What good looks like for digital transformation in health

A banner saying 'Thank you NHS'

A banner thanking the NHS. Image by Red Dot from Unsplash and shared under their license.

As part of our work with NHS Providers (supported by HEE and NHSX) on running digital board sessions for trusts, we often get asked, “Can you tell us what good looks like?". So it was great to see that NHSX is working on this very question, and even better talking about it openly on social media.

When Trust leaders ask us this question they usually are coming from a place of "tell us what the latest technology is" or "paint us a picture of the modern digital hospital". My response is always the same. We could do that, but is that really what you need?

Historically, digital advancement in health settings has been taken through a predominantly technological lens. The most obvious example of this is HIMMS. But I worry this approach has been pretty unhelpful overall, because as anyone with experience at the sharp end of digital transformation will tell you, it’s not just the technology but the culture, processes and operating model you need to worry about if you want to genuinely change. The risk of painting the picture of an internet-era clinic is that you are not giving a trust any tools to help them get there.

With that in mind, here are some thoughts about what good looks like.

  1. Having a clear mission everyone understands. Digital strategies that are 40pages of shopping lists are hard to remember. Make it clear to people what you are trying to do, or they wont come on the journey with you.

  2. Relentlessly focus on your users' needs. If you aren't actively focussed on understanding and addressing the clinical, practical, or emotional needs (Ht Janet) of either patients, clinicians, or other staff people won't use your services and you will never see any benefit.

  3. Talk about services not projects. Services start at go live, projects end at go live. Your digital services should be seen in the same way as any other service you offer- to be supported ongoing, iterated, improved. The NHS Service Standard has all the advice you need.

  4. Invest in skilled teams - with internet era capability covering not only engineering but product and design, and pair these with clinical and operational staff. Work together, don't chuck requirements over the fence. And please please try not to design things without some design expertise!

  5. Use modern cloud based technology. Don't lock into long contracts. Work with suppliers who want to collaborate with you as one team. Stop putting tin in the basement.

  6. Be agile. Focus on the minimum viable product based on valued delivered and iterate when you learn more. Minimum viable governance that is proportionate to the need. Show the thing, don't hide meaning in 2" inch-thick board packs.

As a board, be servant leaders. Take collective responsibility for your digital transformation, put it at the top of your agenda. Ensure you have the right technical knowledge in the room where it happens. Unblock things for your teams. Move authority to information not information to authority.

The title of this blog post is 'What good looks like for digital transformation in health' but the same principles apply in every sector. None of this is news. It’s all already in the Public Digital book, blog, and in other places like the digital maturity scale my colleagues developed with Harvard Kennedy School. Many of my former colleagues and others all around in the health and care system have been saying similar things.

A common picture for what good looks like is beginning to emerge across the NHS. In some places, it is already more than just words - you can see it, and so can patients. But that’s not true everywhere. What comes next must be the harder discussion about what makes good so difficult to achieve, and so hard to scale. Because the answers are likely to be rooted in the topics that all too often fall into the ‘too hard to fix’ category: money and power, legislation and legacy, the rules and tools of the game.

If you’re interested in this work and want to continue this conversation you can find me @e17chrisfleming.

No comments yet

Let’s start a conversation

We’re not like other consultants, we make an effort to understand your circumstances and context, and give you advice that’s tailored to them.

Public Digital


Public Digital
Clerks Court
18-20 Farringdon Lane
London EC1R 3AU


[email protected]

Our Positions

Our values expressed in action and outcomes.

Read them here


A regular scan about internet-era ways of working in public and private organisations around the world.