Are you digitally ready?

The essence of the session I presented at #NIPEC18 today

Are you digitally ready? I am hoping I am!

Maybe you are expecting a technical presentation; this is not that. That’s because I actually believe that this whole agenda is about people. Its not about a list of technical capabilities – its about how people respond to technology and its about everyone in this room, so how do you know if you are digitally ready?

First of all, for context, I would like to reflect back.

Its 1983 and I am a fresh faced student nurse. Much of the technology we have now didn’t even seem possible then. We had no mobile phones and as a patient I was boiling my insulin syringe in a pan in the kitchen.

Over the decades since then I have assimilated technology into both my professional and my personal life, as I am sure you have too.

I have had no training in any of these things but I bank online, I order my meds online, I look loads up on google, I have an insulin pump and a Continuous Glucose Monitor. I love the connections I gain on social media and I use this in both my social and professional life.

I feel I am digitally ready in many senses.

But what is it exactly that makes me so?

Here are the 5 characteristics that I think make me digitally ready:

The first is that I am change positive; that is I have a positive professional orientation towards change, seeing it as an opportunity rather than something to be avoided. I like doing novel things. I was the first complaints manager at our Trust, I was part of the team that set up NHS Direct, a nurse led telephone triage service and I think was one of the early nurses to work in an informatics role. I experiment (safely of course) all the time, like I am experimenting today with you, presenting without slides. You will have to let me know how it goes!

For me being change ready means exactly that, prepared to try new things, experiment and play.

I believe that all nurses need to be change positive as nursing as its taught today is unlikely to be the nursing of the future. The pace of change is ramping up and technology is a large part of that, for example genomics and personalised medicine is likely to be come a reality in my lifetime.

I have already seen significant professional change. I used to be a staff nurse on a cadiology ward. The only way we could do surgery on someone’s lungs was a large incision in someone’s chest. It took days for them to recover. It was painful. Now, today they can do this type of surgery using keyhole surgery. Think of the massive difference it makes. It improves recovery but just think about the changes it makes to caring for these people! It shifts the focus for nursing too. And I predict it will be robotics next.

Being change ready is a good life skill as well as a professional skill too!

The second trait is Curiosity, when I mentor people I always advise them to remain curious.

Curiosity drives progress. If we are not interested in ‘what if’ then things will always stay the same.

Curious people can be intimidating though – they challenge the status quo and make people feel uncomfortable. I have often asked developers difficult questions about the art of the possible and hopefully driven better outcomes for patients as a result. Its part of being able to see a wider perspective and to be able to see how technology and data can be used to a fuller strategic perspective.

So what am I currently curious about? If we want to care for more people at home how can we lever technology to help? I visited a brilliant care home near Coventry last week where these are using noise detectors in a large home to help to identify when things happen at night. This increases rather than decreases privacy as it prevents the night staff having to actually go in to rooms at night for checks which in turn frees them up to support people who don’t sleep and focus on their ‘Wide awake club’ meaning care overall improves (and falls have reduced too). I am interested in technology like Alexa and exploring how we can use it with patients. Artificial intelligence too……. I could go on…… technology is a rich seam of interesting stuff for a curious person.

Curious people often have great imagination too and can describe how things might be, having conversations, visioning, and leading strategic change.

The third trait is a relentless focus on improvement.

I care deeply about the experience of people we care for, their carers and families. This is fed from my own long term condition but everyone has the potential to empathise.

Sometimes the status quo is fine when you are on the right side of the service. But it might be less so when you or your loved ones are unwell. It changes the dynamic and you suddenly have what I call ‘real skin in the game’.

An example:

This week I received a letter from my GP. It pointed out that I have a prescription for pre-filled insulin pens but I have no prescription for needles and it enclosed a leaflet on how to give injections. It concluded that they had set up an prescription for me to have needles.

What they failed to do was check my record.

The data they hold about me should have told them that I have an insulin pump. I only use pens as a back up and rarely use them. I have a box of 100s of needles prescribed 10 years ago that I have yet to use.

