Digital delivery should just be what trusts do now. It’s the business of the whole leadership team, not just the chief clinical information officer’s (CCIO), chief information officer's (CIO) or your chief digital officer’s (CDO). Digital should be an underpinning principle of your trust’s strategy. It cannot just be discussed when a business case is submitted to the board and as leaders it is important to understand the practical elements of delivery alongside the
strategic vision.

Be proactive. Leaders need to create the case and environment for change, and then go out and actively find the resources to make it happen.

Plan for long-term, sustained resourcing. Good health systems are clinically led and data driven. Focus on investing in good infrastructure to take advantage of the data, train clinicians in digital skills and encourage them to be curious and ask the right questions. Invest in continued iteration and improvement of digital solutions – funding shouldn’t end at a go-live date.

Prioritise. Prioritise. Prioritise. The less you do, the better you will be able to do it. Build in regular prioritisation exercises and create a culture and operating model, including the right governance processes that allows you to stop things when they are not working or don’t add value. Reprioritising is a sign of a mature, learning organisation, so focus on explaining why. Smaller, shorter delivery cycles, regular checkpoints and shorter feedback loops to inform when an investment is working, and when course-correction is needed are all mechanisms that successful digital organisations use to make sure they are delivering the right outcomes, not against a plan.

Leaders need to create both a clear digital strategy and an organisation that can deliver incremental, iterative improvements. Beware of false quick wins, that don’t join up with other services, or fit with your strategic goals. Equally, mega-projects that only deliver value at the end of a long development cycle risk disappointing your users and becoming too big to be allowed to fail.

The only digital service of value is one that is being used by staff and patients. Delivering and demonstrating progress on a weekly basis is a good habit to build and will not only speed-up the realisation of benefits, but also reduce risks by helping to spot problems early on. Seeing regular progress also builds trust and excitement amongst staff, which in turns increases adoption.

Be an expert customer. Working with suppliers effectively requires your technical, clinical and commercial experts to work together, with a clear idea of the outcomes you want to achieve and the ability to build trusted, honest relationships. Often a trust's purchasing approach can be out-of-step with modern approaches to technology, so board leaders will need to think about the best contractual and commercial options. Mitigate the risks of dependency on a supplier by ensuring teams are asking good questions about for example how you will get data in and out of the system, and any guarantees about data standards.

Why getting delivery right is important

Most transformation investments are underpinned by digital. It’s chief executives and their boards who set a tone for an organisation – that use of technology as an enabler is taken seriously and talked about at all levels of the organisation.

We also know that many digital technology projects ‘go wrong’ or fail to deliver the benefits we thought they might when we started. Focussing on how you deliver will help mitigate those risks and ensure that your transformation succeeds.

Robust business cases for investment are important but relying on these alone drives the wrong behaviours – a risk of optimism bias on benefits to ‘make the case’, and/or reducing implementation costs to make the numbers more attractive to decision makers.

As a board, creating the conditions and opportunities for continuous adaptive investment and delivery will enable your teams to focus on the outcomes not technical milestones.

Hear from a trust leader

Watch the video below for reflections on digital delivery from Caroline Clarke, group chief executive at the Royal Free London NHS Foundation Trust.

Digital delivery at the Royal Free London NHS Foundation Trust 

Common pitfalls

  • Trusts focused solely on delivering to a plan, looking at implementation as the goal not at delivering the outcomes you want to achieve. Instead use impact not activity metrics to measure success that reinforces this behaviour.
  • An optimism bias that means not enough resources, time or people are committed
    to delivery.
  • A focus only on cost benefits, usually from the original business case, instead of a wider discussion about value and benefits of change, enabled by digital.
  • A cycle of boom and bust, not iterative improvement – a commitment to large scale
    changes, with go-live dates far in the future, or a lack of investment and 'sweating assets', instead of a commitment to continuous iterative improvement and delivery.
  • Trying to deliver too many things at once, due to lack of prioritising and not being able to say 'no'.

Questions to ask

When you come together as a board to discuss delivery progress, these key questions can help you assure whether you are setting the right conditions for success:

  • Do you talk about your users' needs or the business' requirements? If the former, are these based on educated guesses or a genuine understanding of user need?
  • Can you clearly articulate the impact your digital investments will have on staff
    and patients?
  • Do your funding, governance and procurement structures encourage incremental
    delivery and ongoing improvements?
  • Are teams able to be honest about the risks involved in digital transformation?
  • How are you working in your system to make the most of your opportunities and
    capacity for delivery?

To learn more, read our longer guide to digital delivery – in it you'll find more about how to create the conditions for success in your trust.

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