Recently at the IT Service Management 2014 conference I got into a debate via social media about the need for a Chief Digital Officer. The presentation was on cloud computing and service management and the presenter suggested that an organisation going down a cloud route ought to have a C suite person responsible for data.
I challenged this with the comment that if an organisation has a Chief Information Officer then they already have this in place! A little cheeky really as I guess I would protect the role of CIO, but the rise of Chief type roles relating to technology will at some point be unearthed as a cash cow for the IT executive. In some respects maybe we ought to come out now and be honest that at the executive level, if we can have one role responsible for technology generally then that is a great achievement and a leap forward in the last five years.
Chief Technology Officer, Chief Digital Officer, Chief Innovation Officer, Chief Information Security Officer, can we roll all of these into the CIO role? Surely this is just begging for the ‘too many chiefs and not enough Indians’ phrase to be used by someone. Even at the Information Security Forum Congress there was a whole workstream on ‘will the CISO be the new CIO?’. It seems everyone wants the CIO role to become something else.
Organisations want to place the release of benefits from technology at the centre of what is being delivered. I believe that the CIO is the right role to do this. Information is surely the most important phrase out of all the chief related roles, after all we don’t just want to collect date, we want to change data into information and put it too good use, and with that in mind surely the CIO is the role at the top of the technology chief-doms?
We have been using phrases centred on the collection of data to create insight for a couple of years now. Hearing it echoed back by some of the most senior people in our organisation makes me think that we have got the message right. The fact that our information is credited by our CEO as being our second most important asset tells me that the role of information is more solid in its foundations and we have matured from the need for a Chief Data Officer as we have a collective responsibility for information through a single point of responsibility at the top table.
The elaboration that the information strategy had to go through to reach the point where the organisation consistently considered information over data was quite a journey.
For us this journey started with creation of the Information Strategy in mid-2011. At the very core of the strategy we pinned our designs on a transformation where the systems that collect and manipulate the data are considered separate to the information the organisation lists as an asset. This separation would allow the organisation to have a clearer understanding and view of the value of its information rather than considering everything to be technology, wires and tin.
The team that volunteered for the delivery of technology across the organisation were the key authors for this strategy. However to ensure that the transformation from data as part of technology to information that delivers insight required the team to work at the core business end of the organisation. This would require far more understanding than had been seen before from a technology team, suddenly empathy became a skill for a technologist to have.
The engagement of research teams and executives from many speciality areas was actioned on the basis that they would ultimately then be able to influence the deliverables that ensured the implementation of the strategy.
So now several years later we are coming to the end of what the strategy prescribed, and as I said earlier we now hear the most senior parts of our organisation echoing back the information that delivers insight phrase rather than data collection. However we need to maintain this attitude, once there it doesn’t simply exist because it has been achieved.
So our organisation is sticking with the concept of one C suite role responsible for the delivery of business change and benefit through technology. The role will remain strategic in focus and be the voice at the board that is responsible for making the most from technology, but, they will be responsible for the data, its security and the innovation it brings as well.
The race for the truly smart home is on, when your fridge can create your shopping list on your phone. It can add to that list as your friend takes the last cold beer, advising you which supermarket to call at on the way home from work to pick up the best value replacement! Then the Internet of Things has become truly valuable.
This isn’t science fiction, this is here now, the Palo Alto company Nest Labs are now making the API behind this and other smart home solutions available ranging from kitchen appliances to the smoke detector and thermostat.
As your home starts to build an IQ what will the impact be on clinical research? I have been wearing the Jawbone Up since February, researching my own sleep versus activity and trying to hit the magic goal at least five in every seven days. The correlation between sleep and activity is clear, however I guess I didn’t need the Up to tell me that if I did lots then I needed more sleep! What is interesting is how that data can be added to with information about location and food consumed, the ease of keeping a food diary to understand the impact on sleep is now there and I now know to avoid cheese for a good nights sleep and that if I am away from home I can expect no more than four and a half hours sleep on the first night.
In a recent Gartner study it was reported that by 2020 there would be 30 billion connected devices worldwide. An IDC report indicates that there will be 212 billion ‘things’ connected to the Internet by 2020! McKinsey have been looking at the value that the size of this market could bring to the global economy, they have a suggested value today of $2.7 trillion against the market place that they define as the Internet of Things, by 2025 they suggest that this could grow to $6.2 trillion. All of these numbers make me shudder though, they seem to be equal in their impenetrable hugeness in a way to some of the big data numbers are.
