeable and proactive about information security and digital clinical safety.
  • Digital nurse leaders are familiar with and understand clinical safety standards such as DCB0129 and DCB0160, as well as frameworks such as the Digital Technology Assessment Criteria (DTAC).
  • Reviews are regularly performed to identify digital clinical safety incidents related to nursing care. Themes from this process are identified and shared across the ICS and on a regional and national level.
  • Clinical Safety Officers (CSO) engage with nursing to ensure safe nursing practice is considered part of digital clinical safety.

What good looks like for organisations:

  • Digital nurse leaders are trained in digital clinical safety and use this information to play a key role in the digital clinical safety process.
  • All nurses have knowledge of the risks associated with data and digital solutions and how this applies in practice.
  • Nurses are supported to identify, escalate and address clinical risks and incidents related to digitally enabled care through the governance process in the organisation.

Success measure 4 - Support nurses

ICSs and organisations ensure that the nursing profession has the right skills and support in place to provide digitally enabled care. As a result, teams across health and social care can build system-wide nursing knowledge and capabilities which transform the provision of care.

Information:

“Every nurse is equipped to ensure the service they work within is always striving to provide a better experience with better outcomes today than it did yesterday.”

What good looks like for ICSs and organisations:

  • Digital nurse leaders can access relevant training to lead digital transformation and enable safe and effective practice. For example, working with the Clinical Safety Officer, information governance, clinical safety, cybersecurity, leadership and change management training
  • Nurses have the digital and data literacy skills necessary to make best use of technology and data, in line with competency frameworks.
  • System-wide nursing networks share best practice and case studies in digitally enabled care from across the ICS, such as the COVID-19 Catalogue of Change.

What good also looks like for organisations:

  • The Digital Literacy Self Assessment Diagnostic tool is used by nurses to support individual self-assessment and continuous improvement.
  • Regular engagement and feedback sessions are held to understand the successes and challenges faced when delivering digitally enabled nursing care.
  • The organisation’s digital nurse leader is trained with the key skills to work in a digitally enabled environment.

Success measure 5 - Empower people

Nursing is consistently found to be the most trusted profession in Britain6 and is best placed to empower citizens to take an active role in their own care.

ICSs and organisations ensure accessibility and digital inclusion throughout nursing care, supporting all citizens to be part of the digital transformation journey. The ability to access personal healthcare information is key to success, and nursing is best placed to enable and support citizen engagement.

Information:

“Involve, don’t just engage”

What good looks like for ICSs and organisations:

  • The use of national tools and services, NHS.uk, NHS login and the NHS App, along with any additional local digital services, is promoted as part of nursing practice to best support people.
  • There is consistent system-wide nursing knowledge of local healthcare record accessibility to promote people accessing and contributing to their own care record.
  • Nurses use new and existing systems such as patient participation groups (PPGs), where citizen voices are heard and their findings are shared, to design digitally enabled care which reduces disparity of services.
  • Citizens are identified and encouraged by nurses to take part in service design, providing information to patient groups and user design forums.

What good looks like for organisations:

  • Nursing assessments to measure people’s digital literacy are incorporated into nursing care, ensuring identification and support for those at risk of digital exclusion.
  • Nursing contributes to the organisation’s discussion about citizen digital literacy which can be used to inform care delivery.
  • Citizens are identified and encouraged by nurses to take part in their care using the available digital technologies.

Success measure 6 - Improve care

Your ICS actively seeks out new ways data and digital solutions can improve the care delivered by nursing. An open and safe environment is created in and across organisations for nurses to lead and deliver on projects and research which support improvements in digitally enabled nursing care.

Information:

“Continually aim to push the boundaries of what is possible - once one achievement becomes the norm, be safe and brave to see what is possible using the most up to date technology to improve care.”

What good looks like for ICSs and organisations:

  • Nurses are provided with the information and skills to support digitally enabled care pathways, ensuring a consistent system-wide approach and involving citizens to choose their care delivery preferences.
  • Examples of national and international innovative digitally enabled nursing practices are identified, adapted and implemented across organisations and sectors, in partnership with social care and shared with others.
  • Nurses work with academic partners and citizens to develop and implement a programme of nurse-led research. This will create new evidence to support the digitally enabled nursing profession.
  • A shared approach to creating a data-driven culture is developed that supports nursing practice.

What good looks like for organisations:

  • Resources provided by the CNO Shared Governance: Collective Leadership programme are used to develop local programmes that improve quality outcomes using data to support accreditation.
  • Nurses are part of the multidisciplinary team leading the development of evidence-based clinical decision support within the organisation.
  • Nurses are part of multidisciplinary teams that regularly use data to support service improvements and nurse-led research.
  • Opportunities within the organisation where data and digital solutions can support nurse-led improvements are identified and implemented, such as remote monitoring and virtual care, in partnership with social care.