If the people focused hard on improvement using data they would have realised a number of things:

I am a pump user so don’t need many needles

I have had diabetes since 1979 and maybe sending me a leaflet about giving injections was slightly patronising (I suspect I have given more injections than the practice nurse).

I think using data is an important part of improvement science. But use it well. Focus on outcomes and do proper PDSA cycles.

I would love to know what outcome they expected when they sent me the letter.

Improving my injection technique might be the aim and I am grateful for that but they need to use the data in a better way.

Data is the lifeblood of improvement science.

If they wanted to make things better what outcome are they measuring? And how will they judge if they have made a difference.

Nurses who are digitally ready focus on service improvement informed by data! I can’t stress strongly enough that a digital ready nurse understands the value of data and the contribution it makes to better outcomes.

My fourth point is resilience. Its quite a trendy word right now so what exactly do I mean?

Resilient people keep trying. They are bouncy and in this instance keep advocating for the technology no matter how many times they are shouted down or doors slammed in their faces. When you innovate using technology it doesn’t always go well but you have to keep adjusting, reframing until you get the best outcomes.

Its OK to say ‘That didn’t work did it? Now how can we try to make it better?’ It takes a particular tenacity and resilience to safely fail and keep trying. It’s a mind set. I suppose another word for this might be an optimistic mindset.

I honestly think that technology and data create a great opportunity to make the lives of patients and nurses better. But it’s a journey. Its not a one off. It takes hard work, as an ongoing endless journey.

I have been in this space for 17 years and I have often felt like I was talking to myself.

Things are changing but digital nurses need to not fall over at the first hurdle but believe data and technology CAN make things better.

Finally trait five!

Networking and learning from each other.

I believe in stealing other peoples good ideas and building on them, if it improves care. I don’t mean stealing patents, and those type of ideas, but I do mean the sort of mentality that looks around to see what other people are doing to see what you can learn!

Social media is one way of doing this. Digital in this sense has created a whole new way of learning and communicating across the world.

Networks are a fantastic way to feed your curious traits, or your creative skills. I urge you to connect and look around. Are you well connected? Do you have fantastic networks?

I am lucky that I am often these days asked to judge awards. It shocks me how often nurses describe their projects to us and see them as unique, special – when in fact the trust in the next county or in NI or Scotland or wherever, are doing the same thing better! Just think of the potential of networks when they are cumulative for the development of ideas.

Networks are generous spaces; if you don’t believe me take a look at the Fab NHS Stuff site where people are generously sharing their ideas.

So, finally – why do I think I might be digitally ready?

The five characteristics:

I am change positive, curious and relentlessly focussed on improving the experience of service users and importantly outcomes. I am resilient, prepared to try new things and learn from others.

How are you digitally ready?

curiosity and my cat 🙂

Sharing no more

Imagine this….

You have had a really shit few years. The details don’t matter but suffice to say you feel you are moving on, you have met someone who you want to spend more time with and all of the things you have been through are being pushed back away somewhere quiet in your mind. You know you will need to talk about it at some point, after all its nothing to be ashamed of, but you are not ready. Your new partner doesn’t know about your loss and you are both enjoying the next phase of your life. You have decided to move in together and you have been clearing stuff out, sending old clothes and junk to the charity shop. Most of it you will never use again so you feel good pushing things into black bin liners and giving them away.

A few weeks later you are sat in bed on a Saturday morning having a lazy coffee when one of your friends messages you on Facebook. The next thing you know you notice you have a few messages which is unusual – you have an account on Facebook but you are not a big user as you are quite a private person really, but it just seems the thing to do right now. Your friend says have you seen the post of you on Facebook?

You open your Facebook timeline and staring back at you is a picture of yourself and David, before he died, when he was looking drawn and ill. The photo is a precious one but is not for sharing, yet here it was. You read the post and you realise that the precious memory stick that you kept all those memories on must have been left in one of the handbags you took to the charity shop and one of the assistants at the shop was trying to find the owner. You knew they were trying to be kind, to reunite you with your photos, but its unbearable.

You didn’t expect the next thing to happen either. Before you could blink an eye the post was being shared, posted and shared, posted and shared. The list of messages were people who recognised you and who wanted to bring the post to your attention.

