“To scrap £50k of development effort was a big decision, but we’d built the right solution to the wrong problem”
One of my most favoured touchstones is a sentiment first expressed by H L Mencken: “For every complex problem, there is an answer that is clear, simple, and wrong.” I reach for it frequently in client meetings, discussions with my highly skilled operations team, and anyone else who presents a requirement, specification or solution as a fait accompli. It has saved projects more times than I care to remember. But it’s incomplete. The corollary is that complex, sophisticated solutions often obscure simple needs.
I lack a proper IT background – the last time I wrote a line of code was in Visual Basic 1 – so I’ve always tended to come at problems differently. In particular, I look for the true business need and whether existing technology can be configured, rather than assuming the need for custom development. After all, almost all organisations have similar core business needs and therefore it’s possible to pre-build much of what they will ask for.
I founded Cloud2 with my business partner eight years ago, after great learning (and a spectacular falling out) with the managed services and development firm for which we worked in York. We quickly became a Microsoft Gold Partner and one of the leading SharePoint firms to support the NHS. So when our Microsoft friends brought us a project at East Midlands Strategic Health Authority two years in, to help with the crisis in referrals from GP to hospitals, we were totally up for it. “It’s simple”, said Microsoft, “they need some kind of portal to exchange information between GPs and consultants to avoid unnecessary referrals. SharePoint can do that. Off you go.”
The rest of this column is some learning from this project.
Insight 1: When you get paid to swing a hammer, everything looks like a nail.
I genuinely like Microsoft, the people and many of its technologies. Some people may find that odd, but the firm’s techie mindset, the corporate market it addresses, the groundbreaking things it has established over the years, and its commitment to the people it’s trying to help (however disorganised and dysfunctional that is sometimes) has always worked for me. I’m not blind, however: at times, Microsoft’s sales teams have been targeted on what the firm is focused on rather than what the market really wants. This was one of those times. SharePoint was Microsoft’s main focus for a while, and everything looked like a SharePoint solution as a result.
Insight 2: What they say they want is not what they need.
As a sceptic by training, and with a background in health, I set out to discover what the NHS folk genuinely needed – and it rapidly became apparent that this wasn’t a SharePoint problem. What the lead clinician and the project stakeholders envisioned was something that provided real-time chat between GPs and hospital specialists, with the ability to escalate to voice conversations, transfer documents and notes and share screens.
Today, we’d call this Skype for Business; back then it was Office Communication Server (OCS) – a technology we couldn’t do. Fortunately, we were friends with a firm that did and which was happy to collaborate on the project based on our NHS expertise. It was convinced it could customise the OCS interface and functionality to meet the need; the NHS team was sure that would be great, and budget was duly approved.
After several months of toil, we rolled out the beta version. It was clunky, slow, complex, unstable – and licence costs were scary. The client was initially happy. Then we showed it to the end-user GPs. They didn’t get it – their working reality was that they’d never have time for a chat session during the day; the consultants would never be at their PCs anyway. Our prototype was what they had specified; but what people say they want is not what they need.
Insight 3: If it isn’t fit for purpose, don’t try to fix it.
After much soul searching, conversations with potential users and a crisis meeting with the sponsoring CIO (a genuinely decent chap), we took the decision to write off the entire development and start again. To scrap £50k of development effort is a big decision when your turnover the previous year was £250k. But it was clear that we’d built the right solution to the wrong problem. A different type of solution was needed; it still wasn’t SharePoint.
Insight 4: Make it as simple as possible (but no simpler).
We had to think hard about our development partner. Although technically strong, the people there struggled to see that real-time messaging wasn’t the answer: GPs were happy with something that could assure them of a response within a few days.
Ultimately, we approached Bliss Systems in Wetherby; I knew its MD (physicists tend to attract each other) and had seen the company’s ability to work up innovative custom solutions. Also, it could do what we needed for the pitiful remains of our budget in the scant timescale remaining, loved the concept, and was happy to do a joint IP arrangement. This time I stayed close to the users to ensure that we were truly addressing their needs.
GPs have remarkably little time. Pesky patients turn up every ten minutes with some ailment, injury or concern in search of treatment and reassurance. GPs can’t know everything and don’t have time to research the things they don’t have a quick answer to. If in doubt, their professional and ethical duty is to refer to another expert, via an outpatient appointment. They mostly do this at the end of the day via a hastily written referral or a dictated note to their staff. Time is acutely precious (pun intended).
They required something simple. It really only needed to do three things: enable users to quickly find an expert and ask them for advice; ensure a useful response in a clinically meaningful time frame (72 hours was the initial aspiration); track the outcome of the request to see if the advice avoids a referral. Our target was to train groups of users in 15 minutes. We built the replacement using .NET and SQL Server – simple, fast, stable, secure and largely licence-free.
Insight 5: Evolve both the technology and the innovation process. Consider putting your users in charge.
Five years have passed. The Strategic Health Authority completed the pilot successfully, but the new government disbanded all such authorities, leaving further progress unsponsored. Its departing CIO gave the IP to us with the thought that there was “something in it, and we should see if we could get it established”. Wandsworth Clinical Commissioning Group (CCG) – a client for our SharePoint work – was searching for options to improve referrals and asked to pilot the tech.
Its insights drove enhancements based on user feedback. Another CCG came on board. We rewrote the application to be a multi-tenant platform. Two more CCGs adopted it.
We realised that we were no longer the people with the best insight into the product, so we established a user steering group and put it in charge of identifying development needs and prioritising them, while ensuring that it remains simple for end-users. Most enhancements have been on background business functionality, with only subtle introduction of new user features. Training still takes only 15 minutes.
Insight 6: Great technology is only 10% of any effective solution.
Most successful users have really worked at it. They’ve driven adoption across their GP practices and hospitals and evangelised the benefits (not the system). They’ve actively sought user feedback and brought that to us to address. They understand that for every early adopter there will be a laggard – such is the nature of diffusion of innovation – and acted to bring on those in undecided ground between. They recognise that great technology is only 10% of any effective solution.
Insight 7: Success rarely happens overnight. Keep the faith.
Today, we have a technology platform that’s about two years ahead of anything in the market, driven by users, and currently generating around £1 million net savings for the NHS per year. It has the potential to save around half a billion pounds per year as we roll it out to further clients and as GPs increase their use. It’s gradually growing as GPs and specialists extol the virtues to their friends and colleagues; almost all our new leads come through referrals. Real patients are being kept out of hospitals.
We still haven’t made the national breakthrough I believe it deserves, but my clients love it, and that makes me happy. The outcomes data says that one patient avoids going to hospital for every two requests for advice put through the system; that makes me happy too. We’re on track to double the client base this year. There’s talk of moving the entire product onto the Azure platform to deal with growth, resilience and performance. That makes Microsoft happy.
With the benefit of hindsight, three things seem obvious. The first is that one should always ensure that the real-world user need is understood. Second, that being trusted and liked by your clients enough, so that you can admit when you’ve collectively got it wrong and work together to start again, is a core business and personal principle. And, ultimately, the trick is to find a balance between the complex and the simple. If it doesn’t match what happens in the real world then you can’t drive user adoption, regardless of the clever technical features you’ve built in.← Other blog articles