Then you ‘throw in’ the iWatch in 2015, if it becomes as ubiquitous as the iPhone then many millions of people globally will be recording all manner of health information every day and perhaps making it available without the difficulties of consent to organisations that Apple believe are appropriate to be delivering research.
Tele-Health, eHealth, Tele-Medicine, terms that have been used interchangeably for years without a real leap forward in the beneficial impact they can make on the provision of health care. However as the Internet of Things truly takes hold these terms do come into their own and at last begin to put in place the building blocks to release benefits.
The concept of the Internet of Things breaks down an equally powerful social concept of the Digital Divide particularly for health and clinical research. After all ‘things’ is used as a definition largely to demonstrate how ubiquitous the internet will be, the digitisation and therefore connection of so much ‘stuff’ reducing if not removing the much maligned divide. As the next generation (and what will we go to after generation ‘Z’ I wonder?) takes to the digital world and the next generation of researchers and clinicians become qualified we will truly see an empowered citizen world wide.
Earlier this year I got involved in the creation of a piece of work called ‘The last train to Data-Topia’. In this we described a world in 2030 where research and health care went hand in hand. As the ‘Internet of Things’ moves from being part of the catch phrases of the famous consultancy firms and becomes more related to the reality of what can be done with technology the impact on clinical research can truly begin to be explored, not as science fiction, but as a reality.
eHealth and an easier path to clinical research really has become a possibility if the right ‘Things’ can act as the catalyst needed!
Earlier this yeah I volunteered to project manage a migration project that would affect everybody within the Clinical Research Network (CRN). The project brief was simple, to migrate over 500 accounts from the traditionally deployed email solution to the new NIHR Hub built on the Google collaboration platform.
Fairly straight forward I thought!
It quickly became apparent that there was a lot more to this project than to simply confirm user account details, migrating the data and let people loose in the wonderful collaborative world of Google. To begin with it was a challenge confirming who the users were, if they needed an email account or even who the host employer was?
Then we began to speak to people about how they used their email. That was an eye opener! It should not have been, I have never worked anywhere where I have been told how to use email everybody has a different idea, lots of different ideas! Some people store emails with massive attachments within their email account, others archive every email going far back (in some cases) as far as 15 years and some opt to save them locally on their machine or on a network drive.
A lot of work and education to do then!
Like any transformational project some of the affected people understandably didn’t want to change, “I really like out Outlook” was an actual quote for a lot of people. To counter this we did a fews things:
It worked! The sceptics and resisters were won over by their colleagues who were empowered as change champions, giving credibility to transformation that would be hard to drive forward otherwise. Demonstrating the new product for people so see what they were going to get was also very effective, reducing the fear of the unknown.
The big day arrived and we did have a few teething issues but our migration partner and change champions were on hand to swiftly resolve the vast majority of issues. Within days people settled in to the quirks of Gmail, quickly learning new ways of working and drop-in sessions continued to be offered to help support the workforce.
For most people the Hub is a now vital tool for their day-to-day job. Gmail has been well established and the initial resistance to change has withered away.
People are using other features such as Google Docs, Google Forms, Drive, sites, groups and forums to communicate and collaborate with all sorts of people from within the NIHR and beyond, seeing the benefit of collaboration tolls in the world of clinical research.
Tasks that once took a huge amount of effort and generated large volumes of email traffic and documentation can be done simply on Drive with minimum fuss.
Polling people or collecting info can now be done on Google Forms or via the forums in Google Groups, meeting can be arranged within the NIHR across one shared calendar, Google Groups can also be used to manage workflow, replacing clumsy spreadsheets and email trails. Google Sites is being used to quickly create information and communication portals across the NIHR.
The list goes on, growing as the appetite and appreciation for the NIHR Hub grows too…..
Collaboration has become the word of the year for clinical research in the NHS because of this ‘simple’ project.
Was it an insult I thought, being congratulated for not being technical? It felt like an insult! Of course it wasn’t but it got me thinking about what it means to be leading a technology team in a large organisation where the best way to get engagement is to take away all references to technology, to ensure that the business benefit is at the heart of all conversations relating to the delivery.
