Angela Ryan: advocating the nursing voice

Nurses are celebrated across the world — revered and credited for their dedication, stamina, resilience and compassion towards all who come into their care. Yet, historically, nurses have not had a place at the decision-making table when it comes to health policies and planning.

The Australian Digital Health Agency’s (ADHA) Chief Clinical Information Officer, Angela Ryan, is passionate about the leadership capabilities of women in health care. She wants to see nurses at the centre of the decision-making table, informing policies and making important decisions.

With more than 30 years’ experience in hospitals and public sector organisations, including more than 14 years’ experience as a registered nurse, Angela is a founding Fellow and Vice Chair of the recently established Australasian Institute of Digital Health, and President of the (former) Australasian College of Health Informatics (ACHI). In 2020, Angela presided over the merger of the ACHI and the Health Informatics Society of Australia into the Australasian Institute of Digital Health.

“It’s been a bit of a journey to position nurses front and centre at the decision-making table,” Angela said.

“Being the largest component of the health workforce, we have a lot to offer and some unique insights into advocating the patient perspective, among many other things. We’ve had some work to do over the years shifting the mindset that there is real value in supporting nursing leadership where decisions are made, and we can thank the many nursing and midwifery organisations and individuals who have contributed to this evolution; in particular, the Australian Nursing & Midwifery Federation, the Australian College of Nurses, the Australian College of Midwives, and the many Chief Nursing and Midwifery Officers across the country speaking on behalf of nurses and midwives everywhere.

“It’s also worth highlighting the contribution other organisations have made and, in particular, the Australasian Institute of Digital Health, which has valued and promoted the importance of the nursing voice in the work that they do.”

Angela anticipates that the National Nursing and Midwifery Digital Health Capability Framework will have a significant impact on facilitating nurses’ transition into leadership positions.

“This is the first time we have been able to provide nurses and midwives with the ability to assess their knowledge and skills in regard to digital health. The framework can be used to identify learning and developmental needs or inform personal and professional development plans relevant to their current or future workplace or role. It can be used to develop tools to assist in extending the digital health capabilities and will provide direction for career advancement planning in digital health or other nursing and midwifery specialties.”

A path to leadership in digital health

Angela began her career as a registered nurse, specialising in paediatric and adult intensive care. A move to the Royal Prince Alfred Hospital’s ICU saw her move quickly into the role of CIS Manager with only basic experience of the system. It wasn’t until later that Angela completed formal qualifications in digital health — a Graduate Diploma in Health Informatics (eHealth).

During her time at the RPAH, Angela managed the expansion of the CIS from the then 12-bed ICU to a 54-bed ICU ‘hot floor’— co-locating the general ICU beds alongside cardiothoracic and neurosurgical beds into a new wing in the hospital, with hundreds of nurses and medical, allied health care and administrative workers.

“We established a research partnership with the University of Sydney School of IT, testing machine learning techniques including natural language processing across the ICU data to derive reports for analytics and research,” Angela explained.

Angela shifted to health policy in 2010, managing telehealth services for NSW Health, which saw innovative reform programs delivered across the state. From here, Angela managed statewide clinical information system programs, delivering an intensive care solution across the state.

“I was engaged in the formal establishment of the eHealth NSW strategic advisory and design governance and assurance functions for the Office of the CCIO, ensuring safety, quality and usability are at the core of all clinical systems and powered through clinical engagement and adoption.”

Working in the digital health space

Despite the many highlights that a career in digital health provides, Angela described the growing acknowledgement of ‘digital’ as fundamental to the way health care is delivered as being a standout.

“It used to be seen as a niche industry but this has well and truly changed — and of course the onset of the pandemic has very much brought digital into even sharper focus,” she said.

When considering the main challenges to health care in the coming years, Angela points to rising complex and chronic healthcare needs, ever-constraining fiscal environments and the need to continue to do more with less.

“Nurses and midwives are growing more scarce and we need to radically rethink the way the workforce can participate in the delivery of health care. Digital first must be our overarching premise — it’s the only way we’ll ever reach a person-centric system that puts all Australians first.”

Research informing practice

In 2017, Angela was awarded a Churchill Fellowship in the area of digital health safety governance. This saw her travel within the UK, USA and Canada to research strategies ensuring patient safety. The report is available here.

“Research has shown that better coordination of digital health safety governance can improve patient safety and prevent patient harm.

“In 2018, I travelled to England, Canada and the United States to interview clinicians, researchers, policymakers and industry stakeholders with expertise in digital health and patient safety, to understand lessons learned associated with the design, development, deployment and surveillance of digital tools and technologies. I met with dozens of these professionals who kindly gave me their time and shared their learnings with me.

“My key takeaways: safety is everybody’s business and should be a shared responsibility; we need to strive for learning healthcare systems; digital health safety shouldn’t be seen as a standalone issue; we should be utilising existing policy, regulatory and legislative instruments more efficiently; patient safety measures should be adopted now; we need to strive for greater openness and transparency; we must better support the workforce in health; and health care is a complex adaptive system — and we must never lose sight of this. I continue to work to ensure these findings underpin everything that I do.”