In our previous guides, we set out some pre-conditions for successful digital transformation: clear leadership, brilliant digital teams, a good digital strategy and making the right technology decisions.

In this guide, we have set out eight principles to help guide digital delivery. These principles are designed to help trusts realise the opportunities of digital transformation and to avoid common mistakes. We've based these principles on some hard-learned lessons from digital successes and failures across the NHS and other sectors. These principles are complementary to the NHS service standard, which sets out how to build and run great digital services.

We also suggest the following list of questions that board members – both executives and non-executives – may find useful to evaluate their trust's digital approach:

Deliver things that patients and staff need

  • Do you talk about your users' needs or the business' requirements?
  • How regularly do your digital teams get feedback from users?
  • What's the riskiest assumption your digital team has made?

Set clear, realistic goals

  • What's the primary aim of your digital investments?
  • Are your digital transformation business cases realistic, given the risk of optimism bias and challenge of realising benefits?
  • Can you clearly articulate the impact your digital investments will have on staff and patients?

Test, measure and learn how it's working

  • Are delivery teams focused on delivering the plan, or delivering benefits?
  • How will you know if your digital investments are working?
  • Do you have weekly or monthly reporting in place for key metrics?

Think long term, deliver in the short term


  • Are your digital initiatives working towards a 'north star' vision?
  • How frequently are you able to release improvements to patients and staff?
  • Do your funding, governance and procurement structures encourage incremental delivery and ongoing improvements?

Invest in a dedicated, cross-functional in-house digital team

  • Do you have a 'minimum viable digital team' in place?
  • Are clinicians supporting digital initiatives as part of their job, or as a favour?
  • How dependent are you on technology suppliers and contractors?

Get the best out of technology suppliers


  • Do you have the in-house skills to navigate technology markets?
  • Are you using the right contracting methods?
  • What would happen if your relationship with an important technology supplier went wrong?

Build trust, not barriers

  • How frequently are digital teams able to release changes to digital services?
  • How joined up are your digital transformation, system integration, quality improvement and practice development initiatives?
  • How often do those actually building digital services have direct contact with users?


Don't stick to the wrong plan


  • Do your business cases create a false sense of certainty?
  • Are teams able to be honest about the risks involved in digital transformation?
  • What mechanisms do you have to review and reprioritise digital initiatives?