A Perspective on the PACS Programme

1
A Perspective on the PACS Programme

• David Whitfield
• 20th April 2005

2
A Perspective on the PACS Programme

• Introduction and Context
• Scene Setting
• Bidding
• Contracting
• Early Delivery
• Growing Pains
• Conclusion

3
Scene Setting (1)

• Features of Successful Programmes
• Have a clear vision and real sponsorship
  (otherwise failure is not left to chance)
• Concerned with outcomes rather than deliverables
• Embrace systems, processes and people aspects
• Involve the stakeholders and deploy clear
  management
• Embrace control change rather than resist
  stifle it

• Some Danger Signs
• Over ambitious
• Over complicated
• Over long
• Few early benefits planned

4
Scene Setting (2)

• Some things to remember
• By default, large programmes fail / under-deliver
• You cannot contract for the behaviour you require
• Partnership is essential its a long term
  relationship
• Shared objectives, recognising different measures
  of success
• The behaviour that you incentivise rather than
  penalise
• Contracts are baselines/agreements not management
  handbooks
• Contracts are the reference of last resort in
  court
• Nothing of real value is achieved without a
  struggle

. its meant to be hard!
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Bidding to April 2004

• Small procurement team
• Bidder-to-user contact
• Limited by process
• Good reaction to supplier initiatives
• Information baseline
• Detailed requirement specification
• National solution from multiple vendors
• Consultation process
• National integration vision
• Sequence change without impact analysis
• Moving goalposts and short timescales

6
Contracting (1)

• Supplier selection end April 2004
• Then, all of a sudden, nothing happened ..

... and after a while, nothing more happened
..
.. and then it was July .. .. when
things really did start to happen

• Discussions on contractual matters
• commenced
• faltered, and then
• resumed in earnest
• early engagement at 3 Trusts

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Contracting (2)

• Small procurement team handling multiple LSPs
• IT procurement model based on the core contract
  model
• Top-down deployment targets drove
• cookie cutter model with rapid responses
  committed from the NHS
• introduction of encouragements for the
  contractors
• significant obligations agreed on the Trusts (and
  the wider NHS)
• Governance and management model
• A number of cliff-edge moments
• After nearly 7 months had elapsed from supplier
  selection
• agreement reached on 11th November 2004
• with no change in deployment target dates

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A Business Change Programme

• Systems
• Processes
• People

. with a contract which focuses on the
delivery and operation of the enabling IT
component
9
. which is only about this .
Southern Cluster Primary Image Store
West Dorset Server Rack
10
.. to facilitate the changes from this ..
11
.. to support the vision of ..
12
.. film-less and paper-less imaging
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The Going-In Environment

• Centrally established requirements
• Standardised buying method
• Output based service charging
• Limited user involvement
• Information centralised

• and then.
• Huge urgency
• Lean scaling
• Unclear financial arrangements
• Limited communications
• Lack of ready answers on important topics

.. hence some tricky starts were to be
expected ..
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Early Engagement

• A fast start was essential but had to be
  sustainable and strategically aligned
• Pre-contract work provided a framework for wider
  engagement
• Focus on delivering early results
• Temporary Order mechanism avoided many start-up
  delays
• Initial equipment configured and ordered for 3
  Trusts and for the Cluster Image Store within 5
  weeks
• Working with the Trusts rather than doing PACS
  to them
• Finding ways round obstacles / challenges rather
  than using them as explanations for delays
• Striving to fill the information gaps for the
  Trusts ..
• .. and feeling a way through the governance
  arrangements ..

15
Stakeholder Relationships around PACS
National Programme for Information Technology
Southern Cluster
SHA
XYZ Hospitals NHS Trust
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Contractual Relationships for PACS
National Programme for Information Technology
Southern Cluster
SHA
XYZ Hospitals NHS Trust
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Deployment Sequence
Prelim Config
Final Config
Bus Case Approval
Place Order
Initial Meeting
Ongoing Service
Test Accept
Rec Stage Eqpt
Install Integrate
Go Live
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Deployment Status - Today
Royal Surrey, MTW
Plymouth
Gloucestershire
Poole
Dartford Gravesham
Worthing Southlands
Prelim Config
Final Config
Bus Case Approval
Place Order
Initial Meeting
North Bristol, NOC, East Kent
Brighton Sussex
Royal Cornwall
Temporary Order
Milton Keynes
Salisbury
Ongoing Service
Test Accept
Rec Stage Eqpt
Install Integrate
Go Live
Ashford St. Peters
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Growing Pains

• Life changes after any major service goes live
• Priorities restoration, continuity, enhancement
• Environment continually changes - PACS is not an
  island
• Technology presents new opportunities
• The service must evolve or risk becoming
  irrelevant
• The current early nursing is not scalable
• Broader engagement ahead
• Industrial strength processes to be
  institutionalised
• Governance and management gear change
• BUT each Trust sees their PACS deployment with
  fresh eyes

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Conclusion

• The urgency was a significant factor in building
  momentum
• The end of the beginning has now arrived
• One Trust may not a Cluster be . . . . but it is
  at least a tangible start!
• There is no realistic way back

• It will get harder ..

.. before it gets even harder

• .. but lessons can be learned to make it
  easier
• Change will be both an imperative and a potential
  threat
• The deployment will inevitably cause the vision
  to evolve

.. and finally..
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PACS . . .
Enabling a step change in healthcare provision