A manifesto for digital transformation in healthcare in Wales
We have an extraordinary opportunity to transform the way we think about the use of digital technology in healthcare in Wales.
My manifesto has five core principles:
We don’t have all of the answers.
The only constant is change.
We should work in the open; we must be transparent and foster rigorous debate.
We set broad top-down principles and standards, but empower trusted teams who have freedom to deliver but also take responsibility for their work.
We must deliver, deliver and then deliver again; we iterate, we improve and we continuously learn.
Technology is a tool; our work in developing and deploying technology is not an end in itself but instead, its use should help us to deliver our wider strategic aims.
It therefore follows that our goals must be to deliver technology as quickly and as safely as possible. Some argue that those goals are contradictory, but evidence from the highest performing technology teams shows that adding more processes and procedures designed to add safety has the paradoxical effect of worsening safety. As such, we need to rethink our approach to project management.
Our culture must be open so that we are transparent about our success and our failures. We must foster constructive debate. Challenge me to defend this approach and let’s all learn from it!
It is seductive to think that, as a small nation, we should centralise. It is similarly seductive to think that we lower risk by centralisation. Neither are true. Getting more and more engagement to understand requirements up front does not work. The best approach is to deliver functioning technology and then improve it based on rapid and continuous feedback.
As none of us have all of the answers and we work in a complex and highly adaptive group of organisations, we must recognise that any credible plan must, itself, be adaptive and capable of evolutionary change.
Likewise, we must recognise that one size truly does not fit all. While Wales is of similar size to a strategic health authority in England, our structures and existing technological investments are much more complex. One of our goals must be to safely reduce needless variation, and yet at the same time foster innovation, permitting that new work to scale across all of our services when it is proven.
But not one approach solves everything we face; instead we should buy products that are an established solution to a problem and focus our in-house work on solving problems that only the public sector can do. That means blending different approaches and being transparent about the decisions we make.
The steps we need to take are:
- focus on our customers; that means professionals and patients. We align our information technology work with our wider service goals.
- modularisation, so we break apart our architecture into smaller, discrete components that can be developed independently of the whole.
- create small, cross-functional teams who are tasked with delivering those modules, iteratively, building in quality and safety from the onset.
- adopt open standards, so that we standardise the interactions between our modules speeding up delivery by permitting parallel developments and limiting the number of people from different teams who need to be involved in any decision.
- prioritise tools to acquire, store and make sense of meaningful clinical data.
- become open by default; for example, one of our first debates must be whether it makes any sense to run two data centres in Wales. Let’s debate!
- focus on developer productivity, let’s copy the architectural and cultural practices from the most productive technology teams.
- we should consider developers in three broad categories, and treat them equally with the same tools, frameworks and documentation available, those providing shared national services and components, those working in and across health boards developing solutions using the national toolbox of services and those outside of the NHS in a thriving commercial and academic ecosystem.
I truly believe that Wales could have the best health information technology in the World. We are small, we have a unique and special health service that could be transformed by the safe and efficient deployment of technology.
But we need to do things differently to what has been tried in the past. Almost all of my blog posts explore these issues in more detail.
Tell me what you think, let’s debate… and learn.