Success by degrees: how to overhaul inefficient healthcare with Small IT

In the tricky pursuit for next-generation healthcare technology, the NHS has often found itself entangled in the complexities of ‘Big IT’ programs. For decades, these large-scale nationwide programs, often championed by consulting giants, promised transformation but delivered little more than frustration and inefficiency. The time has come to pivot towards a new, and arguably better, notion: Small IT.

The allure of Big IT solutions, with their expansive scope and proposals of comprehensive integration, once held sway over healthcare decision makers. But bloated budgets, delayed timelines, and systems plagued by interoperability issues have become all too familiar hallmarks of these grand endeavours.

For the NHS, another fundamental flaw of Big IT initiatives lies in their top-down approach. These monolithic projects often attempt to impose standardised solutions across a diverse landscape of healthcare providers, disregarding the bespoke challenges and workflows of individual institutions. This ‘one size fits all’ mentality inevitably leads to adaptation struggles and, ultimately, suboptimal outcomes.

Adjusting to a nimbler evidence-based approach and building from proven localised successes allows for innovators to partner with the so-called integration giants in subsequent phases of rollout. The tail stops wagging the dog. Innovators lead, partnering with scale-out enablers at the right time and only after ROI proof-points have been demonstrated. This is where Small IT comes in.

The ethos of Small IT centres on leveraging modern technology stacks to empower innovators to tailor solutions to the specific needs of healthcare providers and patients alike. It marks a tactical pivot towards agile solutions delivered by passionate teams with a focus on both service and profitability.
Small IT also thrives on collaboration and customisation. By working closely with healthcare stakeholders, operations heads can gain a deep understanding of their needs and pain points, crafting solutions that seamlessly integrate into existing workflows while addressing specific challenges head on. This bottom-up approach fosters a sense of ownership and engagement among end users, driving adoption and ensuring that technology truly enhances, rather than hinders, the delivery of care.

The agility inherent in Small IT allows for rapid iterations according to evolving healthcare requirements and emerging technologies. Rather than being shackled to outdated systems and cumbersome bureaucracies, healthcare organisations can embrace change as an opportunity for growth and improvement. Dynamic responsiveness is crucial in an industry that changes as rapidly as healthcare, where the ability to swiftly respond to new challenges (spikes in patient admissions and evolving ailments, for example) can mark the difference between success and stagnation.

Critics of the Small IT approach may argue that it lacks the scale and robustness of Big IT solutions. But the goal is not to build massive systems that attempt to solve every problem under the sun, rather to create flexible, modular solutions that can be easily modified and scaled as needed. Small IT embraces the concept that solutions can’t do it all, yet are pragmatic, cost-effective, and, most importantly, deliver tangible value to end-users.

Plus the rise of modern tech stacks – cloud computing, microservices architecture, and open-source software – has democratised access to powerful tools and platforms for all Small IT users who can rapidly prototype and deploy solutions with minimal upfront investment. It levels the playing field and empowers a new age of healthcare entrepreneurs.

The era of Big IT dominance in healthcare is coming to an end. Decades of failed initiatives and wasted resources have demonstrated the limitations of top-down, holistic approaches. Software development efficiencies only add to the case. It is time to embrace Small IT’s agility, collaboration and customisation to revolutionise the delivery of care throughout the NHS.

By harnessing the creativity and passion of smaller IT teams, we can finally realise the promise of technology to improve patient outcomes, enhance clinician satisfaction, and drive efficiency throughout the healthcare system: a fundamental change meaningful to us all.