You wanted it to stop. Your new partner had no idea about David and you weren’t ready to share the story.

The trouble is you just can’t stop it. The messages keep coming and no matter how often you ask someone to delete the post it carries on being shared. It is breaking your heart.

This isn’t a true story but the essence of it is true. I shared something on Facebook recently – I thought I was being kind and helpful and I had no idea what distress I would cause. The person who messaged me I don’t know them well but I could sense their hurt and distress. I removed my post but of course it was too late and I was just a link in a chain of many postings.

The lesson I learnt was that kind sharing acts can cause harm. I had no idea those photographs I shared would hurt but they did. We often talk about the negative aspects of sharing and I often see posts from teachers who are deliberately showing kids how far images can spread but I have shared things when I thought it was the ‘right’ thing to do. I won’t do this anymore. I have never really shared missing person pictures either and here is a great blog on why:

You never really know the back story and no matter how well intentioned you might be it can go wrong – so I will be sharing no more.

Anne

Practicing what I preach – role modelling and social media

This blog is a bit of an experiment :0)

Despite not really setting out with any grand intentions in mind, I was identified as a Social Pioneer by the Nursing Times in 2014, mainly for both my promotion of engagement with people with long-term conditions on Social Media but also for my work with professionals in encouraging and role modelling.

I believe that in a modern society nurses should be digitally competent and have a high level of digital professionalism in order to:

‘uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to. This should lead to trust and confidence in the profession from patients, people receiving care, other healthcare professionals and the public.’ (Extract from the Code, NMC 2015)

I try hard to do this at all times and aspire to role model digital behaviours. Here are some examples of how I try to do this:

I work hard at holding professional conversations at the same time as maintaining a balance of being human and authentic.
I try to help others if they seem to be struggling.
I add value through adding content and materials that further nursing.
I share my knowledge of social media and have worked with NHSIQ to produce a simple film for practitioners – see here.

As part of my nursing revalidation I need to collect feedback about my practice.

It would be really brilliant if you could leave a comment for me below that I can use to further reflect for my professional portfolio!

Constructive feedback from anyone is welcomed, not just other nurses. Feedback from patients and students is particularly welcomed.

anniecoops

Thank you so much xxx

Social media and me

I think I joined Facebook in 2007; not exactly an early adopter but not a late-comer either. I can remember who sent me the link and why she said I would like it. She was right I did! Before that I was a user of ‘Friends Reunited’ too – you remember that? Where you could look people up from school? I became a Facebook fan and, as smart phones came into my life and I spent increasing amounts of time travelling with my phone in my hand, social media an increasingly important part of my personal life.

A little while later, in 2009, someone at work suggested I join Twitter. I am always curious about new things so I duly logged in and created my account – @anniecoops was born.

In February 2009, when I started my Twitter journey, I took ages to warm up. Like many people who I speak to I didn’t really ‘get’ it and after around 3 months of trying I gave up. Here is my illuminating first tweet :0)

I can’t remember what made me go back but after those 3 months but I suspect it was a challenge from someone who probably said ‘If you don’t get it, you are probably not trying hard enough’ and I absolutely can’t resist a challenge like that! I met some important friends along the way and by April 2015 I find that I have tweeted 74K times and now have 8600 followers. With the launch of a social media film that I have worked on with @NHSIQ I thought it was time to reflect on that journey and what has happened.

Here is a link to the film

Annie was never my name, I always thought it was a bit twee for me, more of a nice girl name rather than the firm, straight and solid name Anne. I always say Anne is a good name, you can’t shorten it and it’s hard to mess with but I had no idea how ‘Annie’ was going to become part of my life. I had been called ‘Coops’ at work for quite a while and my son in the Cadets was called the same. When I tried to register @annecoops it was gone as was @annecooper. The addition of the ‘i’ to my first name was simply a pragmatic thing to do. I had no idea what was going to happen and that, by 2015, more people at work would call me Annie than Anne!

My social media journey has been a great addition to my professional life. Later in September 2012 started my wordpress blog and I re-discovered my love of reflecting through writing. By then AnnieCoops had taken hold as my ‘brand’ and also became the name of my blog.

