21 things I learned in 2021

In no particular order…

1. When teams are under pressure, the path of least resistance is to stick to what they know. To collaborate with people who work differently slows things down and feels like a luxury.
2. It’s easy to overlook adoption and improvement of what we already have in favour of more and more new things.
3. Working in the open is a hard habit to start and maintain.
4. Communication still feels like an extra thing that teams are asked to do on top of their job, not an essential part of it.
5. There’s never a good time to focus on the long term – but that means there’s never a wrong one either.
6. People can be reluctant to connect their work to service outcomes for a number of reasons – not wanting to take the credit for others’ work, or for fear of being held accountable for things beyond their control.
7. Without psychological safety, teams that are already overloaded are unlikely to propose additional work that might be added to their backlog.
8. There’s great value in having people on the team who know their way round the organisation and wider healthcare system.
9. Funding projects, not teams, is still a barrier to sustainable digital transformation.
10. Senior leaders need to be on the same page about the ways of working, as well as what work is to be done.
11. Service design has become a term overloaded with meaning and expectations: some people see it as a step in a waterfall process.
12. Service design can help us understand the world, and make better decisions, but the people who do the work need to own the design and the decisions.
13. When you move jobs, your reputation precedes you.
14. A budget alone does not give you leverage when the bottleneck is delivery capacity, and others control the allocation of scarce resources.
15. The commissioner-provider split makes it hard for a senior responsible owner to influence the competences required for digital transformation.
16. The 2018 health tech vision principles still hold true; they should be more widely understood and championed.
17. Interoperability is not an end in itself, but a means to achieving workflow agility.
18. Health and care still has a shortage of people experienced in working with and through the tech sector.
19. The topography of urgent and emergency care is complex. We need to navigate it thoughtfully to make the most of digital.
20. Primary and secondary care can sometimes be at cross-purposes because they have different assumptions about what patients need, and how things get done.
21. It’s hard to get out to visit busy services without feeling like a tourist, but we must do it all the same.