Why is a digital transformation project more like having a baby than buying a car?
From the Frontline – a semi-regular series of blogs featuring independent thought leadership and comment from a range of leaders that span the healthcare industry.
Many IT teams spend long hours preparing solid business cases to gain board approval for digital transformation. James Freed, Chief Digital and Information Officer at Health Education England, argues that this approach is neither the best way to get the go ahead for projects, nor the right approach to deliver successful change.
IT-driven business cases are the wrong approach
It was during a presentation to the board to propose the business case for adoption of an EPR system that I had my lightbulb moment. My team had worked long and hard to investigate the options, cost the solution and make the plans. We’d expended a huge amount of time and effort documenting our proposals, preparing and rehearsing presentations, and trying to second guess every possible question and objection which could come from the board members. We thought our approach was the best way to gain approval for the much needed project. We were wrong.
This was my experience during cohort 1 of the Digital Health Leadership Programme. The board was fake, the prep was real. The feelings it evoked were very familiar.
Digital transformation is so important to the future of healthcare that it can’t be viewed as an IT project or programme of projects owned and driven by technologists. The key word is transformation, not digital. The impetus to begin, and the best way to ensure success, is for there to be a need and desire for change coming from the organisation as a whole, with the board acting as the lightning rod to spark the right projects into life. To gain the best chance of success, there has to be a ‘pull’ rather than a ‘push’.
Don’t disenfranchise the board – or absolve them of their responsibilities
I realised that by taking an IT-driven business case to the board, in essence all I was doing was asking them to say yes and sign a cheque. That was the extent of their involvement. This approach systematically disinvested the board of their responsibilities and reduced the chance to tap into their experience and creativity. It made them feel that this was an IT project, not a transformation needed by the whole organisation which required changes in every area to make it successful.
IT didn’t, and could not, have all the answers as the board members and the workforce as a whole were the experts in their disciplines. Their input and pull for solutions to improve patient care and remove the barriers they faced were essential for digital transformation to happen successfully. It’s not about an IT project but a collective endeavour. It shouldn’t commence unless everyone round the board table understands the investment and change which each of their areas needs to make. The decision cannot be boiled down to a one-off choice related solely to cost.
What are the real problems you are trying to fix?
For digital transformation to truly be successful and baked into the organisation, your starting point needs to be focused on the real problems you want to fix. It’s not about a single decision point on a business case based largely on the financial investment needed to implement an IT system. It’s about instigating a change programme which the whole organisation needs to sign up to. That is why a digital transformation project is more like having a baby than buying a car. A long-term commitment is made, capabilities learned and a relationship built.
You need to get to know the possibilities and continue to learn, teach, and develop so the organisation gains the best outcomes and continues to find new possibilities. You will benefit in ways that could not be envisaged from day one. If the workforce buys in and sees the returns, they will make the tools you provide their own. They will take the initiative and evolve the way that the tools are used to address the changing challenges they face and remove the roadblocks to improving patient care.
Help the organisation understand the possibilities
As we’ve seen, the role of IT shouldn’t be simply presenting business cases for technology which purports to be ‘magic bullet’ solutions to completely address challenges. Long before investment decisions need to be taken the IT team should help educate senior management on the possibilities of digital… and also the limitations.
Within a board, throughout a Trust and, increasingly across health and social care organisations in a locale, there will be many different views as to what digital means. This will come both from professional and personal experience. Some people will be addicted to their smartphones; others will be interacting daily by voice with their smart speakers, phones, fitness trackers and watches. Some will be wary if they’ve personally experienced identity theft or cyber fraud, or interacted with an organisation targeted by cyber criminals. Long term champions of IT may even be skeptical of the security of digital solutions and be wary of relinquishing some control as the frontiers of the IT landscape are pushed beyond the physical boundaries of the organisation(s).
The IT team needs to create a common understanding and help foster new ways of thinking through ongoing explanation of what new technologies offer and how other organisations have benefitted from innovations. The board must have a clear understanding of what the organisation is doing now and where it needs to get to before it can know when and where to make the right digital investments. Digital transformation needs to be seen less as a cost and more of an enabling investment with short, medium and long term returns.
Increasing the chances of success
To meet the current demands on the NHS we need to do more of what we already do which will be at additional cost or do things differently to drive more efficiency and productivity. Given the financial pressures, it’s the latter option which is the more possible to achieve. The expectation is that digital initiatives will enable the productivity gains needed, but research shows that in the past 7 in 10 digital projects don’t fully deliver on their objectives.
Well over half of digital projects that underperform do so due to cultural issues. Problems with the technology itself and the resourcing of projects each negatively impact 1 in 5 of underperforming digital projects. This is why it is so important to focus on the people, culture, education and change management – from the board down to each frontline worker – to give yourself the best chance of success.
We need to provide the right tools to the 1.4 million people in the NHS workforce and allow them to make the changes. We have to make them digitally willing and able. The IT teams are there to provide the enablers. Senior leaders are responsible for empowering people so they can make change happen fast whilst putting in the right light, joined up controls to ensure that change happens safely and in a way that compromises speed as little as possible. The healthcare profession has always been very risk averse. We need to allow people to move faster than ever before to innovate while remaining safe. This requires light touch but joined-up governance and a culture which admits issues early, learns fast and feeds back into an ongoing improvement loop.
What do we need to learn?
The Digital Academy for Health and Care is there to support teams to deliver more value tomorrow than they did today through education and learning. There are a number of development offers aimed at Boards, Digital, Data and Technology staff and the wider workforce. Many offers are open to both NHS and social care organisations. Bringing up a baby is far more complex that buying a car, but we’re here to support you.