A healthcare CDIO’s unexpected path to interim CEO

Andy Callow was appointed CDIO at the University Hospitals of Northamptonshire in December 2020, and has spent the last three years unifying the Kettering and Northampton hospitals through one digital strategy, taking strides to adopt cloud, build an RPA Centre of Excellence, and roll-out AI proof-of-concepts.

Then the call came that CEO Simon Weldon was leaving temporarily for personal reasons and looked in-house for his replacement.

“It wasn’t part of my trajectory but I agreed to do it out of loyalty to him,” says Callow. And although it was a departure for him to helm an unfamiliar leadership role, unique opportunities presented themselves like fresh intellectual stimulation, addressing white privilege, and plans to stabilise the hospitals through winter.

Gaining a new perspective

Having started the interim CEO role in October, and appointed an interim successor for his CDIO role, Callow admits he’s still coming to grips with the new structure. In the first few weeks, he spent time preparing the organisation for a challenging winter, opening internal conferences, addressing Black History Month, and hearing from staff around the wards. Knowing that his role is temporary, his focus is on not letting anything slip through the cracks, as he adjusts working at a system level with less hands-on, day-to-day involvement, and more emphasis on being a facilitator for outcomes.

It’s still early days and Callow is unsure if he’d pursue a CEO role in future, but he’s enthused about a new perspective.

“The technical challenge of my substantive role as CDIO provides a lot of intellectual stimulation, but I’ve been pleasantly surprised to find similar stimulation in the new challenges I find on my plate now,” he says. “What I didn’t appreciate is that I’d also get that buzz from some really tricky problems you’re trying to deal with, which are wider organisational issues. I’ve been involved in conversations about the money for a while, but now I’ve got accountability for that to happen, rather than being part of the solution.”

This leap into the unknown can be unsettling, even for the most experienced leaders. Callow casts his mind back to earlier in his career when a series of promotions pushed him further into leadership roles and away from his love of coding. A “grieving process” ensued, as he moved away from a skillset he had built his reputation on, but he believes it won’t happen this time around.

“I’ve not felt that I’m losing all the techie stuff,” says Callow, formerly the head of technology delivery at NHS UK and programme director at NHS Digital. “I’ve thought that this is actually helping people do their best work in a different guise.”

A CIO’s leadership principles

Callow attributes his transparent and reflective leadership style to workplace experience and his own development, and cites Daniel Pink’s Drive as an influencing factor in letting teams become autonomous and take ownership, continuously improve, and buy into the mission of the NHS.

Callow also believes in the value to reflect on past achievements in order to tackle future obstacles and land key messages in meetings. The weekly notes he writes have also become a routine that helps crystallize successes and challenges, but also prompts new conversations with colleagues and third parties, helping to make sense of the more troubling weeks.

“I look back [at my notes] and say, ‘There was that situation’ or, ‘That conversation was fantastic’. Or, actually, ‘There’s a situation I need to put more effort into progressing’, or, ‘There’s a person I need to give more time to.’ If no one else read them, I’d still do them because it’s a discipline to look back on and think about what you’re doing.”

Callow keeps what he calls shadow notes of circumstances he’d rather not make public, and attributes this activity to the importance of being open, a key NHS principle that’s pinned to his wall at his office in Kettering, in North Northamptonshire. He takes a similar approach to Twitter, saying the social media platform doesn’t have to be about mudslinging, but an opportunity to forge connections. He recalls a time he Tweeted about the possibility of machine learning being used to improve bed management, an idea that would eventually spark online conversations, NHSX funding, and a proof-of-concept on bed scheduling with AI start-up faculty.

“That has now gone into a product that’s available, and that code is open-sourced on GitHub,” he says.

A CIO’s guide to addressing white privilege

Ranked in the top five of this year’s CIO UK 100, Callow drew high praise from the judges for a proactive approach to tackling diversity, equity and inclusion.

Last autumn, he bought 10 copies of White Fragility by Robin DiAngelo and invited the 300 staff across the digital directorate of both hospitals to borrow them. Later that year, Callow hosted discussions about tackling diversity and discrimination with the directorate and trust board, leading to a joint board development session on how to address racism.

The University Hospitals of Northamptonshirewould go on to launch a new leadership programme for Black and Asian staff in the spring, while Callow has since recruited up to 25 board members to volunteer their time for career coaching sessions to these same professionals. Callow himself offers two hours a month.

“A lot of colleagues don’t have access to somebody who can have those kind of conversations, particularly if you’ve come from overseas and you haven’t built up a network,” says Callow, who is executive sponsor of both Trust REACH (Race, Equality and Cultural Heritage) staff networks. But he admits that addressing such issues can only begin with leaders getting uncomfortable, and tackling subjects that may be beyond their expertise.

“Reading White Fragility was a pivotal moment,” he says. “It made me feel more equipped to have some of these conversations.”

2023 is about stability and the next job

Callow says he is most proud of his automated coding project of endoscopy patient episodes, whereby the Trust has used AI to automatically code 87% of monthly endoscopy activity, with an average accuracy of primary diagnosis and procure assignment of 94%—approximately the same as a human coder.

He acknowledges there are challenges ahead for his successor Dan Howard to the CDIO post, from integrating digital strategies to rolling out electronic patient records, but as interim CEO, Callow is looking at the bigger picture of improving clinical collaboration, managing rising costs, and supporting staff through a difficult winter.

“We need to strip out some of those things that are no longer needed [from Covid],” he says. “And that’s hard when you’ve still got your emergency department full, ambulances queuing, and wards where people wait a long time to be discharged.”

Callow believes that CIOs are equally equipped to take the CEO role as other board members, and admits he would be more interested in a deputy CEO position than six months ago. Yet a return to familiar territory beckons.

From mid-January, Callow will become CDIO at the University Hospitals of Nottingham, a move influenced in part by a new challenge as well as a shorter commute. “There’s a lot I can contribute to their digital progression and I like the established links with the university that I can be part of,” he said. “The focus for the new year will be on getting up to speed with the NUH CDIO role and strong delivery.”