One of the founders of the NHS National Programme for IT has told HC2010 that it failed to understand that "culture eats strategy for breakfast". Professor Aidan Halligan, who now works in senior roles at University College London Hospitals (UCLH) and Brighton and Sussex University Hospitals, said that the programme has been …
Leadership? They've heard of it.
At least these yoyos are admitting they fscked up and pissed away billions. Leadership not only means admitting you fscked up, but preferrably do it in a timely fashion. You know, so there's something left to salvage. But since it's public money anyway, pissing away a couple billions is all for the common good, no?
Or at least our politicians know very well how to do it and get away with it too. Because it certainly isn't just the organisation that was supposed to make the whole thing work that's at fault. It's equally the micromeddling votemongering horsetrading attention whores, excuse me, politicians, that let them piss away the billions and gave them some extra billions to piss away too, that are at fault. Would you like a well-paid cozy job where you never had to perform but can give out pork barrels by the imperial arseload to your well-connected layabout friends? What do you mean we're no longer a feudal society? I see no indication it isn't so.
Pork Barrel Projects
So, same non-changes on both sides of the pond, eh?
So £12Bn to teach *one* senior manager some humilty.
and recognise that an organisation has to *allow* and preferably *want* to be changed.
Seems kind of expensive.
Just give up?
No one has explained what the preferable IT strategy would have been. Bottom-up doesn't work when those at the bottom end think they have vested interests to protect. IT itself doesn't work well if everyone has to retrain to be a typist first. Of course you need explicit data standards and a common strategy for something that is (for better or worse) a single giant organisation with a single set of use-cases. So, they've tried everything and not found perfection - who suggests they just give up?
let me rephrase that for you prof.
When asked by SmartHealthcare.com what he would do if the next prime minister put him in charge of informatics in England, Halligan replied:
"You'd have to be daft to give the job to someone who was a proven, confessed failure and covers up his inability to consider a core fundamental premise of software delivery by being wise after the event"
"unless we start from the bottom-up rather than the top-down this time, it will not work. And by the way, prime minister, it needs to work."
He added that there were three things the health service required: "Leadership, leadership and leadership,"
"Leadership" comes in many forms. Recent history in the Health Service, as evidenced by his project, is one of attempted dictatorship. What are we expected to draw from his words? A Damassene conversion or that he is full of management bulshit and it is coming out!
What he may really be meaning is "Engagement, engagement, engagement". That has been missing at all levels because the project has no common of idea what they are engaged in.
IT as a busines process or making life easier?
If you look at the NHS, there is IT working well in all sorts of areas - and adopted without any need for force from the centre **because it serves a purpose and makes life easier for all involved**
GPs have gone from using Lloyd George envelopes to having totally paperless practices, including business processes (registration, pathology links, QOF) which are useful - and even, with some resistance when it doesn't work, C&B and ETP (Electronic Transfer of Prescriptions)!
Acute Trusts adopted PACS with enthusiasm - and grumbles are largely confined to being unable to view images held in other Trusts.
When a thing is useful, there is little trouble in getting it adopted: but the remaining systems being promoted by NPfIT - like the EHR or even the PAS replacements needed prior to EHR - don't appear to give early results to the end-users (clinical and administrative front-line staff) and do require a lot of work from them: time which can not be afforded when you're a junior!
If there wasn't a constant change in requirements (the 18 week target came after the contracts were set) suppliers might also find it easier to produce products which actually addressed the needs of the Acute Trusts - once there was an understanding of those needs.
As a GP, my ways of working have changed dramatically over the years since my practice invested in a GP system - and the demands and workload have changed and increased as well.
Everyone focuses on what has *not* been achieved: GPs were computerised long before NPfIT threw them off course: - but it is nice to see someone admitting that they got it wrong: is this a first? ;->
I've had too many up-close and personal experiences with the NHS, and the problem isn't really the Doctors and nurses. Or, individually, with others such as physiotherapists. But there's a bit too much internal division, and my most recent experience has left me wondering if, sometimes, things get lost in the gaps.
