Recognise people's role in technology

'What experience and history teach us is this - that nations and governments have never learned anything from history, or acted upon any lessons that they might have drawn from it.'

These were the words of the German philosopher G W F Hegel at the start of the nineteenth century. When we look at how UK public sector organisations manage change mediated by information systems, they seem to be entirely appropriate today. Academic bookshelves groan under the weight of books written over the last forty years which stress that there is no such thing as an information systems project isolated from the people who will use that system. There are only business change projects - a fusion of people and technology with all the personal agendas, fears and mixed motivations that we all bring.

In 'The New Utopians: A Study in System Design and Social Change', published 36 years ago, Robert Boguslaw wrote: 'We tend to think of Utopians as being starry-eyed philosophers or wild eyed reformers but there is a new breed of utopians afoot, threatening to rush down all the exciting pathways and blind alleys frequented since the days of Plato. These people are known by such titles as system engineer, computer manufacturer, and system designer.... The new utopians are concerned with non-people and people substitutes... They are concerned with neither souls nor stomachs...'

A stream of reports over the last five years have emphasised that public sector (and also to some extent private sector) IT projects still tend to regard the people who will use these systems as a necessary evil rather than the heart of the projects themselves. What might the new architects of change in the NHS learn from this history? Let me suggest six key points:

Beware the status quo

Don't simply replicate in software and silicon the processes currently in use. Even the most junior of users will be delighted to tell you what is wrong and time-wasting in the current methods - if you take the trouble to ask. A rare few users, who understand the potential of new technology as well as the details of the tasks being carried out, will go further and can give you real breakthroughs in process change.

Budget honestly

If people are at least equal partners with information systems in delivering service, then surely they deserve at least half of the project budget allocated to them in order to communicate why change is required, how it will be achieved and the new skills required, and to reward positive change.

Provide genuine champions

People need role models that they can relate to. Find the practitioners (consultants, doctors, nurses, managers, administrators) who already have experience of the real benefits that well-designed new systems can bring to patient care and use these to evangelise change for a wider audience.

Deal with the disincentives

Recognise that the business models of existing health care may need to be changed, as the detail of the old models may contain large disincentives to the use of new processes and technology.

Challenge pay & conditions

Don't be frightened of overhauling existing structures of pay and conditions of service. Large-scale business change will need pay and bonus incentives in order to be driven through. Efficiency will initially fall rather than rise during this transition.

Don't over centralise

A small number of large linked systems may be more effective (and less vulnerable) than a single mega-system.

Above all remember that, as stated in the CSSA/Intellect report Getting IT right for Government published in June 2000: 'there is no such thing as an IT project in isolation from its business change programme'. The motto of Health Service IT should be, in the words of Buckminster Fuller: '...rather than attempting to teach people the right things to do, one should design organizations such that doing the right things was simply the path of least resistance.'

Jim Norton is an independent director and former head of the Cabinet Office Performance and Innovation Unit ecommerce team