There is a risk though, every time we re-iterate to the team that we are delivering business change projects that use technology to assure the benefits, that it is potentially another nail in the coffin of technology as an expertise area. And, if we forget technology because we are busy ensuring benefits are related, then just maybe the technology won’t work. After all it will not look after itself! The role of ‘IT Professional’ has been a recognised role now for an unbelievable 80 years.
The role is now at a pinnacle position in the majority of global organisations, and as we all know, ‘with great power comes great responsibility’. The question though is where does that responsibility best sit, with the business change capability or with the delivery of technology?
So, the trick is where to draw the line. The CIO of any organisation needs to be technically capable and aware of technology and the innovation that can be delivered through its implementation. The need to innovate can only be limited by the organisation’s capacity for change and the business need to do so. The CIO must be able to facilitate change and lead change in some cases due to the disruption technology can bring. However being able to tell the difference between a CAT5 and CAT7 cable is still important! The CIO has to maintain credibility in his or her own peer groups and some of that comes from business drive and success but some will come from the technical battle scars and badges that the CIO has. Without these badges and scars a good manager with a bright mind could lead any technology team, and actually maybe they can!
Early in my career I worked in a team of four project managers. We were not like the IT Crowd, but the next sentence may call that into question. We argued, probably daily, who was the number one technically capable out of the four of us. The challenges ranged from identifying the CAT cable type to being the office Excel Wizard and master of the pivot table. The fact that as number three on a good day back then I am now CIO of an organisation, speaks volumes for the role of the modern CIO compared to the perceptions of the role maybe as recently as five years ago. And yet in the last couple of weeks I feel the need to try to revitalise the importance of technology knowledge and capability in the CIO role.
To be a good CIO requires the ability to translate technology into business delivery. Not to allow all projects to assume technology is business delivery with a wired layer above it. We have successfully migrated the provision of email in the last couple of weeks, but there were bumps on the way. The vast majority of those bumps were technology based, sizing servers for the migration process and replacement kit issues. School boy errors! How did we let this happen? We focused so much on the business benefit. This was not to be a technical project – the training delivery and business change element of this project was immaculate, but we missed two technical elements that, on day one, gave us a bump because we were concentrating on ensuring the business had everything it needed.
The team were great, spotted the issues and ensured that user impact was minimal, but, if we had run the technology part of the project as we would have in the past then we would not have been distracted and missed the elements that caused the bumps. The technology team can and should deliver for the business, it should talk the business talk, be useful for more than wires, but, it should never forget it is there to make the technology work for the customer.
Searching for the balance between technical capability and business focus is like looking for black cats in a dark room! So how to find the cat! In health the balance between technology and business capability is a fine line, and not even a straight line I would suggest. Each delivery project or service needs to be evaluated not just for the final delivery but against the stakeholders within it. With our email project we knew that the stakeholders needed to be ‘sold’ on the business benefit of the migration and that the words we used could not be technology based. Ultimately, migrating was a business imperative, but, the business needed to be taken on a journey.
What was once known as next practice with technology is now best practice and the role of the technology professional now needs to be multi-faceted more than ever before.
However I am now counselling the team to also remember we are here as technology professionals, and we must not forget the technology, let the ‘geek’ part of us be at peace and shine through. It makes sense as organisations flourish that they begin to look to technology to be innovative in the delivery of a disruptive change rather than fighting a rear-guard action to save money and we need to be there for that, but when a project is about delivering a technical change we have learnt we need to get the technology 100% right and support the business change, and in that order!
The butcher, the baker and the candlestick-maker – or in this case, the educator, the shop owner, the mechanic and the know-it-all – were in discussion at the recent UK CIO 100 event.
(As an aside no one has worked out what a collective noun for CIOs is, although suggestions have included a ‘wally’ of CIOs and an ‘agenda’ of CIOs!)
As a group we were discussing whether a CIO of mechanics in the manufacturing industry can become a CIO in the health sector, primarily dealing with patients, doctors and nurses? My starting point was absolutely yes, be aware of the learning curve in doing so, but every CIO starts the response with the idiosyncrasies of their industry. “Yeah sorry, we are a complicated organisation, what it really means is…” they say, and therefore the learning curve is universal.
At the CIO 100 event we also heard how certain themes are the focus of so many CIO minds at the moment, when thought leaders speak and so many people sit and sagely nod you know that you have a group of people in the room who are ‘like minded’.
