I don’t know, let’s go and find out together

A new government can bring a fresh start, and this new Labour government promises to usher in a new era of change.

I started my career in the NHS when the last Labour government came to power, and with it, the much-vaunted National Programme for IT (NPfIT) was in full swing. Championed by Prime Minister Tony Blair, the NPfIT was a vision of a modernised NHS and a single, shareable, digital healthcare record for every patient. It was meant to revolutionise the way the health service worked. However, instead of heralding a new age of efficiency, it is now widely perceived as another failed IT project, one of the most costly in history.

This new digital revolution brought with it new levels of complexity and uncertainty. Most management approaches before then tried to manage change using industrial-age techniques that had previously been successful. Think of factory lines developing a certain kind of product and only releasing the product when it is finished at the end of the line.

This meant that the first projects I was involved in took a ‘big bang’ approach to digital change, where the whole hospital went live at once when the software was ready. This approach to change created a lot of problems.

• Operational and clinical processes often had to adapt to the way the software worked rather than vice versa.
• Project managers complained that requirements kept changing, making it impossible for them to deliver.
• Medical professionals complained that they were never consulted on what they wanted the new system to achieve.
• There was reduced efficiency. A common complaint was that “we used to see 20 patients in a clinic, we’ve now had to reduce the numbers”.

Compounding the issues with these early digital projects was the taboo around admitting “I don’t know.” It was perceived to show weakness and insecurity. But as the example of the NPfIT showed, it’s often impossible to know all of the requirements in advance—the unknown unknowns. Once a system is in use, new needs are discovered, creating new requirements.

As our understanding of software deployments has grown more sophisticated so too have our approaches. Agile methods have become ubiquitous. Hospitals now often conduct smaller ‘go-lives’, rolling out changes on one ward, for example, before a wider rollout. This allows for testing, iterating, and making changes before a wider implementation.

Now there is a new Labour government and a new commitment to the NHS. A new era of change is beginning. So, when it comes to change, it’s okay to admit that we don’t have all the answers. At Keystream, we use a blueprint to explore and understand the readiness of any project. So, if you are embarking on any change and you’re unsure of what the next steps could be remember: You don’t need to know everything from the start – let’s go and find out together.