Anyway, trying to catch up with what's been happening in the world for the last couple of weeks (whilst my head has been stuck in the PRINCE2 manual) and very very slowly catching up on emails!
This story came out of the BCS Newsletter today - a report on the Thought Leadership Debate on transforming health services. http://www.bcs.org/server.php?show=ConWebDoc.18922
The key points made are that:
- given the pace of change is faster than our ability to learn, centralised solutions aren't appropriate and that modularity is a more realistic approach, especially as the NHS itself is modular in nature. Prof Eddie Obeng pointed out that policy makers should use this to their advantage rather than work against it. It's an interesting perspective - centralised solutions can be costly and overly generic but having said that, without some kind of central drive, what happens to interoperability?
- there is currently an over-focus on processes. I wonder if this is because of the need to use PRINCE2 methodology for managing projects which is process-driven. Although PRINCE2 does acknowledge the need to engage people, it perhaps isn't accorded the status it deserves - MSP does address stakeholder engagement to an extent but even that probably isn't enough (though have to admit haven't read the latest version of the MSP manual).
- another point made was that the end goal is improving performance - why isn't the NHS achieving this? The elements (e.g. hard working workforce, political drivers, funding) are there but there doesn't appear to be a holistic approach to pull it all together.
- some of the points made in the ensuing debate include:
- there aren't sufficient incentives to drive change
- there is no shared vision across the NHS - the NHS is not one organisation and doesn't have a single culture
- one size fits all solutions won't work - some things are best done locally, some nationally - but even national solutions may need to build in the facility for local personalisation, otherwise people will develop workarounds
- the NHS needs early adopters to help coach others (this model was used in the ESR programme)
- we shouldn't underestimate incremental change