Break Up the NHS

The NHS needs to be broken up. That's the first conclusion from the application of
Systems Thinking to the NHS.

Bottom-line: if the NHS were to fully adopt Systems Thinking
it wouldn't just save billions.

We'd also end up a lot more satisfied;
NHS people, patients, public.

Why bring this up now? Well it was recently announced that Britain's National Health Service is facing a huge budget short-fall and the BBC Today programme has been canvassing opinions on "where savings might be made".

But this is not quite the issue. It's more about how the NHS organisation can be more cost-effective - which is different, because it first looks at what the organisation's real aims are (and that of each part of it), and how well they're being accomplished.

So this means not piddling about with Systems Thinking (because the NHS does have courses on Systems Thinking, and it is used for trivial issues). It means adopting Systems Thinking into the culture and fabric of the NHS.

Systems Thinking isn't about computer systems; although these are included. It's about seeing everything as a system - in fact as a system within a system, with systems within it.

You are a system. A tree is a system. The Universe is a system. You and your laptop are a system. A football team is a system. The London Stock Exchange is a system. Every business & government organisation is a system. The NHS is a system.

This may all seem a bit academic at first, but Systems Thinking is practical and proven. It's a strategic yet structured way of looking at an organisation and each part of it, especially it's processes.

Here are ten Systems Thinking principles:
1. Everything is a system within a system, with systems within it.

2. Every system has a purpose, whether known or unknown.

3. Synthesis before analysis:
first determine the subject system as a whole in terms of it's boundaries, and then the external/contextual environment with which it inter-relates.

4. Every system must inter-relate effectively with its external/contextual environment environment to survive and remain viable.

5.a. The parts must intra-relate effectively for a system to inter-relate effectively with its external/contextual environment.
5b. Human organisations need effective dialogue and collaboration to inter-relate effectively with their external/contextual environments.

6. Synergy is where the whole is greater than the sum of the parts;
it results from the actualisation of ideal intra-relationships between the parts, for the respective purpose of each intra-relationship, within the overall purpose of the system.

7. Every part of a system is dependent on the other parts.

8. If each part of a system operates as efficiently as possible in itself, then the system as a whole will be ineffective.

9. First look to the idealised design based on the purpose of the system, regardless of practical constraints.

10. Every system has an optimum size beyond which it ceases to be viable, due to loss of effectiveness resulting from intra-relationship complexity and, for organisations, bureaucracy and loss of human identity.

These principles have deep implications for the NHS, and indeed for any business or government organisation. There are a few organisations around the world whose leadership has made Systems Thinking happen in their organisations, and it has made a big difference.

So which of these principles is the NHS especially in need of recognising and/or adopting?

The most apparent is that the NHS should be broken up. It's the biggest per capita organisation in the world. True, the Chinese Army and the Indian Railways are bigger, but these two countries have much bigger populations.

If it's to be more cost-effective the NHS needs to be
broken up, de-centralised, and federalised.

P.S.
One last thing: Systems Thinking cannot happen unless the leadership of an organisation gets behind it.

At the same time, neither can it happen unless NHS people are also behind it. There is a way of doing this which, like Systems Thinking, is also practical and proven. It's called Genuine Action Learning (GAL), as originally developed by Professor Reg Revans, and successfully applied in many different contexts around the world.

It's a form of DIY change management, and it has been described by a very successful business leader as "The most powerful management tool ever identified."

But this blog article is already long enough, so Genuine Action Learning must await a future posting.

How IT Can Save The World

In our day to day working life the pressures of time, information and task naturally lead us to be concerned with the immediate issues on the plate; how to resolve this, make it easier to do that, get better at something else, or even what to do about the job itself.

But there is a huge issue which overshadows every other issue
- at least when it comes to Business and Information Technology (IT).

It's an issue that's right at the top of the Business Agenda and, if it could be resolved, it would affect for the better virtually everyone and every company, if not the national economy.

It has been called the "Holy Grail" of Information Technology in Business, and it's the issue of:
How to get Business & IT truly integrated, aligned and joined up.

By this is meant:
Joined up
Business Needs & Opportunities
with
IT Capabilities & Resources.

If it could be achieved it would lead to significant payback:
1. For people.
2. For your organisation.
3. For the national economy.

If, or perhaps when, this joining up (as it's called here) can be achieved, it will enhance our working lives in the form of reduced stress, enhanced satisfaction, and greater achievement. That is, we'll be able to get things done more effectively, efficiently and enjoyably.

It will make the organisation we work for more cost-effective, profitable, and achieving of its aims. And it will, or at least could, improve if not restore the viability of the national economy itself. Even further, it will enhance the quality of life across society as a whole.

These are grandiose claims! In fact they appear similar to the recent Freudian slip made by the head of government who claimed that financial measures about to be introduced through Parliament would "save the world".

