Originally published on the Microsoft NHS Resource Centre on 15 March 2011
With all the assurance of First World War generals certain that their next offensive will break through when all else has failed, the eyes of government IT chiefs are shining with enthusiasm for a new weapon.
This time, it's called "agile working". Like the tank in 1917, its existence is no secret: if all goes well, its impact will come from the scale with which it can be deployed.
'Agile' is the modish term for developing systems in a quick and messy way, but with the capacity to be tweaked (or abandoned) in the light of experience. The basic philosophy is that, rather than try to assure against failure by asking every user and their dog what they want from a new system, and rigorously specifying and procuring the technology to tick all the boxes, we should keep things small, quick and simple.
In practice, this means breaking projects up into small components, each capable of generating quick results for the largest possible number of users, and with the flexibility to adapt as things go on.
In the words of an important new report* by the Institute for Government think tank, agile projects are "modular, iterative, responsive to change and have users at the core".
Purists will grumble that the term "agile" should be reserved for a distinct methodology, originating in the 1990s, for developing software. However the Institute argues that its principles can be usefully applied to wider aspects of IT-enabled business change projects. The concept chimes nicely with the "Web 2.0" spirit of releasing beta versions of systems, which can be tuned or adapted as users require.
An agile solution, the report claims, "can actually deliver more for less". Concentrating on priorities allows organisations to strip out the cost of non-essential elements. "It can also help overcome the inertia arising from traditional practices of needing 100% agreement from all the stakeholders for all requirements".
Meanwhile, the systems benefits start to appear sooner, generating enthusiasm and bright ideas which can be fed in to an iterative process of improvement. The result, the report says, could be to transform the whole experience of government - allowing it to join the IT revolution “rather than watching from the sidelines".
The Institute seems to be pushing at an open door. The report has the blessing of some of the top names in public sector IT policy. We'll almost certainly see its thinking reflected in the government-wide IT strategy to be published by the Cabinet Office this spring, as well as in the forthcoming Information Revolution strategy for the NHS in England.
Heaven knows, the NHS could use a bit more agility. However we should act with some caution before adopting too much of a modular and iterative approach. In health services there are good reasons to subject new systems to rigorous testing before trying them out in anger.
Much of the cultural mind-set about innovation was nurtured in the pharmaceutical and medical devices fields, with their rigorous routines of clinical trials and post-marketing surveillance. In these sectors, the pendulum of opinion is starting to swing towards allowing a more liberal approach; or at least admitting that current thinking hinders innovation.
In healthcare informatics, we are still a long way from seeing that swing in opinion. Managers are understandably nervous about launching beta versions on clinicians and patients, and about the political fallout if anything goes wrong.
Let’s be agile, but not scare the troops. Remember: in the First World War, new technology and tactics did eventually break the stalemate on the Western Front. Admittedly with an awful lot of casualties along the way.