Barts & the London
Fast track ITIL adoption in the NHS
Barts and the London NHS Trust is one of the UK's leading teaching hospital trusts. The Trust handles over 750,000 patient attendances per year at their three hospitals and employs over 8,500 staff. There were inconsistent processes across the ICT department and insufficient communication between the ICT department and its users. The existing ITIL implementation was ineffectual and needed to be harnessed. Using Plan-Net's quick and selective methodology, the Trust has achieved a rapid ITIL implementation at the service desk. Adoption of Best Practice also helped the Trust introduce new Service Level Agreements.
An ambitious £1bn modernisation programme at Bart's and The Royal Hospitals was accompanied in 2004 by the introduction of ITIL. This was driven by the Trust's focus on maintaining high clinical standards and delivering new clinical facilities, which had to be supported by a reliable technical ICT infrastructure.
At first all ICT staff were given ITIL training, after which the Trust started defining and documenting existing processes and trying to get all staff to follow these processes. "It didn't work. We spent a lot of time and money without achieving any changes", says Doug Howe, Deputy Director of ICT.
Chosen for its track record of successful and rapid delivery of ITIL processes across the NHS, the Trust turned to Plan-Net to fast track the ITIL adoption. "Plan-Net had previously undertaken a health check of our ICT department so it had a really good understanding of the maturity of the ITIL implementation at the Trust," Howe confirms. "Furthermore, Plan-Net guaranteed to get ITIL adopted within a short timescale and at a good price."
When Plan-Net commenced their work with the Trust, processes across ICT were generally good, but there were inconsistencies. With 60 staff members, the department experienced many of the problems that typically affect large teams. There was an insufficient understanding of how calls to the helpdesk interrelated and occasionally inconsistent management of call follow-up. Most importantly, there was little insight into the impact call management had on users across the organisation. Simply recording the call levels was not enough.
The Trust wanted to provide consistency across the department, based on coherent process definitions. ITIL appealed as it provides a far more structured framework that the Trust could work towards to achieve improvements in ICT service delivery.
The Plan-Net consultants were keen to leverage the existing ITIL work where possible and appropriate. Coupled with the focus on generic processes, this approach enabled a speedy implementation. "The Trust had proved that a desire for a ‘technically perfect' set of processes does not work. Plan-Net's approach was to provide a relevant set of fit-for-purpose processes; all the Trust had to do was to ensure they worked within this environment," Howe explains. "The consultants were very flexible. They guided the Trust through good practice and what would or would not work."
Plan-Net undertook rigorous knowledge transfer with the key people leading the ITIL implementation and ensured there was a process champion and process lead in each discipline. These people were tasked with communicating the process within their departments, assisted where necessary by the Plan-Net consultants. "It was essential that the new process was recognised as an ICT, not a Plan-Net, process," confirms Howe.
An important component in the project's success was Plan-Net's insistence on a tightly defined initial scope. The Trust highlighted three areas that would deliver the biggest benefits: problem management, change management and service level management. The focus was limited to three application areas: the Pathology communications system, Active Directory and Microsoft Exchange. The three areas were chosen because of their importance to the Trust. Any problems with Active Directory or Exchange would have an immediate impact on users across the hospitals. With a more manageable project scope, ICT staff were able to rapidly adopt the new processes within the defined areas
However, the Trust was also struggling with managing problems within the pathology system, and a lack of communication between the ICT and the pathology departments was undermining the quality of service. The pathology department wanted to have a direct relationship with the software supplier, rather than through ICT. Howe says: "Within one month of implementing the ITIL framework the relationship had been transformed."
The new process was put to the test when the supplier announced a software change. When the new release was implemented, it failed. "The level of support ICT provided the pathology department during this time was significant. ICT informed the supplier the process was inadequate. The next time, the implementation was correctly tested and supported and worked perfectly," explains Howe.
With the value of the improved ICT service delivery processes clearly demonstrated, the pathology department is now firmly committed to an internal, rather than external, relationship. The ICT department now handles the Service Level Agreement, and ensures redress if problems occur with penalty claims or extended contract terms.
Furthermore, service desk improvements that track the reason for calls are now providing a true picture of the state of the pathology system. Calls actually tripled in the first few months but this was indicative of users preferring to call ICT for help rather than use complex work-arounds that lead to recurring problems. Howe concludes: "This understanding enables proactive problem management to improve the quality of the system."