Success measure 7 - Healthy populations

Nursing is embedded within communities and responsive to each population’s unique health needs. Your ICS provides nursing with the system-wide access to data and digital solutions that best support the health of the population.

Information:

“Our vision is that we will use population health data to inform how we work, ensuring we provide services and care early and close to home.”

What good looks like for ICSs and organisations:

  • The nursing voice is included as part of population health management discussions across the ICS and in the development of data intelligence platforms.
  • Nurses work closely with data analysts and scientists to maximise insights from population health data.
  • Standardised data principles such as SNOMED CT and PRSB standards are implemented across the ICS to ensure nursing data that accurately represents people and supports population health is collected consistently.
  • Nurses and multidisciplinary leaders identify population health data gaps and advocate for their inclusion in the minimum data set.

Background

CNIO digital maturity assessment

In 2021, the CNIO office at NHSX undertook a nursing digital maturity assessment which included a survey across NHS health and care organisations. Findings emphasised an urgent requirement for accountable nursing leadership roles to support digital transformation across the NHS health and social care systems. This provided an opportunity to broaden the digital strategy within the nursing workforce and build strong relationships between IT, clinical and operations teams across the spectrum of professions.

Discovery approach

To capture the unique needs of nurse leaders, we co-created this guidance with a group of stakeholders that represent the breadth of nursing practice. We carried out 1:1 interviews, group interviews and huddle sessions to identify key themes and recommendations for the guidance. The quotes used throughout the success measures are taken from contributions during this discovery process. The guidance was developed and iterated in line with nursing feedback, with the aim to provide a clear vision for digitally enabled nursing that will allow teams to improve care outcomes and deliver safer care.

Terminology guide

See a list of terms used

Clinical Safety Officer (CSO): A Clinical Safety Officer is someone who is accountable for clinical safety and ensuring that effective clinical risk management is carried out by organisations.

Digitally enabled care: Health and social care that is supported and improved by digital solutions.

Digital literacy: Health Education England (HEE) defines digital literacy(-ies) as the capabilities that fit someone for living, learning, working, participating and thriving in a digital society.

Digital nurse leader: Term used in this guidance to describe the Chief Nursing Information or Informatics Officer (CNIO), with nursing informatics defined by the American Nurses Association as "the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice."

Digital Technology Assessment Criteria (DTAC): National baseline criteria for digital health technologies entering NHS and social care that are designed to be used by organisations to assess whether suppliers meet minimum standards.

Digital transformation: Health and social care that is supported and improved by digital technology.

Integrated care system (ICS): ICSs are new partnerships between organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.

Nursing informatics: Nursing informatics is defined by the American Medical Informatics Association (AMIA) as “science and practice (that) integrates nursing, its information and knowledge, with information and communication technologies to promote the health of people, families, and communities worldwide.” On a broader level, clinical informatics staff analyse and use data and their clinical knowledge to support other health professionals in their work along with developing and implementing digital tools.

Nurse leader: An individual who leads the nursing workforce in their ICS or organisation and is accountable for digital transformation there.

Organisation: Term used in this guidance to describe an NHS provider organisation.

Population health management: There is no single definition for population health management, however it is a way of improving the health of a population through using data with a focus on reducing health inequalities.

Professional Records Standards Body (PRSB): The PRSB develops standards for the content of digital health and care records and promotes their use to ensure safe and effective care for people.

Shared care record (ShCR): Shared care records allow people involved in care to access health and care records safely and securely and enable joined up care across the health and social care system.

SNOMED CT: SNOMED CT stands for Systematised Nomenclature of Medicine Clinical Terms and is a structured clinical vocabulary for use in electronic health records.

References

See a list of references
  1. ‘Digital nurse leader’ refers to the Chief Nursing Informatics or Information Officer (CNIO) role, with nursing informatics defined by the American Medical Informatics Association (AMIA) as "science and practice (that) integrates nursing, its information and knowledge, with information and communication technologies to promote the health of people, families, and communities worldwide."
  2. National Community Nursing Plan Engagement Document. NHS. October 2021.
  3. Quotes taken from participant contributions during the discovery process.
  4. Given the breadth of nursing, the structure of this team may vary in different contexts.
  5. Reducing the documentation burden, joining up care, releasing time to care, improving safety, reducing avoidable harm and personalised care
  6. Ipsos MORI Veracity Index 2021