Study IT history for good health

To deliver significant changes to the health service there must be a fundamental rethink in organisation, process and people...

To deliver significant changes to the health service there must be a fundamental rethink in organisation, process and people skills and not only increased investment in IT

What do Tony Blair and Hewlett-Packard (HP) chief Carly Fiorina have in common? Is it charisma, marketing and communications skills? Are they fans of Hooty and the Blowfish? Well, maybe but what I was really thinking of is that they are both attempting the impossible in pursuit of heroic glory. Has anyone told them that this is crazy? They will certainly be the subject of business school case studies in five years' time.

Conventional wisdom would suggest that the integration of Compaq and HP has a less than 50% chance of delivering enhanced shareholder value. Having stuck her neck out to win a marginal victory in the shareholder vote Fiorina will either turn out to be a hero or an easy target should things go awry.

Blair, some might argue, has stuck his neck out even further, with a commitment to increased health spending to the tune of £40bn, including £13bn in the next six years on IT and with the promise of significant changes in service within the next two years. When the case study is written (it might even justify a whole book to itself) it will also highlight that the expectation was that this investment in IT was going to be the lever that would bring about major changes in service levels.

The business books suggest that the odds are stacked more heavily against Blair than against Fiorina: not long after the business process re-engineering phenomenon of the early 1990s, we learned that 60% of major change programmes fail to deliver benefit.

What is worse, surveys over the past three years (admittedly a bad time to do a survey on the subject) indicate that between 80% and 90% of managers believe that investments in IT have delivered no business benefits.

So what are the stakes in these two huge, long-shot bets? Well, not dissimilar in dollars. And who stands to win? In the case of HP, a few thousand shareholders, while the corresponding shareholders of Sun, IBM, Dell and so on are hoping to clean up when Fiorina fails.

By contrast there are 55 million citizens hoping that Blair can pull off the miracle. Meanwhile I don't think that anyone (not even the Conservatives or Bupa) wants to see this fail.

In fact, the last time the quality of life for so many people in this country hinged on the success of a piece of technology was when codebreakers at Bletchley Park cracked the Shark Enigma code.

Let us be realistic: the lessons of IT over the past 50 years tell us that IT alone will not bring about this miracle. To achieve the goals that have been set there have to be some fundamental changes in organisation, process and people skills and attitudes.

More than one million people are involved in the delivery of healthcare in this country and it will be difficult to change the way they work.

It will be difficult, not because anyone wants to sabotage change (unlike some private sector situations) but because they are a mixture of highly intelligent and highly motivated staff whose primary concern is the care of the patient and they will put this short-term goal ahead of any long-term objectives in their list of priorities.

My plea to the Government is simply this: let us think positively and rise to the challenge but also, let us recognise that this is the most difficult change programme under way in the world today and bring to bear upon it the appropriate techniques of programme management, risk management and benefits realisation.

Personally, I believe that most stories of failed change and IT programmes arise because organisations fail to follow some basic rules of management. Government guidance from the Office of Government Commerce tells us how it should be done - let us get it right this time.

After all it is our (the citizens') gamble - the worst that can happen to the Government is that it loses the next election. We face the prospect that, if the change does not work, then in five years' time we will still be booking two weeks ahead to see a GP and waiting eight hours in casualty for an x-ray.

No doubt though, if I am in the waiting room then, I will be able to leaf my way through a Computer Weekly article about how the previous Government flew in face of conventional wisdom and failed to deliver as predicted.

Ironically, if we succeed in managing this one properly I probably will not have that spare hour at the surgery to read the article about how the Government, in its third term, has broken the mould of change programmes to deliver unprecedented benefits against all the odds.

Tom Abram is chief executive at project management consultancy Mantix

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