Malcolm Gladwell: why the NHS computer programme is like Paul Cezanne

 

A chat with Malcolm Gladwell the other day has thrown an interesting across-the-pond perspective on the malfunctioning relationship between the NHS and information technology. Gladwell believes that many of the problems encountered by the health services IT programme (£12.4 billion and counting, before you ask) may actually make for a better service.

Gladwell has taken an interest in the IT project — the linking up of personal care records, hospitals, GPs, pharmacists et al into and integrated, computerised whole — because of its intersection between the public and innovation.

He has two simple categories for such relationships, “special innovation” and “experimental problem”... and no prizes for guessing where the UK’s decade of computer wrestling fits. But it’s no bad thing, says Gladwell, drawing up the interesting comparison with the artistic development of Pablo Picasso and Paul Cezanne. Picasso was the great radical, revolutionary and innovator, churning out dramatic ideas that jumped into the unknown. Cezanne may have been a radical too, but his was a slow process of refinement, a process of trial and error.

The NHS is its Cezanne stage now, he believes...

Attempts at sudden innovative overhaul — a great top-down revolution run by Westminster — ruffled feathers, but floundered. Now we must focus on the more thoughtful tinkering that can usher in the sought-after changes.

The service limitations, a decade into the 21st century, are still severe: many people still cannot email their GP’s surgery, most can’t get prescriptions processed online, none use and manage their own online care record. What Gladwell reckons the project needs is a “slam dunk for the users” which will lend it proper public momentum.

Once up and running, the benefits will be obvious: as services shift from hospital to high street and home, and care becomes more responsive to needs of the individual, information will determine the quality of the patient experience. We will see patients, led by the massed ranks of those with chronic conditions, taking an ever greater responsibility for the medically-informed management of their health. Those once cared for in wards or residential homes will stay longer at home in the community. The monitoring of illness will not be conducted with occasional check-ups, but by the continuous assimilation of medical data. Diagnosis and treatment decisions will no longer be restricted to the GP’s surgery and the consultant’s clinic. Outcomes from good practice and trend irregularities from bad will help refine the best quality of care.

But what will provide Gladwell’s gamechanger? He points to something along the lines of the ATM machine for online banking: an IT revolution came upon us almost unnoticed after we had been won over by the wonders of cash out of a wall. That, as Gladwell might observe, generated the tipping point... He hopes the NHS can find the same.

Comments

[Frank Upton]

The NHS system is only a database and an intranet. It's as complicated as one wants to make it.

[Paul R McAlonan]

As an individual, employed by the NHS in an IT role for the past 14 years, I found this most interesting and having witnessed some of the early brushstrokes I can't help but feel that until someone with a true understanding of the big picture takes up the palette, the "system" will continue to suffer setbacks and localised failure.

[Bill Melsom]

The artical does the usual. The ideas have merit. But the underlying problem is if you put British Government (whatever party), civil servants and the NHS together in an IT project it will always fail it has to date and will continue to do so until their is a mass change of people involved.

[John, London]

This was a disaster from day one.
A huge project like this requires a consultation process with users and IT professionals at the start to discover what's desired and what's feasible.
Then one decides what will be delivered in 1st, 2nd, 3rd wave etc, and more importantly, what will not be delivered. The project needs one project manager to act as chairperson to reach agreement on this.
Following this, you implement. Obviously there will still be scope creep, but the project manager makes sure this does not overwhelm the project.

The NHS project was still in consultation after implementation had started, and no-one was checking scope creep, with ministers continually promising something new.
This is the blueprint for a project that will take forever, cost the earth, and not work properly.

[U.S. Doc]

Like the rest of the genre: trivial poppycock.

The reason the NPfIT is a mess is that people imagine Gladwell is insightful. There were plenty of qualified people who pointed out that NPfIT was a non-starter but the gov't ignored the genuine experts and listened to the one-slide-deep folks.

But take heart, on this side of the Atlantic we're going to spend much more to do it right and still end up with a pile of crap.

[Frederick Roots]

I have a son who works for a multinational IT services company. They deliver ultra secure services to banks, controlling most of the hole in the wall banking network. The system works. It is secure. They also deliver services to several large multinationals, reorganising data from many sub companies that have been taken over over the years, so that everyone in the whole outfit is using a common platform to store and access every kind of data they have, from financial data, and production data in factories in many different countries, to human resources information. They do this in a very cost effective way, and they do it in close consultation with the operators of the businesses they work for, from the board room to the factory floor. He (my son) works in different European countries every week, and sometimes two or three countries in the same week. What is so special about the NHS that its systems A) don't work, and B) cost so much of our money? Oh yes - I forgot, the Labour government is involved and constantly meddling with the specification, after back of a fag packet talks in Cabinet, and at the Department of Health.

[scass]

Great how Gladwell manages to assimilate this idea...http://www.wired.com/wired/archive/14.07/genius.html ...and make it look like his own.

[the_near_side]

JOHN of London @13:35 10 Nov 2009 hit the nail on the head.

I suspect a lot of public sector IT systems don't work well because a standard system has been amended and amended to suit the old-fashioned string-driven paper-based procedures currently in operation, and the politicians keep changing the requirements.
Review the current system, eliminate the unnecessary, simplify what's left, THEN look for a best-fit standard IT system. Or, the plane won't take-off at the end of the runway.

Hugh Elliott

[Lorne]

It is a failure because the policy is to recruit complete idiots in the cause of fairness.

[Allan]

The agency set-up to oversee the NHS IT, NHS Connecting for Health is to blame for non-delivery. After 6 years the basics such as controls, methodologies, and information systems are not in place. It employs 2000 staff to do work that a professional team of around 100 Programme managers, project managers, business analysts and admin could do more efficiently and effectively. It is a job creation scheme, riddled with politics and hamstrung by poor quality leadership and sub-standard staff. As someone with several years experience working with the NHS, I see their incompetence and inefficiency everyday.