NHS Benefits from Soft Systems Methodology

CMC was commissioned by Health Solutions Wales, which together with the Information Standards Division of the Health & Social Care Directorate General of the Welsh Assembly Government, provides the secretariat to WIGSB, to identify how responses to Impact Assessment (IA) requests could be improved both in volume and quality and how information provided through the IA process could be held and put to future use.

The Requirement

The Welsh Information Governance and Standards Board (WIGSB) is responsible for coordinating information governance and standards issues for health and social care in Wales. It covers clinical, managerial and technical informatics standards to be applied in Wales. Its aim is to ensure that data can be captured, shared, stored, used and analysed consistently and coherently throughout NHS Wales. WIGSB supports its partner organisations in all aspects of business, and ensures that information is handled in a confidential and secure manner to appropriate ethical and quality standards.

WIGSB Sponsors and Project Managers are charged with implementing changes in areas such as performance reporting which rely on the collection of new data. An established process is in place to show that plans for these changes have been well-thought through and are practicable. The Impact Assessment element of this process involves consultation with Health Boards and other NHS organisations to test whether the new data collection requirement places a reasonable and acceptable burden on the Service.

CMC was commissioned by Health Solutions Wales, which provides secretariat support to WIGSB, to identify how responses to Impact Assessment (IA) requests could be improved both in volume and quality and how information provided through the IA process could be held and put to future use. There was limited definition of the IA process, no formalised good practice guidance on IAs, and limited standardisation of approach. Some expertise had been built at individual NHS teams and programmes funded by the Information Services Division within WAG. The WIGSB guidance and documentation templates did include some information on IAs, and the need for developers of Information Standards (IS) or project managers to complete the WIGSB Information Governance process documentation was a major driver for the existing IA process.

However, lack of stakeholder engagement and lack of consistent involvement with the IA process was having a detrimental effect on the ability of WIGSB to positively influence the IS development process. Assistance was requested to propose a solution that would address the fragmented approach to IS development.

CMC’s Approach

CMC did not feel that simply recommending another IT-based tool would address the key underlying issues surrounding lack of stakeholder engagement. Similarly, just mapping the process would not address fundamental issues of attitude and perception that appeared to be causing the failure of key areas to engage with the existing process. The process itself had not been clearly mapped, which also contributed to a lack of uptake. CMC sought feedback from various stakeholders on the perceived current issues with the IA process with a view to making recommendations/proposals for process improvements.

Firstly the ‘As Is’ process was mapped to incorporate all process elements to create a high level end-to-end view. Soft Systems methodology was then applied to interviews with key stakeholders to build a real world view of the problem, including stakeholder perceptions of the underlying issues. This rich picture was developed during multiple interviews to create a comprehensive representation of the perception of the underlying problem. Further analysis was applied to define the root definition to form a sound basis for considered solutions to be mapped against.

Findings were then presented during a series of workshops to gain further views of the underlying issues. During the workshops, stakeholder profiles were developed to identify the problems and proposed solutions most relevant to individual stakeholders. This information was then analysed to identify the proposed solution that would provide the widest and most immediate benefit.

A key outcome of the analysis was that an IT-based solution alone was the least favourable option. In fact, building new communities of stakeholders was seen as providing the most tangible benefit, ensuring sharing of information and developing a common understanding of the process. Establishing a user community would provide information and content with a suitable environment to function in. Once the community and content had been established, a suitable IT-based delivery mechanism could be scoped and implemented.

Benefits and Outcomes

• By analysing the perception of the problem, the key underlying issues were identified and given clarity. These enabled an informed approach to proposing a solution that could deliver immediate tangible benefit.
• By engaging key stakeholders, involving them in the analysis and building an enthusiastic and focussed core group the solution identified was capable of sustaining systemic growth and momentum.