And yet the potential rewards in the microeconomic, macroeconomic and sociological effects of joined-up Business-IT in the aggregate, across the national and international scene, are simply staggering!

Few have been able to see this Big Picture Impact of joined-up Business-IT. Many have instead been bemused or bedazzled by the technology, regardless of its people and business net-benefit.

And some will not be aware that we have a problem
- or an opportunity.

For surveys repeatedly show a huge gulf between the priorities of people and business on the one hand and what IT could contribute on the other. As evidence of this we occasionally learn of big IT failures, even though these are just the tip of the iceberg.

So there are trillions of dollars, euros, and pounds sterling being wasted every year, and thousands upon thousands of lives being negatively impacted.

But, notwithstanding the wonderful advances in IT, the answer is not in new technology, for IT in business is a double-edged sword. It can be a blessing or a curse; it all depends upon how it's developed, managed and used. So what's the answer; how do we get joined-up Business-IT?

The answer is in a holistic approach. That is to say, there is no silver bullet; not in better business process, project management, development methodology, data cleansing, protection against malware, software testing, or whatever. Joined-up Business-IT and its benefits can only be achieved through a holistic approach.

A forthcoming book by the author of this article, The JUMP Model: Joining Up Business and IT, follows upon several years of global research with leading academics, with business leaders , with people 'on the ground', and with feedback from sharing with professional and corporate audiences.

The JUMP Model and its accompanying Process is not a development methodology. It is a holistic, practical, action-oriented approach for getting Business Needs & Opportunities joined up with IT Capabilities & Resources.

As a professorial friend of mine at a leading MBA school said: "So James, do you think you've got this Alignment Thing finally sorted out? My answer: "Well since you ask, yes, I believe I have".

It's the reason why this blog posting is the first for quite a few months; the author has been busy!

P.S.
The photo of the first BlackBerry President of the United States is a supreme example of a non-IT person who has grabbed technology with both hands (or with one hand, at least), and put it to effective use in (a) beating the competition, i.e. getting elected, and (b) doing his job. An examplar for joined-up Business-IT!

IT and Your Health

You hear so much bad news about big money and scarce resources being wasted on mega health projects that it's nice to get some good news about IT and your health. It's particularly nice if that good news affects your own life for the good.

To begin with, a good search engine now knows more and can tell you more than your doctor can, with whatever concerns you, either preventive or remedial. You are your own best doctor. So between you, your doctor and the Internet (and it might be a good idea to include God as well), you should be able to optimise your health situation.

And of course, not forgetting a healthy diet and exercise - on which you can also get the best advice through a good search engine. For example, it was on the internet that this writer discovered the amazing health benefits of sprouted seeds. They contain much needed enzymes to keep the stomach and digestion healthy, and are an organic, ever-fresh source of nutrients which are about 40 times more nutritious than ordinary, fresh vegetables.

But getting more specific on technology, if you have ever had to wait interminably for X-rays to be processed, or in some cases having them get lost, then the good news is that old-fashioned photos and use of snail-mail are going out.

Instead, some hospitals are now scanning the image straight into a central radiology database and making it instantly available across and between hospitals and consultants. Not only that, but because the images are available on high-resolution screens, it does make it easier to scrutinise the image and make a diagnosis.

Also, speech recognition is being added for the radiologist, so as to reduce writing, typing and transcription errors, and the time involved.

The x-ray images are input, along with any drawings made by the doctor, consultant or specialist, and get integrated into your electronic patient record.

In addition, with wireless networks, it means that bedside input & output to/from the patient record becomes feasible.

It means no more lost records, more reliable data, and much faster response to patient needs.

At least this is what it means in theory. The other factors, apart from the technology, are the people, process, organisation and management (PPOM) factors. These things, more than the technology itself, are the priority for getting things right in Health Care.

P.S.
Systems Thinking; treating everything as a system, within a system, within a system, is the key to getting PPOM right, and a future article will focus on Systems Thinking.

Innovation through Customers

About a year ago Dell Computers launched a community site aimed at interactive feedback with customers, for the purpose of improving products and customer service, and responding effectively to customer needs by using this Web 2.0 technology.

The site is called IdeaStorm and, judging by the comments and interactions so far, and especially the rapid response to customers enabled by the site, it seems to be a great success.

The site is powered by SalesForce.com, a SaaS purveyor of Customer Relationship Management Systems (CRM), and is based on their own Ideas Exchange.

Standing back and taking the Big Picture view, what's happening here is improved innovation and product leadership through collaboration with customers through a fairly new technology tool.

It represents innovative synergy between (a) the business organisation, (b) its customers and (c) information & communications technology (ICT). The prediction is that it will benefit the Business in achieving competitive advantage, provided Dell continue to innovate, and tie in its Business Processes with the site.

