Thread by @mwardle

A new blog post: Let me tell you why we, in health and care, need to copy how the highest performing technology companies build & deploy software. You might accuse me of trying to create a public sector /NHS “Google” or “Amazon” and you might be right.
wardle.org/strategy/2019/…

Firstly, I’m sure that we all agree that we want to create a seamless patient-centred service that blurs the boundaries between disciplines and organisations across health and care. Likewise, we surely recognise that technology is an enabler of those ambitions.

But, I discuss the paradox that while the best way to build that seamless service is with technology, that technology should itself be highly modular, fragmented, & developed and continuously improved using an agile, responsive, adaptive approach & built on open standards.

It is vital that we stop thinking we can gather requirements upfront in workshops & move to use
real-life fast feedback to build a continuous learning system. But we need much more than agility in our software, but also agility in our approach to management & funding.

We know that modularisation offers the hope of independent and semi-independent development - permitting work in parallel and therefore at pace - with interactions defined by agreed technical standards, our “contracts”.

But we must also have overarching set of broad coherent principles, and to be open & transparent in setting strategic direction (“this is where we want to go”). We need that shared vision, and that must be focused on high level strategic outcomes - for patients & professionals.

At the same time we should be looking to create smaller, semi-independent teams trusted, and empowered, to take the incremental steps to get us closer to our intended destination. Those teams need to be cross functional and long-lived. Product not project is important.

We must focus on the outcomes we wish to deliver & recognise the importance of aligning our governance with architecture so that we can deliver true digital transformation for patients in Wales. Eg It’s important that we treat internal & external developers in the same way.

It is easy to conclude that we need Big Bang transformation change in organisational structures & governance, but in fact, we can be agile in our transformation efforts by picking on one or two small examples & delivering valuable results and most importantly, valuable learning.

I suggest picking on demographics and appointments/scheduling - as programmes of work to demonstrate how this approach can work.

We need seamless health and care service - to do that we must become patient-centred, with a “single patient record”, creating data and software services that can span organisational & speciality boundaries to provide a truly coherent single care system, from cradle to grave.

I personally think that it’s our job in the public sector to build some of the foundational systems I touch on here - and unashamedly - want to build in-house capability - but also see this approach as opening up to our academic and commercial partners.