‘Fail fast and fix' – why NHS IT needs to approach risk differently

14 Jun 2016

A visit to the US highlights some important lessons for how the NHS can make the most of new technologies to transform services.

I am always inspired by the US Healthcare Information and Management Systems Society’s annual conference (HIMSS16). Faced with 50,000 expert delegates and 2.25 million square feet of exhibition space, it is hard not to be.

Besides my excitement over the latest groundbreaking products, I returned from this year’s conference with a powerful sense of just how enthusiastically the US embraces new ideas and culture change.

Not for the first time, it made me reflect on how progress in NHS IT is held back by the UK’s rather more cautious attitude to risk.

The government recognizes that technology can be a key enabler of the major change that is urgently needed within the NHS. It has pledged £1.8bn of funding to support a more joined-up, paper-free and efficient service.

There is no shortage of brilliant ideas for how technology can help.  From major software companies to start-ups, the UK is a hotbed of healthcare IT innovation.

Yet the sad fact is that the majority of innovations never break into the mainstream, where they could deliver huge benefits at scale.  At best they remain as small ‘pockets of excellence’ dotted across the country - at worst, an idea stuck on the drawing board.

Why?  The reasons are complex, but a central problem is that the NHS is not good at accepting risk, particularly in the high-profile arena of IT. 

Scarred by the legacy of failed national tech projects, managers are wary of investing in new initiatives they fear could cost them their job if they don’t succeed.

Then there are fears around patient safety – in NHS IT, an error in the system could literally mean the difference between life and death.  Data security and patient confidentiality are other areas of concern.

So what is the answer?

“Firstly, I believe it’s about changing our attitude to risk, and recognising that the radical change the NHS needs can only be delivered through brave thinking.”

Dr Shaun O'Hanlon

Risk-taking is an essential ingredient in innovation – by definition, breaking new ground means that you face an uncertain outcome.

The recent move by government to give every patient online access to their full GP record is a good example.  This is a bold move that will enable more patients to take control of their own care - but it has taken more than 10 years to overcome concerns about the pitfalls and to make it happen.  I firmly believe the benefits of this move will far outweigh the risks (and let’s be clear, there will always be risks).

Fail fast and fix

‘Fail fast, fail often, fail cheap and fix’ is the entrepreneurial approach evident in the US – we can learn much from this. 

“Rather than fear failure in healthcare IT, we must embrace it if we are to embrace success.”

Dr Shaun O'Hanlon

The NHS needs to move away from its tendency to procure over-specified IT systems that can take years to deliver and often don’t fulfil their intended use.  Instead, it could adopt a more iterative approach - working with agile suppliers to develop reliable, scalable and cheaper solutions that can be delivered much more quickly.

We are already seeing new businesses entering healthcare that have successfully applied this philosophy and made significant progress, generally working around rather than within the NHS.

Clinical leadership

Finally, but most importantly, strong clinical leaders have a vital role to play. 

“Without exception, every successful NHS IT project I have ever worked on has been down to the vision and drive of the people leading it.”

Dr Shaun O'Hanlon

We need to support and nurture these inspirational leaders, people who can harness the power of technology to deliver change and who accept that risk is part of that process.

We don’t have to look to the US for examples of this.  In areas like Liverpool, Cumbria and east London, for example, clinicians in CCGs and hospital trusts are realising the power of technology to transform patient care - driving through ambitious projects with passion and vision.  I applaud them.

The role of Chief Clinical Information Officer (CCIO) is pivotal. The CCIO has a vital role in selecting the best IT solution, but they must also make sure it is safe and that they create an organisational culture that celebrates success and progress.  This culture must also fix the inevitable challenges that arise, and prevent them from becoming obstacles and ultimately points of failure.

The CCIO network is doing great work to promote the role of these leaders but we need to ensure that they get proper training, recognition within careers programs and appropriate seniority within the NHS trusts.  In the US, most CCIOs are board members and if we want them to take the responsibility to lead the transformation clinical services through technology then why not here too?