‘The NPfIT -Lessons from elsewhere’
Chris Clegg
Craig Shepherd
Leeds University Business School
7.2.08
Overview
•
•
•
•
Overall Aims
Lessons Learned
Implications and actions
Concluding remarks
Clegg, C.W., & Shepherd, C. (2007). ‘The biggest computer
programme in the world … ever!’: time for a change in mindset?
Journal of Information Technology, 22, 212-221
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Overall Aims
• Using a socio-technical perspective, to:
– Offer a commentary on the NPfIT and its
techno-centric approach to change
management
– Elaborate the lessons learned from the fields
of new technology and business change
– Discuss the potential implications of the
lessons learned on the NPfIT’s approach
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Lessons Learned
• Six main lessons
– Performance
– Need
– A systems view
– Ownership and continuity
– Project management
– Senior management
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Royal Academy of Engineering/ British
Computer Society
• “The overall UK spend on IT is projected to be a
monumental £22.6 billion… only around 16% of IT
projects can be considered truly successful”
• Basil Butler, Chairman, Joint RAE/BCS Working Group,
2004
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Productivity
IT investment
Low
High
High
1.6%
4.6%
0%
-3.7%
Organisation
change
Low
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IT investment
needs to be
accompanied by
organisational
change
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Performance
• Consistent evidence from a wide range of sources,
irrespective of level of analysis, discipline or method of
investigation
• IT systems often fail to deliver against their objectives
and often disappoint their users and sponsors:
– 40% complete failures
– 40% partial successes
– 20% complete successes
• “You can see the computer age everywhere, except in
the productivity statistics” (Solow, 1987)
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Need
• Does the business really need the new IT system that is
being developed?
– Is this investment the best use of the business’ resources?
– Does the new system further business goals?
– Will the new system help staff deliver a better service?
• If there is no real need, the investment is unlikely to be
successful, however good the design and
implementation.
• Failures reflect underlying problems
– Lack of understanding between the IT community and senior
managers
– Ways in which organisations allow the IT community to take over
ownership of projects
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Product vs. Process
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Capability
Capability maturity
Time
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Systems view
People
Work & Structures
Systems &
Culture
Procedures
Goals
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Technology
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A systems view
• Introduction of a new IT system demands changes
elsewhere in the business (and vice versa!)
– Business processes
– Working practices
– User roles, skills and competencies
• No single discipline or professional group is likely to be
able to provide a complete understanding of the overall
system
– Each discipline has its own area of expertise
– All necessary forms of expertise must be included
– IT should not lead the change programme
• Don’t blame the IT community (Plumbers!)
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Ownership and Continuity
• Pull systems are more effective than push systems
– Pull systems – end users pull products through their organisation
– Push systems – products are pushed at their users
• Change programmes led by IT managers and pushed at
end-users are often ineffective
• The end-user community needs to lead and own the
change from the beginning
– Pull through what it wants and needs for effective performance
• The IT community is only one, albeit important, part of
the process
– It should not own, lead or push the change process
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Project management
• Projects should be owned, led and managed by senior
end-users
• Project teams need to be multi-disciplinary
– All necessary skills and expertise
• Teams should focus on a working system and how the
service will be delivered
– Designing new and more effective ways of delivering a service
– Designing new practices, processes and roles
• Projects are not just about IT
– IT provides support and professional input when required
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Senior management
• These lessons involve a fundamental
change in the way change management
and the role of IT are viewed
• This requires fundamental changes in
underlying mindsets for senior managers
– Senior managers have the power to enact
changes
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Implications
• Major implications from the analysis of
lessons learned
– Understanding
– The NPfIT as a ‘technical infrastructure
project’
– Pros and cons of the current technically
focused NPfIT approach
– Actions for consideration
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Understanding
• Organisations should be designing and
implementing new ways of working
• Technology is only one part of the solution
• It is not possible for a single discipline or
professional group to have all the answers
• Multi-disciplinary, systemic approach needed
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The NPfIT as a ‘technical
infrastructure project’
• Emphasis on the need to put in
place technical systems and a
technical infrastructure
• Serves to focus on IT and to
exclude difficult organisational
issues concerning working
practices, processes and roles
• Main task becomes “Bringing
in the IT”
• Other parts of the problem left
for a later agenda
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• Separation of technical and
social issues is a useful device
for legitimising a techno-centric
approach
– Technology must be in place
to facilitate service delivery
improvements
• Commonplace in large change
programmes
– E.g., Enterprise Resource
Planning (ERP) systems
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Pros of the current NPfIT
approach
•
It simplifies the goals and the
scope of the problem domain
•
– Focuses on a limited set of
problems
– Makes responsibilities clear
•
It may speed up the process
initially
– End-users get the blame for
ineffective service delivery
– Developers claim they met their
contractual obligations
•
– Difficult decisions about
service delivery can be made
later
•
Managing IT projects is what
professional project managers
often do
– Previous experience
– Fits the brief they were hired for
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It may help get developers off
the hook later
It may be the only way it can be
done?
– NHS is so large, complex and
differentiated
– Too difficult to get end-user
community to lead and agree a
project
•
Benefits seem to accrue to
Developer community!
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Cons of the current NPfIT
approach
•
The focus on technology is a
high-risk strategy
•
– Long history of failed
technology-driven projects
•
It is not clear how the
developing infrastructure will
shape and influence current
processes and practices
– Mish-mash of unplanned
variations
•
If not dealt with initially,
organisational aspects may not
get funded or managed
– Reduces joint systems thinking
and optimisation
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Users of the system may
become disillusioned
– Survey of 3092, 91% of doctors
thought the new computer
system would not improve the
NHS (The Times, 2007)
– Have technical and social
aspects been matched?