I completely accept that social media is not for everyone – I dislike those who behave as zealots trying to pressurise people into using social media, particularly Twitter. It’s not for everyone but quite often there will be a platform that works for most people – I know lots of people who love Pinterest for example but I personally don’t get it as I clearly prefer the words and feelings that blogs evoke for me. I love Blipfoto as well but I am too ill-disciplined to be properly focussed on trying to improve my photography skills.

Social Media has been a positive experience for me and I thought it might be helpful to say why:

Professional inclusion

Working in informatics is hard. It’s like the geek club and most of the time I don’t actually belong in it – I’m tolerated and valued but not quite part of it either. Additionally in nursing informatics still feels peripheral. Back in 2009 I didn’t really think I was part of nursing, I had the sense, rightly or wrongly, that people didn’t really get the digital agenda and as a result I wasn’t really part of the nursing ‘family’ – I was labelled a geek* and therefore not part of where the nursing action was. Twitter changed that for me, I started to talk to other nurses and soon established a new network where I felt like I belonged and I continue to feel part of that family. It has given me a real opportunity to feel professionally re-connected and valued and to re-profile myself as more than the perceived ‘geek’.

Creating bridges

Social Media has been great for me in making connections and creating bridges to new spaces. New spaces I have been given a glimpse into include connecting with more professionals including doctors, midwives, pharmacists, medical educators, people who working in housing and local government, the voluntary sector, leadership development, organisational development, education – the list is so long I can’t list everyone and I value all those connections more than I can explain. It has given my personal and professional life a greater breadth and depth that would not have been possible without social media. I value the eclectic nature of my connections and social media friends.

Being a patient

Being a professional who happens to have a long term condition like T1 Diabetes can be a challenge. I think for many years most of the time I ignored it. Social Media allowed me to not only find a Diabetes family but also to try to add value to that community. I have enjoyed blogging about my condition and also sharing via Twitter some of the ups and downs. I have tried to help others too and to share my expertise as a patient. I wish I had found this opportunity earlier in my life.

Access to resources and expertise

One of the very best things about Twitter is the generosity of the people I connect to. I have learnt more in the last few years about so many things and I believe that this is likely to make me a better professional but also a better person. Sharing is not just the technical stuff but thoughts feelings and emotions that help me to understand in a deeper way – it’s a better learning space than any lecture I have ever had at university.

* there is nothing wrong with being a geek it’s just that I’m not one by this definition: ‘”someone who is interested in a subject (usually intellectual or complex) for its own sake”

‘But she’s my friend!’ – the power of making connections

A while ago I can remember @PaulJthinks encouraging people to follow me on Twitter as I was a hundred or so followers short of 3000. I now have nearing 8000 and I have been reflecting what that really means to me and how I use my valuable network.

There are a number of people who theorise about networks and connections. Metcalfe’s law is one of these, originating with a theory around Ethernet connections and now sometimes used to describe how number of possible cross-connections in a network grow as the square of the people in the network increases. In other words the community value of a network grows as the square of the number of its users increase.

It all sounds a bit technical to me, and a bit theoretical, but I’ve been reflecting on what my network means to me and how my numbers of followers seems to have grown without any deliberate act on my part to make it happen.

I have always been a connector in groups. In my social life I seem to create social groups and then, as they become impossible to manage socially as separate groups (there are just not enough days in a year), I join groups together. It’s not something I set out to do but I recognise that’s what happens; I am often the unique connection in our social groups – they lived next door, or I worked with them, or their children went to the same child-minder or I used to give them a lift to work.

I don’t set out to behave this way. I don’t set out to collect connections or people or friends it just seems to happen – I love people and I am very extrovert, not in the bouncing loud sort of way, at least all the time, but in the wanting to hear about people and share stories and experiences way. The truth is I am much more reserved than people think but this fascination with people makes me seem very extrovert I suspect (a previous blog covers exactly this here).