Or are they? My entire tenure as a CIO has been in the health sector. Is that because I am appropriately skilled for that arena or because I am worried about which side my toast will land on if I move out of my comfort zone? The group of CIOs were convinced that the CIO skill set is transferable, and yet the definition of what that skill set is was considered to be different dependent on the market area and the culture of the organisation.
So as a group this was pondered for a little while, very much from a positive point of view. We all wanted to do a job swap for a week at one point just to understand the differences. Key messages that came through though were:
Everyone wants to innovate – If an organisation has invested in the concept of a CIO then they are likely to be doing so because they need to utilise the disruption of information systems and technology to alter the business in some way, i.e. the power to innovate and manage innovation is a core competency.
Influencing up, down and sideways is essential – The ability to see the message at all levels and then influence its delivery is essential. The CIO role is as a friendly manager, stiff message deliverer, honest broker and executive, often all at the same time.
Translation of focus from technology to benefits – The CIO’s skill of technical balance is essential to success. A CIO needs to be excited by technology but not blind to benefits, simply wanting the new shiny thing will not deliver benefits.
Responsibility – The organisation wants a ‘go-to’ face for all things thrown in the bucket as technology: information, data, mobile, digitisation and a plethora of new exciting words that were picked up in a conversation that now need to be looked at.
So, taking the initial nursery rhyme analogy a little further, if our group CIOs were all in a tub and were about to set out to sea, what did that group think was the single skill that would keep the tub a float. The conversation seemed to lead us to that the key skills really all fall under one overarching banner, LEADERSHIP. The key skill that is both transferable and allows the CIO to be transferred, is the quality of the leadership.
In so many ways many of the examples above are simple subsets of leadership. They are skill sets that are transferable, it’s the context and relationships that need to be picked up, when, as a CIO the person moves from retail to health to automotive and still has to keep the tub afloat.
By the end of the evening we came to the conclusion that the transfer from one CIO role to another could be even easier with a community of support, and therefore if we all really were in a tub together about to set out to sea and between us we would know the life skills needed to get it to land again!
Originally published at – http://www.cio.co.uk
Where Does Improvement Begin?
In February 2014, I was at the Lean Healthcare Awards, presenting as a finalist in the Lean Champion category when I was asked how I had started on my improvement journey? I suddenly remembered a chance conversation from the start of my career that had inspired me for more than 15 years. Perhaps it can inspire you too.
Putting the Customer or the Patient First
Since 2006, I have worked on various assignments as a Senior Manager in the National Institute of Health Research Networks, increasingly specialising in service and systems improvement. But, for eight years before that, I worked in the software industry for companies like Hewlett-Packard (France) and Micromuse Inc., a specialist in network management.
I worked as a usability specialist, designing user interfaces, writing online help and user manuals. My job was to make the systems we built as simple as possible for our customers, hiding complexity and enabling efficient use. I now channel the same desire to improve to ensuring patients get the best possible service from the organisations I run.
I had Kaizen (http://en.wikipedia.org/wiki/Kaizen) in my bones long before I knew what it was.
How Developers Can Inspire
At HP, I worked with one of the best programmers I have ever met. Not your typical programmer of cliché; he was dapper, eloquent and had arrived in software via a classical education and a passion for mathematics. We shared a drive to make things simple for our customers.
One day our team was struggling with a seemingly intractable coding problem, when a fix emerged. It looked like we could all go home, but my colleague was not satisfied. He stayed back to work on it some more. When I asked him why, he gave a simple, powerful reply:
“Because we have yet to find an elegant solution.”
When he found that solution a few days later, he solved a thousand problems in one, because the code flowed perfectly. Ingenious simplicity.
So, whatever problems you face today, look for the elegant solution and you may just inspire yourself.
The 1st of April meant so much to our organisation this year! A complete change in how we manage the delivery of clinical research in the NHS goes ‘live’. No fuss, no trumpets, it simply comes into being: a change from over 100 contracts across the NHS to just 15, a change that sees a network of organisations empowered to deliver and take ownership of clinical research delivery still further.
For the area of the organisation that is tasked with delivering information systems to support research what does this mean? Well, firstly ‘big bang’ go live, something you are ‘taught’ to avoid at all costs needs to be done across multiple integrated systems for go live of the new structures, all at the same time on the same day! Changes to the data models, reference data, workflow, user based access controls, task labels, reporting infrastructures, web site addresses, you name it there is an IS component in there that needs to be changed as the clock ticks over into midnight plus one on the 1st of April.
