Service and process improvement was on the agenda for the Leeds Teaching Hospital NHS Trust informatics department when Alison Dailly took over as director of the department in 2009.
In a bid to improve service and bridge gaps between various elements of IT, the department decided to look at ITIL best practice as a catalyst and enabler to implement a service improvement project.
The informatics department at Leeds Teaching Hospitals NHS Trust, one of the biggest Trusts in the UK and home of two of the largest teaching hospitals in Europe, is split into various parts, most notably between IT in the traditional sense, i.e. infrastructure, servers and so on, and informatics, which is mostly concerned with the delivery of reporting.
‘It’s an artificial split, really, but there were also problems within the informatics department,’ says Richard Long, Technical Information Manager at the Trust. ‘It didn’t quite gel, and our new director was looking to move the department forward.’
Some of the areas that Dailly, who had come in from a different trust, identified was that the department seemed too busy, but at the same time it was difficult to see why that was the case.
Another problem was that it was very much structured in silos and there was not much communication happening between the different areas. So the question was, how do you break down silos and encourage interoperability?
Richard, who had taken part in a taster session on ITIL before, suggested bringing in a consultant to look at processes and structures in the department and at ways of introducing ITIL best practice to improve services.
They decided to bring Sysop on board, an ITIL training and professional services company, to run a series of training events and workshops for all senior level informatics staff.
Mapping the purpose
The purpose of the programme was
- to introduce the team members to the concepts and benefits of ITIL best practice
- to identify current strengths and weaknesses drawing out pain points and identifying/qualifying the impact of problem areas on the services provided internally and to the organisation as a whole
- to formulate and articulate a vision of the goals and end-plan of a service improvement project - creating a coherent understanding of where the department ‘needs to be’ in three to five years time
- to define and outline a plan of the steps to be taken and priorities attached to reach the agreed goals
- to engage and motivate team members to embrace the twin pillars of ITIL best practice and the philosophy of continual service improvement
Using a combination of training events, facilitated workshops, mentoring and guidance, Sysop consultants facilitated discussions and exercises to help and encourage the team members to contribute towards the objectives.
At the end of each workshop, discussion points were collated and summarised. These then formed an essential review element for the following workshop, so that each built on the other.
As staff were very busy and the workshops usually lasted around five hours, it was necessary to hold the sessions on a monthly basis. ‘It wasn’t ideal, but it was difficult to take people out for a whole day. We ended up taking about five months for four training sessions,’ says Richard.
The first workshop session, ‘An Introduction to ITIL,’ didn’t go as well as expected. ‘There was an initial degree of scepticism that a best practice methodology adopted principally by traditional IT departments in the private sector would bring benefits to an informatics group who were largely non-IT, particularly in the specialised environment of an NHS Trust,’ Stuart Sawle, Founder and Managing Director of Sysop, explains.
‘I think one of the main problems was that we didn’t have a proper discussion about what we, as a department, actually did,’ adds Richard. ‘Most of the examples used were IT helpdesk-related, which is more relevant to the other branch of our IT department, and people were slightly bemused, wondering what this had to do with their jobs. Of course there were some people who were rapid converts, but from some it was quite difficult to get the buy-in.’
After this first experience, many members of the team weren’t too enthusiastic about attending the second workshop, which aimed to set out common values and see where the department was in terms of ITIL best practice.
‘There were some positive outcomes from this workshop,’ says Richard. ‘It highlighted that we did have some structure, but that a lot wasn’t joined up. However, people still struggled to see what the vision was and where we were going.’
‘It took a lot of energy to recap essential learning points before we could have a fruitful discussion,’ Stuart agrees. ‘Still, there was major progress in the area of team building and cooperation, and we managed to agree a common set of values.’ The agreed values were:
- making a difference
Once these values were established, it was possible to move on to discuss, in ITIL service management terms, areas of concern within the department as well as looking at areas that were managed well.
Still, problems remained: ‘Most team members could not relate to the relative abstract concept of a ‘process’ being applied to their function,’ explains Stuart. ‘Their thinking and mindset was still very much on what they did, rather than on the how.’
Tackling the problem
‘It was a matter of converting ITIL language into a language that was meaningful to our department,’ explains Richard. ‘So Stuart decided that he needed to gather more information about roles and responsibilities of the team
members and he spent a lot of time talking to senior people to find out about their job and how things fitted together.’
This investment brought the breakthrough in the next session, which was made up of elements from Sysop’s Apollo 13 simulation. Apollo 13 is an exercise that has teams building a communication system for the launch and flight of a rocket. When the rocket is ‘launched’, the team encounters various problems that test the communication system and the processes that have been put in place.
‘It’s a demonstration of what would happen if workloads were stress-tested without adequate management controls and how this would improve if these controls were better managed,’ explains Stuart.
The team had 30 minutes to design the system and, after the rocket crashed at the first attempt, it got together again to reflect on how it could build a better process and redesign the system.
Even though the rocket also crashed the second time, the team learned valuable lessons from the exercise, found Richard. ‘The point was driven home that, in the normal run, we coped, but when the pressure was on, to the point of a crisis, we didn’t.
‘A lot of what we did was done on goodwill and mostly we couldn’t provide evidence for what we were doing,’ he continues. ‘It also meant that we weren’t very good at coping with big new projects because we didn’t have a process to deal with anything extra while maintaining the standard service we provided.’
Stuart adds: ‘From the comments made by team members, it was clear to us that they are extremely able in the delivery of their functions to the trust, but lack effective management controls to, for example, help determine priorities, measure effort, manage capacity or predict and manage delivery timescales. What was particularly concerning was that it was only the dedication and values of the team members that allowed them to deliver an acceptable level of services despite the lack of control processes.’
The objective of workshop session four was to gain agreement that correctly implemented service desk functions were critical to successfully improving services and to work out how this could be achieved. In ITIL terms, the emphasis should be on request fulfilment rather than incident management - the usual key driver for an IT service desk.
Knowledge management was considered to be a key factor. It was recognised that there is a lot of knowledge and experience within the department and controlling, centralising and accessing this knowledge would be key for a successful service desk function. Standard operating procedures were given as an example, as each team has operating procedures at one level or another, but they are neither adequately documented nor shared or, in many cases, do they even work.
‘Requests usually come in through various routes, they are dealt with in different ways and there’s no agreement on how the service will be provided,’ explains Richard. ‘There was no systematic way of working. So we had to ask ourselves the question ‘If you want to change the way you work, what would it look like and what part of ITIL would you want to look at first?’’
The session delivered very important results, in particular through providing a common level of communication. While in the beginning, many of the senior staff felt that ITIL was not relevant to the public sector and, more specifically, their role, they now saw the benefits of implementing ITIL processes, even though they were not a ‘traditional’ IT department as such.
The next phase of the project, namely the implementation of ITIL best practices, was scheduled to take place over 12 weeks starting from November. Additionally the trust has agreed 12 consultation days with Sysop to give guidance and advice throughout the implementation and review process.
After agreeing what to implement first, the team initially got together to define the services it provided and work out a hierarchy of importance, define request processes, both current and new ones, and catalogue services.
The next step then is to set up a communication strategy and plan for the rest of the organisation, to inform key people of the changes and also to define key performance indicators. The 12-week cycle will finish with a review, and then there will be the ongoing work of rolling out the principles to all services.