As Britain continues to work its way through and (hopefully) out of the recession, the government continues to explore ways to save money while improving the efficiency of costly public services. Danny Bluestone, MD of digital agency Cyber-Duck looks at why the NHS should consider User Centred and Agile Approaches to IT Projects.
The adoption and implementation of appropriate “eGovernment” policies and practice in Europe, has been high on the European Union (EU) agenda for well over a decade, with it aspiring to be “the most competitive and dynamic knowledge-based economy” (European Commission, 2002).
The theory behind this vision is that governments can achieve savings whilst improving services with modernisation using technology. It is then nothing less than ironic that 10 years later, in the midst of the world’s longest economic slump, a governmental organisation like the NHS is staring at the ruins of a £11bn incomplete and ineffective IT solution.
The NHS National Programme for IT (NPfIT), commissioned in 2002, was meant to provide doctors and other healthcare professionals with the ability to access patients’ NHS medical files from anywhere in the UK. The NHS NPfIT project has proven not to work. As a result of constant delays, mishaps and uncertainty, only 10 of the 166 trusts from the north, midlands and east of England have received a basic version of the system (Telegraph, August 2011). The project has since been sold on to an American IT services provider, CSC, who are continuing to work on it.
So why did the government fail? Gov3, an eGovernment Consultancy, in “Breaking Barriers to eGovernment” suggests that government projects can fail due to a lack of understanding of user needs, lack of engagement with stakeholders and not enough focus on breaking development into small steps.
Many of these shortcomings would not be apparent if a User Centred Design (UCD) approach had been adopted from the get-go. This approach generally involves representatives of all stakeholders throughout the planning and production process. Indeed, one of the most significant complaints that arose from the NHS project was the reluctance of the Department of Health to involve clinicians in the decision making. A system as complex as this should have been built around their requirements (a standard UCD practice) rather than from the perspective of IT professionals.
The other shortcomings of the project would have been overcome by combining this UCD approach with Lean development philosophies. According to an Oxford University study, large IT projects are 20 times more likely to fail than smaller ones. This can be avoided by applying an Agile (or Lean) approach that breaks down large projects into smaller more manageable “sprints”. Each sprint is a bite-sized chunk of the final system that undergoes rigorous user testing before being released. The system can be continually changed and fine-tuned as it is being developed, rather than testing everything at the very end, only to realise that things are not working.
A combined Agile and UCD approach, would involve IT professionals consulting the users (doctors, clinicians etc.). Sections of the system would then be developed in small batches and tested by the clinicians before developing additional features or functions.
The NHS continues to face the challenges of integrating all the UK’s medical files into one system and it’s been frustrating to watch this project unfold over the last 10 years. By applying proven User Centred Design principles, Agile development process and modern programming languages it is possible to achieve a successful product on a national level no matter how complex it is.
Tom Loosemore who works for the UK government was tasked with revolutionising the government’s approach to its own websites by grouping 293 government websites, from paying your tax disc to education and setting up your own business. The project www.gov.uk has been highly successful and at a recent Product conference Tom offered the following advice: “Start small, run fast, gather momentum”.
By Danny Bluestone
MD
Cyber-Duck
www.cyber-duck.co.uk