How did this innovation come about at Dell? Was it a top-down thing, or was it bottom-up? The guess is that it was a bottom-up idea and, if so, it gives an object lesson in using IT and people in achieving competitive advantage.

The people at the bottom, or more correctly at the Coal face, were empowered to innovate, and the people at the top provided the Governance that explicitly or implicitly laid down the principles and set up the organisation structures to make it all happen.

This use of ICT to bring customers into the innovation circle is predicted to grow, according an article in the December, 2007 McKinsey Quarterly.

And it's a good example of what this very blog site is all about.

T5: Lessons Learned

What actually went wrong in the catastrophic and highly publicised opening of the new Terminal 5 at Heathrow? Was it another systems project failure, but this time a high-profile one?

The impact was first upon people; the passengers whose lives were at the minimum disrupted and at worst seriously blighted.

The impact on British Airways (BA) and British Aiports Authority (BAA), was likewise disastrous, not just in terms of the millions of pounds lost, but in lost reputations as well.

At top-level the cause was reported to be the Baggage Handling System; thousands of pieces of baggage piled up with nowhere to go.

However, reading in and between the lines of Transport Minister Jim Fitzpatrick's 31 March statement in Parliament, the failure was due to a number of things:

• A glitch in the software.
• Lack of coordination between BAA and BA.
• Lack of training.
• Poor planning.
• Lack of people integration on the ground.

Of these, web chat sites have blamed lack of training as the biggest reason for the failure.

It's significant that, out of the five reasons, only one was technology.
The others were down to people, organisation and management.

You can learn a lot from blog sites & comments, one such being Joolie Atkins, who specialises in IT training issues, and whose site with its comments gives us further reasons & insights for the T5 Failure:

• The Big Bang Approach; it should have been phased.
• Inadequate User Acceptance Testing (UAT).
• Lack of Systems Thinking; seeing the Big Picture.
• Lack of senior management involvement.
• No rehearsals; no process testing.

Again, only one of these had anything to do with Technology, which was the UAT - if this can be considered Technology.

So the T5 disaster appears to have had little to do with IT!

One commentator pointed to the re-opening of St Pancras Station (a beautiful example of Victorian architecture in London), and the Eurostar Service to the Continent, which was opened by H.M. The Queen, and went without a hitch. So it can be done, even when you have no option but to use the Big Bang Approach.

So what, as Transport Minister Jim Fitzpatrick asked in his statement before Parliament, are the Lessons To Be Learned?

There is only the space to summarise - what to do next time:

1. Senior management governance & involvement.
2. Join up Business and IT.
3. See the Big Picture.
4. Assure & test the end-to-end business process.
5. Provide quality & early (not tacked-on at the last-minute) training, and on what people need to do the job well.
   

Winning the Email Battle

The first thing to do in winning the email battle is to decide to do something about it; to decide to win.

That done, you'll invest a bit of time in winning the battle.

In fact you had better do something about it now, because:
The amount of information is increasing exponentially year by year!
What will happen if you don't do something about it?

Your productivity & performance will continually worsen,
and your increasing stress level will make you ill & angry!

Here's what needs to be done:

1. Use the Software
   Make sure you have the best system for email overload.
   Turn off the Alert.
   Use the Spam Filter.
   
2. Get Training
   Get quality training on how to effectively use your email software, and get more general training for yourself and colleagues (the people from whom you're likely to receive emails), on how to use email effectively.
   
3. Make Sure it's Relevant
   Work out your:
   - Explicit Goals & Objective (EGOs).
   - Critical Success Factors (CSFs).
   - Critical Current Issues (CCIs).
   - Knowledge & Competency Areas (KCAs)
   - Underlying Aims & Interests (UAIs)
   Although subject to change, this is your Relevance Base.
   It's only these things in which you're interested.
   Delete everything else.
   
4. Be a Good Sender/Giver
   - Is it relevant for and needed by the target recipient,
   and those copied?
   - Avoid sending a Victorian Novel!
   - Have a succinct, pithy, stand-alone, action-oriented heading.
   - Not more than five paragraphs, and keep them short.
   - Use good English. Make it easy to read & understand
   - Review for logical sequence and errors before sending.
   - Never send anything angry, impolite, confrontational or insensitive.
   - Action orientation: what do you want the recipient to do?
   - Minimise "For Your Interest".
   - Put yourself in the target recipient's shoes.
   
5. Use Information Net-Value
   Use Info Net-Value and evaluate each email; what's the cost v. benefit of receiving it?
   What's the cost v. benefit for the recipient of those you send?
   What's the cost v. benefit of social chat and news groups?
   
