All on board: overcoming legacy attitudes and technology

It can sometimes be easier to effect transformational changes than it might at first appear. But where to start?
Old Woman In Bed Looking At Screen Of Laptop And Consulting With A Doctor Online At Home, Telehealth

It isn’t easy dragging old technology and attitudes into a new era, particularly when it involves partners who may not share your vision. In 2014, for ­instance, the Ministry of Defence awarded Gen­eral Dynamics a £5.5bn contract for 589 armoured vehicles, with delivery due to start three years later. But problems arose and the order has yet to be fulfilled. 

Anyone familiar with working across many departments will nod in recognition at how an original agreed vision can become lost in the realities of the situation. 

When the Oldham Partnership committed to making the Greater Manchester borough “a place of ­ambition” it started at grass-roots level, rather than the top. This helped to make challenges more ­visible to decision-makers. This in turn energised them to use their ­position to help solve problems. These were the findings of a report by innovation agency Nesta (for­merly the National Endowment for Science, Technology and the Arts), which designs solutions for ­social good. Nesta noted that front-line staff in Oldham Council identified issues, recording how many times each one occurred and its impact. These so-called system con­ditions were then brought to the ­attention of those who could make the chan­ges needed. The programme resulted in three elements of agreed focus: “thriving communities, an inclusive economy and cooperative services”. 

The Covid crisis forced local authorities to quickly find new ways to ­deliver public services at a distance. A study by the Centre for Data Ethics and Innovation (CDEI) shows that at the onset of the pandemic there were skills gaps, budgetary constraints, poor technical practices and problems with legacy techno­logy. There was also a lack of clarity on what personal information could be shared with other authorities. 

But, faced with the crisis, many local authorities switched from using old methods and focused on finding new solutions and working collaboratively. Argyll and Bute Council’s trial of drone technology delivered vital medical supplies across its islands, as well as using mapping tools to support social distancing. Hackney London Borough Council used predictive analytics to help identify people who were particularly vulnerable to Covid-19. 

To help support vulnerable children when the schools were closed, a cross-borough agreement was set up between London boroughs to use cloud software, enabling them to share details of children in receipt of free school meals. According to the CDEI, one participant described the change as “equivalent to taking a leap two years forward”.

But this kind of light-speed change occurs only when working with legacy systems, rather than against them. 

Light-speed change occurs only when working with legacy systems, rather than against them

Doccla virtual wards provide a successful case of marrying legacy ­attitudes and technology to the latest software, so that NHS patients can be monitored at home instead of on a ward. Doccla, a healthtech firm founded in 2019, addressed potential NHS delivery pain points early on, including managing devices, onboarding users, monitoring compliance and providing proper support. The system can refer patients using only their NHS number or directly out of the NHS records system. Dag Larsson, co-founder and CEO of Doccla, says the implementation is fast and streamlined to minimise the work for NHS partners. 

“And it got us to the point where we are delivering an end-to-end service faster,” he adds.

Most users tend to be slow to embrace the new, especially when there are barriers to change such as the need to evaluate options, gain approval at a senior level or wait for legacy contracts to run their course, Larsson notes. 

“You can’t afford to throw out the cumulative result of years of investment each time there’s a new development to exploit – a development that will become tomorrow’s legacy problem,” he argues. “The trick is to embrace openness. If a key supplier takes a year to manage orders or erects commercial barriers to prevent third parties from integrating, you don’t have an open system.”

One of the breakthroughs for ­Doccla was identifying “champions” among staff and patients within the structures that were changing. 

“That could be someone who is already won over by digital transformation or someone who is bearing the brunt of the workload from the pain of legacy technology,” Larsson explains. “These figures have the power to accelerate the process of buy-in across the organisation. We let the stories speak for themselves.”

One champion was a patient – Brian Smith, 80 – who spent two weeks in a ward in Stevenage after a heart attack and whose condition improved once he returned home. He and his wife were lent equipment to provide him with oxygen at home and a tablet computer to record his observations. Smith’s success story helped to increase take-up. His doctor, Elizabeth Kendrick, hopes the service will increase from treating 90 patients in Stevenage to 200 by the end of the year. 

“Hospital is the right place for some people, but others can decondition rapidly,” she says. “It’s also obviously cheaper to look after someone in their own home because we don’t need to deploy a nurse to check somebody’s observations.”

Clarity of vision is also key and lessons can be learnt from how businesses approach innovation. Helen Ashton helped fashion giant Asos through various transformations as CFO before leading her own consultancy, Shape Beyond. She says the private sector overcomes legacy attitudes quickly by outlining clear goals in a style that front-line staff embrace. From there, leaders build trust by sharing outcomes – good and bad – and acting on these.

“Gather feedback, listen and – critically – act,” Ashton stresses. “This should take place via different channels and media, start early and ­finish way after the transformation has finished. The amount of support that people require to embed change is always underestimated and it is definitely a key reason why programmes struggle.”

When transformation is vital, as in a public health crisis, change can happen at pace. But public sector ­organisations can help to maintain this momentum by listening to everyone, developing a clear vision for change and building strategic­ally on what they have.