Protecting ‘the business’ capability through this transition was something the team were tasked with managing, and rightly so. In a business where information is the foundation to what we do, this is a clear priority, the delivery of what we do needs to continue and performance needs to be maintained through any change.
The team has a strategy that by and large sees best of class solutions deployed across the infrastructure and therefore maintaining integration whilst delivering new systems is no easy ask. The control the team have applied to this is through the sharing of resource and a single model of understanding of the changes, not to mention some well placed business understanding and support. We are very lucky in that we have a development team that have an in-depth understanding of our business, our data structures and business needs. As a team the developers were able to get close to the business and the change programme to build a series of specifications in conjunction with the Business Analysis team. Not quite Agile but a hybrid model where the developer was able to translate the requirements directly with the business.
The 1st of April came and went, not completely smooth but the impact of many changes to the systems deployed was kept to as bare minimum as possible. The project and service wrap around the systems deployment was effective and we got to the 3rd of April with the ability to say all systems are live and functional for the new structures. Lessons learnt were how the team worked, how it got close to the business, and maintained that level of interaction throughout and also the level of interaction during go live, keeping all the key stakeholders informed and able to support and react if and when any issues came up.
All in all not an April fools day trick, just a really good result that will continue to be built upon over the next few weeks as any issues are reported, understood and fixed with cutover satisfaction at the heart of the delivery.
Do I want red wine or a beer? What system do I use to make that decision? Recent studies reveal that in so many decisions the human brain actually doesn’t make many choices based on rational though but on instinct. So if it’s a cold evening and I want to have a nice meal with my loved one then a glass of red wine will be a choice I don’t need any additional ability to make. If it’s a warm day and there is a garden to sit in then, again, no rational decision with tools to help is needed.
But with the implementation of the next generation of business intelligence tools we are able to move to a state of ‘natural analytics’. But what does this mean? Having recently been in Moscow I can say I could have done with a state of natural visualisation at the airport; as soon as you remove the modern English alphabet everything seems just a little more difficult to understand and you become paralysed to make decisions.
The concept of allowing space to think rather than know has been used to describe what natural analytics will bring, but even that doesn’t quite get to the ‘nub’ of what it means. To our organisation natural analytics will see the advent of a number of things. First and foremost, an increase in the number of people that systems will enable to become ‘data enthusiasts’ across our organisation. The concept of natural analytics to our organisation includes easy access to large data sets and the ability to wander through the data to create your own insight. The natural analytics concept applied to our Open Data Platform is new functionality we will look to deploy that will allow any user with any analytical competency to feel that they can access information easily, making connections, comparisons and creating insight that informs how they go about their ‘day job’. Natural analytics will extend the capability of everyone’s day job!
Doing things naturally should mean they are easy to do. Take the iPhone. Who would have thought when that disruption landed that the average human being would be happy with a phone with just 4 buttons. Previous to the iPhone the business leading solution for work had probably been the Blackberry, with its 40 plus buttons to access a lesser amount of functionality. It is now natural for us to know that different combinations of key depressions of those four buttons will achieve different outcomes, doing it comes naturally! Our desire for the next generation of Open Data Platform apps is to embrace this concept and apply it to them.
Also fitting in with the concept of natural analytics for us is personalisation. In a world where you personalise your teddy bear on the high street, your shoes on the internet and your musical recommendations at your favourite online store, we need to be able to embrace this commercialisation of personalisation within the creation of applications for business intelligence.
One of the regular questions from users of our business intelligence apps is the desire to make them be specific to their needs. You can currently do this but it’s a bit ‘clunky’ and involves bookmarking rather than truly setting up a dashboard for your own ‘personal’ use. The second phase of implementing elements of natural analytics will be two fold, firstly the further development of some additional skills to aid the creation of these personalised dashboards and then the functionality to do just that. Learning from some of the best delivery strategies for business intelligence out there we intend to ‘invest’ one to three in favour of usability over new analytics capabilities, safe in the belief that data can be turned into insight that can deliver intelligence.
Clearly that rational thought process on the difference between red wine and beer is all a little miss guided, the day before British Summer Time and I am in the sunny garden with a glass of red wine, rather than expected cold beer!