•
Longer term outcome is
unlikely to provide optimal
service delivery
•
Does not match well with the
lessons learned
•
Disadvantages seem to fall on
User community
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The NPfIT as a ‘technical
infrastructure project’
“At the present rate of progress it is unlikely
that significant clinical benefits will be
delivered by the end of the contract
period” (House of Commons Committee of Public
Accounts, 2007, p.6)
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“We are concerned that leadership of the
Programme has focused too narrowly on
the delivery of the IT systems, at the
expense of proper consideration of how to
best use IT within a broader process of
business change” (House of Commons
Committee of Public Accounts, 2007, p.6)
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“The Department needs to improve the way it
communicates with NHS staff, especially
clinicians ….. It should ask the heads of the
clinical professions, such as the Chief Medical
Officer, to review the extent of clinical
involvement in the specification of the systems,
and to report on whether they are satisfied that
the systems have been adequately specified to
meet the needs of clinicians” (House of Commons
Committee of Public Accounts, 2007, p.6)
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Actions for consideration
• Ideas which may help improve the
chances of a successful project
– A new mindset?
– Leadership and ownership
– New metrics
– Reflect and plan
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A new mindset?
• Focus on improving service delivery through
working practices, business processes and work
organisation
– Enabled and supported by IT
• Systemic approach needed
– Developing new ways of working, processes, roles,
structures and IT
• Change of project name?
– National Programme for Service Delivery
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Leadership and ownership
• Senior end-users need to own and lead the project
– Pull through the new working practices needed to deliver a better
service
• IT community needs to work with the end-user
community
– Deliver what is wanted and needed
– Support new working systems
• Project team must be multi-disciplinary
• Time and energy must be invested in understanding and
changing how service delivery is structured and
organised
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New metrics
• A new set of performance
metrics to guide the project
needs to be established
• Many criticisms of
measurement systems (Neely
et al., 1995):
– Lack of a balanced approach too much focus on time and
cost
– Emphasis on short-term
thinking and focus
– Lack of systems thinking
– Lack of connection with
strategy
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• Metrics used for evaluation
and management are often
strong drivers of individuals’
behaviours and priorities
• A change in mindset would
require a corresponding
change in metrics
– Project about providing new
working practices and
processes to enable improved
delivery
– Metrics should include the
performance of the practices
and processes, and the
quality, timing and costs of
service delivery
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Reflect and plan
• In the immediate future, NHS senior user managers need to ask…
– Do we need this new system? Will it deliver service benefits?
– Have we included consideration of all the key issues in the
project?
– Does the project team include all the necessary skills and
expertise?
– Who owns and leads the project?
– Is the project being ‘pushed’ at the end-users or are they ‘pulling
it’ into their work?
– Have we learned the lessons from elsewhere?
• Reflect on the answers
• Put plans into place to act upon the results
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Conclusion
‘There’s no such thing as an IT project,
merely business change projects,
mediated by people and ICT’
(Prof. Jim Norton, Parliamentary Office of Science and
Technology, 2006)
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Case 1 – Lyons Confectionery
• Background
– Make and deliver cakes to retail outlets throughout
the UK
– Sales Director wanted to improve sales, quality of
information, and control over the process
• Change implemented
– Adopted a system of hand-held computers for
delivery drivers
– Information downloaded each day at the depot and
available to all other departments
– Project driven by Sales Director
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Case 1 – Lyons Confectionery
• Why successful?
– Multi-disciplinary team - IT simply formed part of the
team
– Stakeholders involved and needs met
– Project owned, led and pulled into business by senior
end-user
– Systems view adopted – considered business
processes, working practices, roles, skills and IT
• One of the most successful change projects
witnessed!
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Case 2 – A manufacturing
company
• Background
– Major manufacturer and user of IT systems in
UK
– Traditional management of internal IT projects
• Projects managed by senior IT manager
• Expertise, time, money and effort on IT issues
• New IT system handed over to line manager once
designed – push system
• Disappointing results
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Case 2 – A manufacturing company
• Change implemented
– Projects to be managed by line manager
– Responsible for design, implementation, use and
effectiveness
– Continuity of responsibility and ownership
– Increased thinking about the wider impacts of the new
system
• Why successful?
– Change in ownership led to the adoption of a systems
view
– Single most important change in how the company
managed projects
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MESSAGES
• Technology may not be needed
• Technology is more important than people
• People do not have a role in advanced systems
• We should trust the technology and the
technologists
• We should leave IT to the experts
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Why is it harder in the NHS?
• Public sector projects face specific difficulties
–
–
–
–
High visibility organisations
Risk averse culture
Need to meet politically driven timescales
Enormous scale and complexity
• Change more difficult to manage in the NHS
– Large, politically charged organisation
– High visibility and high stakes
– Highly differentiated environment comprising multiple
professional groups, each with their own agenda
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Why is it harder in the NHS?
• Doubts over the competencies and experience
of staff managing changes of this magnitude
– Is there a track record of effective change
management?
• No single performance metric in the NHS around
which everyone can co-ordinate their efforts
• Complex nature of the IT and service delivery
systems
– Cut across professional groups, existing
organisational boundaries and geographical locations.
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Ownership and Continuity
• Artificial boundaries should not be imposed onto
organisational processes
– Don’t split assembly work from testing
– Don’t split design from manufacture
• Logically connected processes should be organised and
managed as seamlessly as possible
– E.g., successful reorganisation of neurology and hearing
departments in Leicester Royal Infirmary to increase continuity of
patient care
• Negative consequences of fragmented processes
– Increase the scope for conflict between stages
– Lack opportunities for learning and improvement
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LEVEL 1
Technology
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Use
Social
44
LEVEL 2
Technology
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Social
Use
45
LEVEL 3
Technology
Use
Social
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LEVEL 4
System
design
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Use
47