Digital Change: Three drivers for fast and effective digital transformation
At the start of 2020, I was a senior project manager closing a portfolio of pilot projects that looked to reduce hospital admissions and visits through video consultations. The pilots had mixed results with some keen advocates but also a significant number of critics that believed video conferencing or consulting had no place in the NHS. At the start of 2020, proposals were being drawn up to extend the pilots and look to build on the gains highlighted in the pilots, particularly in mental health and therapies.
Fast forward 12 months, and thousands of video consultations are held every week on the NHS Wales Video Consultation (VC) Service across the whole of Wales. They say, necessity is the mother of invention and for all the horrific consequences of the COVID-19 pandemic it has been the necessity that bore out the rapid formation and deployment of the VC service from the same team that delivered the early pilots in a single health board.
The NHS Wales VC Service arose from the response to the pandemic but the reception by the public and clinicians to the benefits it delivers resulted in the Welsh Government laying out its intentions to retain the service as an integral part of patient accessibility to care and not just a measure in response to the pandemic. Just months earlier video was a novel, much criticised tool but now an essential approach to delivering health care for the foreseeable future.
In an organisation that still uses fax machines, the change that has occurred over the last year has been nothing short of phenomenal, resulting in a digital programme delivering a national service in a matter of weeks; unfortunately all too rare an occurrence where lessers programmes are forecast to take years. As a project professional with no clinical experience, I was keen to identify the key factors that lead to this new, rapid delivery that seemingly broke convention. Without over-simplifying, I have tried to distill these down to three key points.
Undoubtedly, the pandemic had the effect of focusing the mind on the job that had to be done, particularly in the NHS, however what it also exposed what that in digital projects and programmes, it is all to often the case that the purpose of the project is not totally clear and there is some ambiguity surrounding it. This is particularly the case with large-scale projects with a long lifespan, where personnel change, requirements evolve and even the political influences changing result in different perceptions in the ultimate goals of the project.
With the deployment of VC across NHS Wales we had a simple vision, perfectly understood by all. This clarity of vision and well-defined areas of responsibility meant that the programme was extremely focused with everybody ‘staying in their lanes’ and the work and issues effectively allocated and addressed.
No matter how technical or complex a transformation, the value of having a clear vision understood by all with clear areas of responsibility and lines of accountability are absolutely crucial to the success of the programme.
Quite often, particularly with large corporate or government programmes, a single digital solution is procured or recommended under a ‘one system’ approach. While this obviously has benefits in terms of scales of economy and efficiencies, it can often mean significant business change just to accommodate the system as well as potential gaps in requirements of large parts of a diverse user-base.
With the onset of the pandemic, haste was a necessity but so was immediate success and benefit delivery and Welsh Government did not see one system as the answer but focused on functionality as the key deliverable, coupled with rigorous national evaluation. A mature clinical-specific platform was chosen based on the functionality rather than the ‘one system’ approach, along with the shared understanding that it would not cover every requirement. The national evaluation built upon this shift in requirement from a one system to functionality focus, but also ensured where a platform did meet the functionality requirements it did not need an national edict to adopt but was the logical choice.
From the outset, we knew that mistakes would be made. We didn’t have the perfect plan that if everyone adhered to, everything would go swimmingly. And because of that nobody was overly defensive when there were deviations or impediments. We accepted the suggestions and criticism, and because we were in the mindset of being ready for bumps in the road, we responded to them quickly. This was a perfect demonstration of the Agile ideology; iteratively improving our offering quickly and in line with the users’ needs.
Far too often, a lot of time is spent planning the perfect IT delivery, all the time the needs evolve, only for those challenges to be met with defensive posturing, understandably from a team that invested so much in the initial planning and on which delivery depends — according to that plan. Remember, as soon as a plan is completed, it is out of date.
As much as I wanted to make the last point, ‘failure’ and I could have called these, The Three ‘F’s, I believe that these three very broad points of; giving a team and every member focus; looking to deliver functionality rather than a product; and having humility and taking on the mistakes and challenges will go towards creating a high performing team with a consistent and responsive approach to delivering success, promptly.