The conference as an education, I have never quite been sure whether that was really true or not at least until recently. I have learnt some ‘things’ at different conferences in the past but I hadn’t really experienced the ‘end to end’ learning experience that was the Gartner Business Intelligence and Analytics Summit in London in early March.
I can’t put my finger on what it was that made it stand out from other events, the people, the topic, the venue or just a collection of all of the above maybe?
The summit opened with a description of the different personas that make up the Business Intelligence enthusiast. The question of the whole audience was, ‘Are you an enthusiast, sceptic or pragmatist?’ As you can imagine a good balance of enthusiast and pragmatist, and, well you wouldn’t really dare admit to being a sceptic of the subject that the summit was about I guess.
But as an opening session this then got very interesting as the analysts presenting got into the detail of what each persona brings to an organisations ability to take forward a Business Intelligence agenda, and how to make the most of all three personas. The enthusiast was full of wonderful stories of BI in action. The first of these stories was about SMART Metering, and how, with the ability to track individual energy signatures in each household, in real time, it would be possible to identify houses where a hairdryer was being used excessively. Then make that data available to a hair product company who could drop targeted advertisements to the house for products to fix hair that needed treatment due to over use of a hairdryer! This wasn’t ‘pie in the sky’ this was possible now!
However the next persona was able to point out how close that was to the ‘Creepy Line’ a mythical line in the sand that, if crossed, will turn the population away from your brand. The pragmatist persona could, as you would imagine, see the use in analysing data but was quick to find and alert the audience to the risk of leaping forward too quickly and not considering the impact on customers in realisation to just what data could reveal.
During these three personas being discussed though the audience was able to see examples of the business impetus for BI in several different ways. These included, the connected LED light bulb from Phillips, the character categorisation tool for an individual Twitter feed from IBM and the ability to 3D print simple food items! All discussed and from the different perspectives of the personas.
The conversation moved on though to a discussion around the skills required for the capability of BI to make a difference inside a business. The presenters of this section posed a series of questions, not least of which, how many managers know the difference between, Mean Median and Mode. The team were putting forward an idea that the Information team should not be the team applying brakes, it should be the business asking to go faster and information providing the assurance that brakes exist should they be needed.
What is the reliability of BI and how do we improve its value was also covered as the two days went on. 80% of people would classify themselves as being in the top 50% of drivers when it comes to capability! The information department that provides the assurance of the car brakes will cut through the ‘Noise’ to get to the ‘Signal’.
Even Arthur C Clarke was brought to bear on the delivery of BI, his quote that ‘Any sufficiently advanced technology is indistinguishable from magic.’ Applying the concept of BI as magic was carried through to a number of the supplier presentations. Qlik talking about the work they have done on SMART meter outputs with British Gas and Microsoft and TFL presenting the case study of the analytics they can do, to name just two of quite a few. All of these staying just the right side of the ‘Creepy Line’.
Unlike other conferences I have been to there seemed to be a great deal of discussion over coffee and in the corridors between sessions, one that I found myself embroiled in was around at what point in time does information become BI. The discussion was around the concept of analytics as a staged approach:
The group of people were very quickly coming to the decision that you only truly can describe what you offer as BI if you have information presented that aids decision support rather than acts as a reference for what has gone before.
Comparing a Data Scientist to a Chauffer was the next tack! The chauffer, a role that has largely disappeared as a profession and yet there are still as many ‘drivers’ registered per capita as there were in the 1940s. The suggestion was that Data Scientists and Information Managers will be the equivalent in times to come, they will disappear as specifically identifiable roles as the use of BI becomes ingrained in all that we do, but the need to have experts, educated to deliver the requirement and the number of resource needed to achieve the demand will continue. But there was some additional conversations to this, where the consideration of building BI capability within the organisation was raised, a consideration of Information Systems people as the ‘store front’ to BI only.
As an organisation we want to get to this description and through our investment in BI tools we think we are on our way.
Overall though this is just a tiny snap shot of some amazing concepts and learning opportunities put there for us to use and apply. Certainly the next iteration of our BI strategy will incorporate as much of this as we can and it will even have an impact on the immediate changes we are making to the units we are deploying.
Richard Horton is a Service Delivery Manager at the NIHR CRN, he has responsibility for the service improvement of one of our major systems over the last 18 months, turning around a service described by some as the ‘rotten tomato’ service into one that the service board are now hugely proud of.
