How the NHS could have benefitted from an Agile, user centred design approach

By Danny Bluestone

As we wade through these times of austerity, we have become desensitised to announcements of cuts to public spending and the need to be more efficient.

When we hear the word “efficiency”, the first things that come to mind are workflow optimisation, technology and digitisation, offering long term savings and improvements. This vision was adopted by the NHS in 2002, however, regrettably it ended up blowing £11bn on an incomplete, ineffective IT solution.

Commissioned back in 2002, The NHS’s National Programme for IT (NPfIT) was conceived to give doctors, pharmacists and other healthcare professionals access to any patients’ NHS medical files from anywhere in the UK.

The theory was great but in practice the scheme was underestimated in scale and budget, resulting in shortcomings, delays and overspending by over 100%. Based on data from Wikipedia, the first 4 of the 7 deliverables (systems and health services) were supposed to have been rolled out by 2007, but as of 2009 only the electronic prescription and booking services had been completed, with poor adoption rates.

The scheme’s delay and budgetary issues were blamed on many things, from mismanagement and poor strategy to lack of skills and understanding. However, looking at the approach that was taken to managing the project, it’s easy to see where it could have been improved.

One of the most successful methods to managing a large scale IT project is to use a combination of User Centred Design (UCD) and Agile approaches. This involves a dedicated research phase to distil usage scenarios that are required for a project of this magnitude (as opposed to creating masses of requirement documents encouraged by more traditional project management frameworks). By identifying and engaging the key stakeholders from the research phase throughout the development and testing of the project, must better results can be achieved.

In this instance a UCD and Agile approach would have involved engaging clinicians in planning and then testing small batches of prototypes as they are released. These stakeholders would shape the deliverables and feedback to the development team, understanding that this is not just an IT project but actually a new, more efficient way of working.

During 2009 there was a great example of a successful UK health IT project (Cerner Millennium at Newcastle upon Tyne’s NHS Foundation Trust) where the project leaders ensured that clinicians were extensively engaged with designing the system. Neil Watson, Director of Pharmacy and Medicines Management at Newcastle upon Tyne’s NHS Foundation Trust, stated "Clinicians from all backgrounds have recognised that this is not an IT project and that to make this work it requires clinical buy-in. No matter how much you push from an IT point of view it has to be about clinical change."

A UCD approach entails engaging the stakeholders constantly during the design and development process to ensure that the system is created according to real user wants and needs. By extending the UCD approach and embracing Agile project management frameworks, which welcome change throughout the design and development process, it’s possible to evolve the system without revisiting the requirements and creating extensive documentation. An Agile approach is about iterative development, where the project is broken down into small, bite-sized chunks; with testing and stakeholder feedback at each stage .

For projects of this magnitude, gaining mass stakeholder buy-in is critical to evolving the project successfully. This can be achieved by releasing small versions of the system in batches and engaging correctly with the stakeholders, getting critical feedback early on. It’s stakeholder feedback that dramatically improves the chances of creating a successful user experience that is widely adopted. Hindsight is a wonderful thing but let’s hope that future public sector ICT projects can learn from the difficulties that the NPfIT project encountered.

About Danny Bluestone, MD of Cyber-Duck

Danny is the founder and CEO of Cyber-Duck Ltd, the UK’s leading digital agency in the field of UX (user experience), SaaS, marketing and apps. Danny’s entrepreneurial spirit has led to the company’s rapid growth since 2005 to its current status as an award-winning innovator at the forefront of the interactive media industry.

Danny is a frequent speaker at both academic and industry events. He has addressed audiences at Apps World, Ad:Tech London, Chartered Institute of Marketing (CIMCIG), Internet World, Tobii Eye Tracking Conference, Figaro Digital and is a blogger for PostDesk and the British Interactive Media Association (BIMA). He provides both strategic counsel with a hands-on approach, enabling customers to leverage best-in-class digital practice to maximize their business.

About Cyber-Duck

Established in 2005, Cyber-Duck is a leading independent digital agency with a world-class reputation, working with global brands including The European Union, Aston Martin, Imperial Tobacco Plc, Arsenal FC and Maxinutrition (GSK). Cyber-Duck is ISO accredited with its core services being Web & Mobile Production, SaaS Technology, User Experience, Consultancy, Marketing Branding and Hosting & Support. Cyber-Duck has won some of the most sought after industry awards including Webby Awards, the Construction Marketing Awards, the Davey Awards, the Communicator Awards, the Interactive Media Awards, and the W3 Awards.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s