RSS feedsProfiting from the mistakes of others is one of life’s great lessons, so businesses involved in or planning a major IT project should certainly study the goings-on at the National Health Service right now.
In 1998 the NHS Executive set a target for all trusts to have electronic patient records in place by 2005. So when in the spring of 2002 just 3% of trusts were set to meet the target, the government responded in typical style – by throwing more money at the problem, changing the project’s name, employing a high-profile executive to take the flak and extending the deadline.
But despite the birth of the National Programme for IT and the employment of Richard Granger as its director general, the £6.2bn project (the taxpayer is digging deep for this one) is threatening to come off the rails.
After interviewing NHS trust chief executives, directors of IT, medical directors and directors of nursing, a recent British Medical Journal report came to a worrying conclusion: the National Programme for IT is failing because those who are implementing it have not consulted with those who will ultimately have to use it.
“As a taxpayer, I’m furious,” says one trust director interviewed by the report’s authors. “As a clinician who’s dedicated time speaking on behalf of other professionals who’ve spent hours of unpaid time trying to make this work, I know they feel devalued, marginalised and ignored. There’s enormous anger in this organisation with the way in which we’ve been dismissively treated.” Some of the biggest criticisms relate to how a national IT programme will not meet their individual needs, which require more locally specific solutions.
“Where it needs tailoring to local trusts – I don’t think that’s being listened to at all, and that’s where they’re going to find the biggest amount of resistance,” says another trust manager who was interviewed.
There are many important lessons that can be learned from the BMJ study, but two jump out from the page.
First, for any substantial IT project to succeed, the implementers must talk to the eventual users. IT is too often seen as an end in itself by highly paid consultants rather than the enabler it should be.
The second lesson is particularly relevant today.
Because we operate in a world where mergers and acquisitions are commonplace, some would say rampant, it is important to remember that different organisations have very different needs, problems and cultures. This is true whether you are talking about two health care trusts or two subsidiaries of a multinational corporation.
Another interviewee puts it well. “One of the things that definitely makes life much easier is that we’re a single-site organisation, so there is a single culture around this place.
We’re not a difficult political being with eight or nine hospital sites spread around – from an IT point of view that’s very difficult to support and manage.” While a common IT infrastructure should be the aim for any self-respecting chief information officer, it would be foolish to undermine local efforts to achieve it. One of the surest ways to do just that is by imposing deadlines and forcing through change before it is wanted or needed.
This month’s interview is with Malcolm Wyman, the chief financial officer of global brewing giant SABMiller. He is a man with an idea or two about differing cultures, having recently acquired businesses in all four quarters of the globe. The NHS could learn much from Wyman’s approach.
“We don’t just change everything immediately,” he says. “We try to link in systems. Then over time we analyse and try and work out when the system is going to be replaced and tie that in with an overall programme so that we try and do it region by region.” Not a deadline in sight.
The ignoring of cultural differences between different NHS trusts by the programme’s directors is a constant in the BMJ article. “Experiences of IT implementation in the UK and other countries confirm the importance of sociocultural considerations,” the report’s authors explain.
In March, Granger delivered a keynote speech at the Healthcare Computing conference in Harrogate. A headline aspect of his speech was the news that the National Programme for IT would be renamed “Connecting for Change”. Presumably, removing the damned acronym of IT from the department’s stationery may improve its fortunes, but one still gets the sense of having been here before