6. Manage the In-Box
   Manage your In-Box through the following:
   - Look at emails not more than four times per day.
   - Review for urgent and/or easy-to-deal-with according to the subject heading or sender.
   - If urgent and/or easy to handle, do now.
   - If not urgent or easy to do look at later, and handle all of these in chunks - not one at a time.
   - By end of day should not have more than ten open items, and these not because of delay but because of needing further information before replying or actioning.
   - All the rest should be deleted, filed or archived.
7. Assure Security and Regulatory Needs
   Delete anything from unknown sources unless you're sure it's
   (a) relevant, and (b) not malware, spam or phishing.
   Don't open an attachment unless you're sure it's
   (a) legitimate, and (b) needed.
   Don't delete anything that may be needed later on for regulatory reasons.
   

Lastly, don't be over-reliant on e-mail. It's a double-edged sword. People like the personal touch, and it may be a lot more effective if not enjoyable. Use the phone, or go and see, or write an old-fashioned note.

Not Just the CIO's Responsibility

It's not just the CIO that's responsible for the effective use of IT.

A recent survey by Gartner indicated that Chief Information Officers (CIOs) now need to have non-IT business unit management experience if they wish to pursue new CIO opportunities.

In many organisations, particularly governmental, the CIO still does not have direct report to the CEO, and does not therefore sit at the boardroom table.

Part of the reason for this is the lack of non-IT management experience, so that the CIO is still seen as a "techie", rather than a business manager.

It's a a chicken-and-egg situation: the best way of getting general management experience is for the CIO to sit at the boardroom table, and yet the CIO is often prevented from gaining general management experience by being barred from the boardroom table.

It's a fundamental block in the effective use of IT, and aligning IT with Business needs.

An even more fundamental block is the implicit assumption that the effective use of IT is the job of the CIO and the CIO alone.

Even that most excellent of magazines CIO, both the USA and UK versions, appears to have the underlying assumption that everything connected with IT is the job of the CIO.

If this were the case, then the effective use of people would be the job of the HR Director alone.

And the effective use of Money & Finance would be the job of the Chief Financial Officer (CFO) alone.

Responsibilities like these, IT, HR, Money & Finance, and other key resources - are the job of every manager.

In fact an implication in IT Governance (see the Weill & Ross book), is that although the CIO is obviously at the forefront, the ultimate responsibility for the effective use of IT rests with the whole senior management team.

Education and experience therefore cuts both ways. If business is to get full value with IT then business managers need education and experience in IT.

That is, while it is true that general management experience will help the CIO, it is equally true that appropriate IT education & experience of senior management - and of every non-IT manager - will enable more effective use of IT, and alignment of IT with Business needs.

The HR function has a vital role to play in all of this, because it doesn't just come down to education and training in Business-with-IT. There is also the issue of changed mental models and business change programmes, so as to get Business and IT in a Partnership Paradigm, rather than the Us v. Them Paradigm that frequently prevails.

P.S.
We're not talking education in point-and-click. By appropriate education we mean MBA-type IT education - of a practical and integrated nature.

And by IT experience we mean nitty-gritty experience like business process mapping, preparation of development testing and use cases, and side-by-side collaboration with IT people.

Easter Greetings in Irish

If you go to the Aran Islands at this time of year, and if you greet an Aran Islander with:
Ta Criost eirithel!

- they will respond with:
Go deimhin, ta se eirithel!

It's the Irish for
Christ is risen!
and He is risen indeed!

The Aran Islands were made famous by John Millington Synge who, after studying Irish and Hebrew at Trinity College, Dublin, spent several summers there perfecting his knowledge of Irish and absorbing the culture.

This led to his masterpiece The Playboy of the Western World, which caused riots when it was first performed at the Abbey Theatre in Dublin, in 1907. It's a quirky comedy about Christy Mahon, a young man whose claim to fame is that he has killed his father by bashing him over the head with a garden spade.

It's the way he tells his story (and who are better story-tellers than the Irish?), that makes the women fall in love with him.

Unfortunately for Christy, his supposedly dead father comes back from the dead, albeit a bit worse for wear, and Christy loses the respect and love of his admirers.

So in a way, Playboy of the Western World has a parallel with Easter, when we celebrate the resurrection of Jesus Christ.

In this case however, it's an event that is either the biggest myth and con-trick ever perpetrated, or is the miraculous, non-fiction, actual happening which historians at the time reported it to be.

One of these Historians was Luke, a physician, who "carefully investigated everything from the beginning" in order to write his history for a new Christian by the name of Theophilus, who must have been a very important person for Luke to go to all this trouble; a bit like having your own Alpha Course.

Incidentally, the Aran Isands are/were the home of Father Ted, another quirky if not hilarious Irish comedy about Fr. Ted (himself), his zany young side-kick Fr. Dougal, the drunken priest Fr. Jack, and Mrs Doyle, who would NOT take no for an answer ("ah go on!"), in offering you that cup of tea!

May the joy and gladness of Easter be with us all at this time of year.

Caisc shona duit! Happy Easter!