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IT Strategy – The sick man of IT

Profiting 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

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

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