So why am I thinking about networks and connections now? As I have strengthened my professional network with my social media activity I find I am increasingly focussed on how I can connect people together, that the relationship with me is not the most helpful one but that I can act as a sort of lightening rod to others; connecting wonderful people together. It hasn’t always felt this way but as the strength and depth of my social media network has increased I feel more able to do this – my investment in my relationships seems to have made them deeper and stronger. Again not deliberate act but on reflection that’s is probably what has happened.

When I first noticed this behaviour I did have a moment of anxiety. It’s a bit like when you are at school and your best friend wanders off with another friend that you introduced them to and my instinctive response might have been – ‘but she’s MY friend’.

Interestingly that isn’t what happens now and I’m fascinated by how connecting others to each other seems to step up the power in my network! I have no idea how I got to 250 followers let alone near 8000 – it just seemed to happen but I do know I definitely feel connected to more great people.

In the NHS today it feels more fragmented than ever before. Organisations seem less likely to share than in the past and networks that existed across Strategic Health Authorities for example feel like they have fallen away. I think that if we all behaved as active ‘connectors’ it might just power us up a little bit and we might even find that we become turbo charged if we connect beyond our usual networks; I personally love the fact I have connections in social care, housing, voluntary sector, who work for themselves, who work in the NHS – the list goes on. I don’t know exactly how it happened but I am glad it did and there is nothing more satisfying that making a successful introduction then watching some magic happen! I love my network and seeing it help me to help others through acting as a connector is doubly satisfying – even if there is a little demon on my shoulder saying ‘don’t forget to keep loving me too will you?’

Could you be a better connector? I’m going to keep trying.

Exploring New Territories

It was a usual morning with an early start at 6 o’clock to get the train from Wakefield to London. It was all pretty much typical, Costa coffee in hand and sat waiting patiently, shivering, on the station platform, as I always arrive early. As is also usual, I’m filling in those pockets of time with my Twitter feed on my beloved iPhone and I notice that the HSJ were announcing their first ’Social Pioneers’. As I do, I flick it open and the first thing I notice is a lovely picture of the lovely Teresa Chinn. Then as I scrolled down, there I was: gobsmacked – me a ‘Social Pioneer’?

I am passionate about how information empowers. Information can bring independence and create changes and shift in social order. So bringing information to nurses can enable them to improve their practice, see things in new ways, revolutionise and encourage improvement as well as spotlighting where things might not be right. For citizens, information can drive real change, be disruptive in creating new paradigms of systems and behaviours; I think that ‘Patients Like Me’ is one of the best examples I can think of that shows this; have a look at this story to see what I mean:

‘Frustrated ALS Patients Concoct Their Own Drug’ The Wall Street Journal, April 15^th 2012

This powerful very short TedTalk from Stanley McChystal is about how having the confidence to open up information can make significant differences to what happens and illustrates my point too.

‘Information is only of value if you give it to the people who can do something with it’ Stanley McChrystal 2014

‘Sharing is power’ Stanley McChystal 2014

So what has this got to do with me being a ‘Social Pioneer’?

In around 2010 I discovered social media. I’m naturally curious and experimental so, curiosity prompted, I wander into social media. Wandering is a good description – I had little knowledge beyond being a Facebook user, no skills and little insight = scary!

What I discovered was a space that I think has huge potential for nurses but also those people who have health needs – it has the power to transform some aspects of how we use information.

What I also discovered amongst the nursing community was a reticence, anxiety and resistance and sometimes all of these things are still present. It frustrates me sometimes that I sense a lack of professional confidence about using social media and experimenting with its potential amongst many nurses. I also discovered people who I now realise are social pioneers, people with long term conditions and experiences of the health system that I started to follow and watch – I was amazed.

I saw the huge untapped potential that I believe social media offers us. Yes, it breaks down boundaries and flattens hierarchies, but it also has the real potential to change the very nature of the power based relationship between systems and people. I also believe it still has untapped public health potential but it has to move beyond broadcasting to achieve the possible.

So in 2010 I decided that one of the things that was needed were some role models in nursing that showed what could be achieved and as no one else (other than a few notable exceptions like Teresa @agencynurse and a few other pioneers) were taking that on, I decided that I would. If I was to show the power of social media I needed to ‘show’ it, not just point at it; doing presentations about social media is one thing but living it is another. So my ambition was to be a good role model for nurses in social media. That’s when the real pioneer journey began. My delight on being identified as a social pioneer was partly to do with feeling that it was evidence that I had, at least partly, achieved some of what I had set out to do.