I'm quite willing to believe that soldiers, rather than accountants, could do a better job of managing some things. Can the NHS really be run without spare capacity? How do you measure efficiency?
Personally, I'd be inclined more towards the Royal Navy than the Army. Hospitals are more like ships at sea: complex systems that have to work, rather than something that can be parked in a barracks.
Future episodes to be more dull?
Without dialog with the users there is no chance that a successful system can be implemented.
It always amazes me at the disconnect between what the managers think is happening and what is actually happening at the coalface. I've been given specifications by managers and then made a point of going out to speak to the workers - often against the wishes of the management.
I then find out that what is actually being carried out on the shop floor is completely different from what the managers think. I'll then call the workers/supervisors into the meetings. It's sadly entertaining to see the staff then arguing amongst themselves about how the company actually functions.
To provide a successful computerised system we need to have extremely clear understanding of how the company works. That's the hard part of providing a system. Sticking screens and databases together is easy in comparison.
If I'd have implemented the management's ideas then it would have failed totally when introduced (forced on) the PBI.
The way to get a system is this. Put together a team of IT experts and staff from the company. Between them this team need to put together a picture of how the company functions - and document it.
Then identify the lowest hanging fruit in terms of small systems which will provide most benefit for cost involved. Identify the foundation systems which need to be working properly first; email, networking etc. Then get the management to make choices about which parts they'd like to fund.
You can't fix it all at once - analyse, identify/fix existing probelms, work through list of improvements.
"Then identify the lowest hanging fruit in terms of small systems which will provide most benefit for cost involved. Identify the foundation systems which need to be working properly first; email, networking etc. Then get the management to make choices about which parts they'd like to fund."
I would point out that *Identifying* this minimal subset and ensuring it has the hooks to allow the building out of the rest of the system is *not* trivial.
Military Leadership Training
I did some leadership training in the RAF about 10 years ago and some of it is relevant no matter where you work. e.g. Look after the needs of the individual in your team, look after the needs of the team as a whole and ensure you know what the task's needs are (manpower requirements, procedures, ultimate aim, etc.). I was also taught to ask others for their suggestions as to how to complete a task but make the decisions about how it would be done. Finally, be prepared to take the blame if it goes wrong as much as praise your team if it goes well.
The above is missing in a lot of managers, regardless of what level they work at or what type of organisation they are in.
"Look after the needs of the individual in your team, look after the needs of the team as a whole and ensure you know what the task's needs are (manpower requirements, procedures, ultimate aim, etc.). I was also taught to ask others for their suggestions as to how to complete a task but make the decisions about how it would be done."
When you put it that way you make it sound so easy.
I *suspect* it might have something to do with how the armed services select "management" staff. Where they are recruited *primarily* for staff management (officers) and "promotion" from the ranks is AFAIK the exception rather than the rule.
In private industry it seems to be more of excellence at a specific skill (which might be *very* limited) plus ambition (often accompanied by a *huge* ego). Not the ideal personality to implement *any* of those requirements.
IT system design is crap, in general
IT projects that first find the processess and tasks that are easier to automate gives most benefits for the actual users and tend to be more successful than these kind of top-down monsters where no-one has any idea of what's the benefit on the root level.
"The benefit" because it's very rare that there's even one. Usually there are none, only more work to do on top of the old one.
And then the designers whine about "resistance of change" and things like that. No, that's not the real problem: Real problem is more work to users and anybody would oppose that.
It's easy to design a system which does everything, it's not easy to do such system which does it _better and with less user effort than current system_.
Impossible if that isn't even in design goals and I'll bet it wasn't in this case.
"Ease of use" of course is always mentioned, but never specified in a manner it could be measured or estimated if it has been reached or not. Or is it easier than current system.
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