Use of Information

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Use of Information Communication Technologies
to transform service delivery

• JOHN HARRIES Director BT Global Health Practice
• john.harries_at_bt.com

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• If you think you have a new idea, you are
  wrong. Someone already had it. This idea isnt
  original either I stole it from someone else

Suttons Law Robert Sutton
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People, Process Technology
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But..

• Cranfield Vlerick Leuven Ghent Mng School
  Belgium.
• October 5th 2006 Survey of 1000 organisations
• 57 Organisations are not satisfied that they
  are getting value from IT projects
• 31 Organisations didnt know whether they were
  or not
• 73 said significant improvements were needed
  if their organisations are going to deliver
  satisfactory value from IT investment
• This is the same figure as 10 years ago!

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And why is that then?........When

• 88 Organisations have a formal methodology
  for managing projects (53 10 years
  ago)
• 70 Organisations report having a PMO
• The majority of organisations plan in detail
  for the implementation of technology
• Maybe its because
• 40 Organisations plan for the process change
• 22 Organisations plan for the organisational
  change
• 31 Organisations plan for the delivery of
  business benefits
• 80 Organisations report inadequate review and
  evaluation of projects

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And also..

• ERP projects are on average
• 178 over budget
• 250 over time
• Deliver 30 of expected benefits
• Krumholz, Galliers, Coulianos Maiden
  (2000).

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The bridges across the rhetoric/reality divide
looks like this..
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And its not just IT projects. Most other systemic
change interventions fail.

• Quality Circles 90 Abandonment rate
• TQM
• Business Process Re-engineering
• Lean????

70 failure
There is a huge industry focused on evidence
based medicine but almost nothing on evidence
based management. Service transformation
depends as much on management practice as it
does on medical practice
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Some old (good!) ideas about change

• IT does not drive change. Interpretive
  flexibility is always present so dont bother
  aspiring to command and control.
• Programmatic change endeavours usually fail
• The evidence base for clinical care is often
  contested. The evidence base for managerial
  intervention is usually non-existent.
• Change is often disruptive and can be damaging
• Certain contexts are more receptive to change
• The adoption of innovation is dependent on
  trialability.
• Health and Social Care behaves as a complex
  adaptive system

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Disruptive change.
and
Change or Die
New product introduction and organisational
mortality in the US bicycle industry
1880-1918 Dowell
Swaminathan
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Disruptive Change
Structural Inertia Theory
Mission Technology Authority Structure Marketin
g Strategy
Hannan Freeman
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• New product introduction and organisational
  mortality in the US bicycle industry 1880-1918

Organisational Mortality
Preservation of core routines/competencies
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Receptive context for changePettigrew et.al.
(1992)

• Quality and coherence of local policy
• Availability of Key People leading change
• Long term environmental pressure intensity and
  scale
• A supportive organisational culture
• Effective managerial/clinical relations
• Co-operative inter-organisational networks
• Simplicity and clarity of goals and priorities
• Fit between districts change agenda and its
  locale

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Receptive context for changeMcNulty Ferlie
(2002)
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Trialability.
Enlightened trial and error outperforms the
planning of flawless intellects IDEO
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Trialability
Pilots
Solution Space
Organisations
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The Public Health perspective
The objective is population improvement Not
individual organisation optimisation
Organisational Population
Quality/Performance
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Health Social Care as a complex adaptive
system.Wheatley (1992) Chapman (2002) Plsek
(2001)
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So What?

• Avoid technologies which attempt to mandate one
  best process or organisational structure or
  which make unwarranted assumptions about user
  behaviour
• Emphasise trialability not you do it and tell me
  what happened but we do it and learn from each
  other
• Bridge the academic/practitioner divide
• Choose solutions which provide the potential for
  both local experimentation and national scale
• The emerging User/Patient experience should be
  the driving force behind design

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An example BT Vital Life
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(No Transcript)
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None of these ideas are original!

• Abrahamson E. Management Fashion Academy of
  Management Review 21 1996
• Castorina P. Wood B. Circle in the Fortune 500
  Why Circles Fail Journal of Quality
• and Participation. 11 (1988)
• Chapman J. Systems Failure Why Government must
  learn to think differently
• Demos 2002
• Dowell G. Swaminathan A. (2000) Racing and
  back pedalling into the future New
• Product introducion and organisational mortality
  in the US bicycle industry
• 1880 1918 Organisation Studies 21.
• Easton G. Jarrell S. The effects of total
  quality management on corporate performance
• An empirical investigation Journal of Business
  71 (1998)
• Hannan M.T Freeman J. Organisational Ecology
  Cambridge MA Harvard Business
• Press (1989)
• Krumholz,M. Galliers J. Coulianos N. Maiden
  NAM. (2000) Implementing enterprise
• Resource Planning packages in different
  corporate and national cultures
• Journal of Information Technology 15.
• McNulty T. Ferlie E. Reengineering Health Care
  the complexities of
• Organisational Transformation Oxford 2002
• Pettigrew A. Ferlie E. McKee L. Shaping
  Strategic Change Sage 1992
• Pfeffer J. Sutton R.I. Hard Facts. Harvard
  Business School Press 2006

john.harries_at_bt.com