The NHS electronic patient records system was like a lot of large IT projects going to deliver large benefits to patient care and why shouldn't it? Currently your GP and hospital records are mostly on paper or stored on independent systems which cannot communicate so you could be admitted to hospital and the doctors might not know that you visited your GP a month earlier with similar symptoms. However, also as with most large IT projects it ended up running late and being much over budget until the Government had little choice except to shelve it and cut their losses.
We use so much IT nowadays that we still haven't realised that we are mostly rubbish at running IT projects. In fact, we are pretty bad at running many projects but IT seems especially poor. What seems unreasonable to me is that the risks of IT projects are well known but yet they are not managed or removed to provide the ability to produce a useful albeit large IT system of some kind.
There are various problems and I have outlined a few below. We need to understand these problems, many related to human nature, and then decide what we will do about them.
- Price must not be the main factor when choosing a supplier. While there is so much pressure on price, people are inclined to avoid factors that are seen as low benefit/cost such as quality and process improvements. When things are running a bit late, nothing other than pure functionality is going to be given any space. With a more open relationship with our customers, we can show what we are charging for what and therefore negotiate if unforeseen things happen. A customer will pay a 40% margin if they know anything about business, we shouldn't need to keep this a secret.
- Time must not be unrealistically short. Customers always seem to want 6 months of work in 3 months and we are inclined to agree because we want the work. We perhaps think we can just about manage but of course we can't. People leave, you can't always recruit new people in time etc. Part of quality assurance should require that a supplier will only agree to timescales related to the design and planning and NOT by an arbitrary deadline imposed by the customer unless this is specifically factored in. There needs to be protection against unscrupulous suppliers who will say whatever the customer wants to hear in order to win the work. "Prove it or lose it"
- Someone once said, "the customer is always right" but that is nonsense when applied to all business scenarios. Specifically the customers is sometimes wrong and sometimes very wrong about many things. This balance needs re-addressing and as experts, we need to improve our profile so a customer will trust us when we say something cannot be done or not in the timescale required. I don't argue with my doctor over medical issues so why is it OK for a customer to argue with an IT supplier over a system?
- The more people you involve, the more complex it gets. In order to counter this, you either involve less people (which risks alienating your users) or you make the system simpler as far as possible so there is something for everyone to use. For instance, an electronic patient record system could be very complicated but even if it was a multi-page document like a filing card system, that would be of enormous benefit just to record stuff like "administered 100mg of XYZ". I was once asked to write a database system for a Bariatric clinic even though there was a European-wide database. The Ero one was so complicated, it was useless to any one person.
- Requirements capture needs to be much better understood and only people of a relevant level of understanding in the customer organisation should be allowed to have formal input into the process. Asking every man and his dog for their input even though they might not understand that complexity is cost and that a system is more robust if it is coherent is clearly nonsense. Ideally, you should have a single point of contact with a customer who can have the arguments with various stakeholders on your behalf from a position of understanding. We have some large customers who have 20 people on the authorisation list for functional documents. Can you imagine how long they take for approval?
- We need to understand and manage change better. If we are taking 2 or 3 years to deliver a system, its requirements will change over time. It is futile to pretend we will set requirements in stone. This was done for electronic MOTs and we ended up with dial-up connections required for all garages even though the internet and broadband was in full swing. We need to accept that change will happen and at least consider some things that might happen (even if their details are not fully known). We need to communicate the cost of change to a customer so they don't change things for the sake of it and we need to try and get a system out of the door sooner, even if not all the functionality exists, so at least we can achieve milestones and get paid rather than having a continuous moving goalpost. We should obviously be writing code that allows for change as well and this needs to be taken seriously. All those short-cuts and "quick hacks" should simply not be allowed at all.
- I think there needs to be better scrutiny of suppliers who are getting things wrong and even potentially legal action against people who might pretend to be doing it all right but are covering up incompetence and deliveries of systems that are basically rubbish as soon as they are released. If someone releases something under a quality assurance banner that cannot be maintained to any reasonable degree then they should have to pay some of the costs of re-designing it.
- Quality needs to underpin the processes at every level and sadly this is still an after-thought or box-ticking exercise for many organisations. If they could understand what quality really means. The systems we deliver would be so much better.