Christmas lights and (re)assurance

I wasn’t the biggest fan of physics when I was at school. Too many formulas and too much time contorting my hand trying to remember if it was the Left or the Right hand rule I should be using. But one thing that I do remember is learning about circuits in series and in parallel.

In a traditional string of Christmas tree lights in series if one bulb blows, they all stop. When this is replaced, then the lights carry on shining. This was what sprung to mind the other day when I was chatting to a colleague and friend working for the NHS but very much engaged in digital transformation.

“Unfortunately we then ran into the chief nursing information officer who has put approximately a 3-4 month delay on the whole thing because of a mountain on bureaucracy…Hopefully it is just about to get going.”

When I asked a colleague who works in industry, they gave a wry smile and agreed that these projects always move at the speed of the slowest member of the project team. Which I agree with – except this project wasn’t moving. It had stopped. It was as if a bulb had blown and the whole string of lights had stopped working.

Which really got me thinking – were these questions that were being asked by this individual were entirely new, or whether they were things that had been answered already along the way.

If we think about the process of implementing a new digital solution, it is pretty convoluted. I am going to drill down into one aspect of a digital solution – where the data is stored, and use this as an illustrative point, but in actual fact the requirements are many and varied.

The implementation process starts with early conversations relating to identifying a mutually beneficial opportunity, during which time certain key aspects will be highlighted. Let's stick with Data Storage – the where and the how?

It may be that a PIN (Prior information notice) is released which is a statement of intent to launch a procurement exercise, which is more for suppliers to be on red alert for the next stages which vary slightly, but include market engagement events where questions about data storage can be asked, prior to a selection questionnaire which is to make sure that only suitably qualified candidates proceed to tender submission, and ensure that certain things such as, yes you’ve guessed it, Data Storage have been addressed.

Then the Invitation to Tender process begins, which will have very clear and specific information requests about a range of contractual, specification and technical questions, as well as pricing. I am sure you have got the idea here, but Data Storage will feature here too.

After this is the presentation or demonstration phase, followed by champagne and high fives as you celebrate (or commiserate) the announcement of the preferred bidder.

Shortly followed by the contracting and the raising of the Purchase Order.

At each stage of this process, there is scrutiny and often entirely legitimate questions raised as each person – be it finance teams, or legal, or CDIO, or various other people who can probe and ensure the best and most appropriate resolution of their queries – and importantly make sure that their concerns regarding patient care and allocation of public resources are met. Which is really important.

But having undergone all this scrutiny, with questions and challenges placed at every step along the way and once the ink has dried, the next step of hurdles arises.

These include DPAs, DPIAs and a host of other questions, challenges and acronyms, including questions about Data Storage.

It would be ridiculous to suggest that every PIN and ITT should be reviewed by everyone in the organisation, but it does seem interesting that the processes leading to the review of the project by for example, the CCIO, are not viewed as sufficient.

Herein lies an interesting quandary. I sit on several Boards in varying capacities, and each one comes with its own challenges and nuance. One of the challenges of corporate governance – particularly in a large organisation, is the fact that not everyone can be sighted on everything. But instead it is a fine line between assurance and reassurance. Whilst used interchangeably, they are not the same. Assurance is an evidence based process that the systems in place are sufficient and robust. By contrast, reassurance is about comfort and preventing worry. (These phrases I’ve shamelessly stolen from David Holden's Good Governance Guide - thank you; link below). 

People may be reassured by reviewing a research proposal or a tender submission line by line themselves, but the question is whether everyone in the organisation needs to do this? And if they do, what does it say about how they view their colleagues? And would their colleagues have as little faith in their abilities as they do about others? 

There are all kinds of reasons why this has proliferated. Large siloed organisations might not realise what processes are happening outside their scope - for example, the digital team might not be aware of totally separate processes being performed by, for example the IG team. It might be that the organisations feel psychologically unsafe. It might for a whole bunch of other reasons that I haven’t thought of. 

My hunch is that nobody wants it to “come back to them” - a phrase that I hear so often in so many places. 

And this is just one of the problems. 

Any digital transformation project involves multiple stakeholders. And each stakeholder is worried about it coming back to them and getting the blame for whatever might or might not go wrong. 

This effectively means that there are a ton of people poised to pull the handbrake of progress and very few people prepared to “be brave” to sign off, and be decisive and move things forwards. Scrutiny is essential. Assurance is vital. Reassurance is important. I would argue that not one is more so than the other in different parts of an organisation. But when each part is reinventing the wheel you end up with slowed implementation, mistrust and an interdependence that inhibits progress rather than supports. 

Add to this, the fact that each PIN, tender and procurement is different. So for each of the 42 ICBs in the UK, this process will be unique. This will be followed by 42 unique implementation processes that will be like 42 chains of Christmas lights with their own individual points of failure. Likewise, the story will be repeated across the 14 Health Boards in Scotland, 7 in Wales, 229 Acute Trusts, not to mention Community, Specialist and Mental health Trusts. You get the picture. 

All too often it feels like the process is designed not to take people on a change journey with them. People are empowered to say no but not to say yes. And if one bulb goes out on the Christmas lights, the progress grinds to a halt and they all go out. And that’s really frustrating. 

So, for the decision-makers in Whitehall, NHS England, DHSC and everywhere else - my challenge to you is what can we do to add agility to the procurement and implementation process? And not reinvent the wheel every step of the way. 

https://www.good-governance.org.uk/assets/uploads/publication-documents/assurance-vs-reassurance.pdf

https://theconversation.com/to-understand-the-future-of-ai-take-a-look-at-the-failings-of-google-translate-251642