When organisations look at managing their IT systems as services, typically they start by focusing on how to get people up and running again when something doesn’t work as it should, then they turn to ensuring that changes to the systems in question happen safely. Once this sort of control is in place they start thinking about how to deal with the underlying problems that keep causing things to go wrong. The basic theory here is that behind a problem there is a root cause, so you dig beyond the effect that the problem has and identify the cause, which then means you can fix it.
That makes it sound simpler than it is. Let me take an extreme example – climate change. We know that sea levels are rising. What is the cause of this ? Is it melting ice ? How much does that diagnosis help us ? What is the cause of melting ice ? The world heating up. What is the cause of the world heating up ? And here the situation becomes complex because people don’t agree. Is it all a result of human behaviour ? Is it just natural climate cycles ? Is it a combination and if so how much of this are we able to influence ?
I was struck recently by a scientist who challenged a politician along the following lines. The politician was asked if he insures his house against fire/flood and the answer was yes. He was then asked why, if he insures his house against an event with a less than 1% chance of happening he doesn’t take action on climate change where scientists would say there is at least a 90% chance of it being a result of human behaviour.
Here we see some of the complexities. Insuring your house is a no-brainer – something that is culturally so established that we don’t question it. Changing our environmental impact is completely different. What actions should we change and what difference would they make ? How can we get a global change in behaviour ? How long would an effect take to be felt ? How much is the world prepared to invest ? How far will unilateral action make a difference ?
And all the time we face a challenge. We won’t see the benefit of the huge investment required for a long time, in fact the people who would really benefit (or suffer) from the actions we do or don’t take are our children and their children.
We make decisions all the time based on our perception of risk and opportunity. However, as the scientist’s question highlights, our decisions aren’t necessarily fully thought through or rational and consistent.
I work in the health research arena. Here long timescales are part of the territory, with a drug typically taking 17 years to get from the initial idea to a drug that’s available for patients. So, for example, it’s a concern now that pharmaceutical companies aren’t generating the next generation of antibiotics, though the effect of that absence won’t be felt for a few years.
In the past research didn’t necessarily get its appropriate place in its NHS context. Money was provided but there was nothing stopping that money being diverted to satisfy short term operational needs. While this may keep hospitals running in the short term it won’t address those future questions. Government money has been assigned for some years now, and the supporting research infrastructure has been refashioned to give clearer focus here. The results are being felt in more research happening more efficiently and more effectively. That’s only part of the equation – pharmaceutical industry investment is needed too, for example – but it gives an idea of how some structural changes can make a difference in our effectiveness in addressing problems with complex root causes and hard to quantify risks.
On a micro level, I’m involved in the same sort of activity – seeking to tease out those causes and issues so that the IT services we provide are fit for purpose and support the wider health research community. There is a constant tension between the short term demands of delivery today and positioning our service appropriately for the future. And, as with climate change, it’s a lot easier to argue for concentrating on something today that delivers a tangible outcome than to argue for making an investment for the future that gives a more indirect and less easily quantified benefit.
So, we come back to the beginning. Identifying root causes is a big challenge, but so too is defining the problem appropriately. It’s not just about spotting an immediate effect, it includes spotting time bombs that are waiting to catch us out. It’s not just about the obvious outcome that has already been or could be experienced, it includes having clarity over the deeper impact, and exploring what actual level of risk exposure we are carrying. And even then it’s not enough. If we don’t care about the future or are placed under undue pressure or do not have the capability to gain a consensus among the people with the power to change things, then even with all the evidence in front of us we will take the short term gain decision. Considering the longer term is fundamental to success in areas like health research and climate change, but is not just a Big Picture consideration. We can apply the same principles at our more local levels. We can, and should, seek to improve our practice in this tricky area bottom-up as well as top-down.
Of course it would be nice not to have the problems in the first place. If we can put effort into designing solutions to avoid problems then we make life a lot easier for ourselves – problems are harder and more expensive to identify and resolve after implementation than at the design stage. We can’t side-step cancer like this, but we can address problems faced by researchers by giving the research process that they use this sort of treatment. To go back to my first example, if we can design solutions for the future which anticipate the challenges our responses to climate change are likely to face, and if we can make it possible to address these challenges, then there is more chance of success. Sound a tall order ? I didn’t say it was easy.
To connect with Richard and find out more about his experiences in service management within the Clinical Research Network contact him at: Richard Horton