In my journey I also discovered a very eclectic diabetes community and I am proud to say that I have also been part of that, making I hope, a contribution based largely on my 35 years of living with type 1 diabetes but of course combined with my other skills and knowledge. I have written with another social pioneer – @parthakar (whom I have never met in real life but know that I will 🙂 ) about the use of social media in the professional interface between professionals and patients – this would never have happened without Twitter. Here it is:

‘A New Dawn: the Role of Social media in Diabetes Education’

Famous signpost with directions to world landmarks in Pioneer Courthouse Square, Portland, Oregon

That’s why the word ‘pioneer’ was the part that gave me the most satisfaction when I read the piece in the Nursing Times and Health Service Journal supplement. I was also cited alongside many people I greatly admire – each has made a unique and significant contribution. I was delighted that the write up picked up some of the very things I was trying so hard to do, rather than just my level of frenetic activity! That’s exactly what I set out to do, to start to chart the new territory of social media for patients and nurses and other people who are part of the big NHS and social care extended family and I hope I am a little part of an enduring story.

I also came to realise that being called a ‘pioneer’ gave me great satisfaction for other reasons; I have always taken on roles in leading (and sometime ‘bleeding’) edge environments; complaints management in 1990 (listening to complaints then was not what it is now), NHS Direct, the National Programme for IT and informatics is still, in its own way, pioneering. There is also the point that nursing has a strong history of pioneers like Mary Seacole and Florence Nightingale – fantastic role models.

So on Wednesday I celebrated with a very large piece of cake!

Anne Cooper – ‘Social Pioneer’ – who would have thought it! Now where is the next territory to explore?

So that’s enough about me (a very self-indulgent blog this week AnnieCoops!): A very big thank you to everyone who was kind enough to nominate me (you know who you are), the Nursing Times and Health Service Journal and the lovely judges: Jenni, Andrew, Shaun and Emma. But also I couldn’t be social without conversations and it is those people who increasingly have the confidence to share, debate, support and push conversations in social media that I need to thank. Your conversations, blogs, video blogs inspire me, help me to grow and learn, support me and enable me to see new futures – thank you.

What’s in a name?

I recently went to NHS EXPO and noticed something strange; nearly everyone who I networked with called me ‘Annie’. Now most of you all probably know me as Annie and if you were to meet me in real life you would perhaps call me Annie too, so why is this so strange?

I joined Twitter in July 2012. I remember creating my account and wondering what I would call myself; I instinctively thought it needed to be memorable and reasonably short. I had an ex-boss who used to call me ‘Coops’ so I tried that first but – it’s a common name, Cooper – it had been taken, so as it turned out had AnneCoops. You see my given name is Anne, no middle name, hard to shorten or abbreviate. Everyone who knows me in my family and most of my friends would never call me anything else (unless they were being rude; matron has been known). It was just a flash of, you might say, inspiration – and AnnieCoops was born.

Since then my life lived via social media has been a really fun experience. My career and working life before 2012 was fine but the opportunity to develop my networking skills has allowed me to create a new social ‘me’, I hadn’t really expected Annie to stick in the way that it has. As AnnieCoops I have met many many interesting and incredible people and I hope very much that it won’t stop here.

I never thought of myself as Annie, in fact my paternal Grandmother, who I was not particularly close to, was called Annie. I didn’t think I matched the name but somehow it’s taken a life of its own, so much so that at EXPO I heard my self say (I cringe) to Kate Granger (of all people) ‘Hello, I’m AnnieCoops!’ I have even bought the domain name anniecoops.com for my blog.

It’s become part of me and my persona. I don’t think it was ever a deliberate act but I have completely embraced AnnieCoops and now love being called Annie. It tells me quite often where I know you from and how long we have chatted! Life often creates strange and interesting twists and turns, and I hope AnnieCoops will stick for a long while yet!

So, what’s your twitter name and what does it say about you?

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