Let’s Talk About Insanity


    Confession: I am a total nerd when it comes to ops management in healthcare.

   Warning: Subtlety is something I am still working on.



Close to a decade ago I somehow fell into the world of the NHS and its endless cost saving programmes (for those still perplexed, the NHS is made up of hundreds of organisations trying to deliver a health system). I have supported the delivery of productivity and efficiency across the spectrum and in all cases, I will not be the first encounter for any of my clients. The look on their faces when I turn up: Here we go again…

Einstein said, “insanity is doing the same thing over and over again and expecting different results”. I see this a lot in the NHS, though, by far it’s not the only trending issue I’ve found. Depending on how well this blog goes, I might be tempted to create another piece of nerdy literature to elaborate on the other issues.

But, let’s stay with the topic in hand…


Picture this, a £120bn organisation conducting analysis on spreadsheets. In 2018. On it’s 70th birthday (5th July). Referrals are faxed, printed, put in the post, then scanned again the other side to be saved electronically on a SharePoint somewhere. Someone said to me recently, “We are digital! We have email and SharePoint.” Sigh.


I started speaking to my clients and friends in the NHS about digital operating models as the sustainable solution going forward. I said: imagine getting a notification that alerts you to a potential breach in the emergency department or increased elective appointments waiting time due to a sudden increase in demand. It will give you time to manage it before all hell breaks loose, again. Out of the people I speak to, those that know their ops management will tell me that there is no system in the world that can do NHS ops management and, the change management alone will cost millions.

And so, it is acceptable to carry on with the same cost improvement programmes which cost, you’ve got it, millions.

Critical Success Factors

I was then somehow in the privileged position to develop the first digital operating model for one of the leading acute trusts in the UK. They are seen as the pathfinder for a digital NHS and their digital control centre will be the first in the country to manage the local health landscape. They ticked all criteria on the checklist: vision, funding, talent and capacity.

Target Operating Model

People. Process. Technology.

Let’s just be clear: there is NO technology out there that you can buy off the shelf, press ‘go’ and it will somehow deliver all the benefits you dream of. I’ve often been in Trusts helping them to deal with the latest disaster after implementation of Electronic Patient Records (EPR) – which by the way can cost north of £40m. The mistake is thinking that EPR is all that’s needed when in fact, a whole system approach is required – people, process and technology. In other words, what’s needed is a digital operating model. 

The technology is the ‘digital control centre’. It helps you know who the patients are, what their needs are, who needs to interact with them, when, where, and how. It means that the right staff are in the right place to do the right thing at the right time. The good news is that you don’t need £40m for this.

The tough bit however, is that you have to able to deliver effective change management. This is hard work, it’s dirty work and the returns so far have been poor. But, we (the royal we) can do something different. We have to. If we get it right, the benefits will be substantial and more importantly, sustainable. (My clever health economics friends at FTI Consulting are hoping to quantify these benefits so definitely stay tuned in for the updates).

The digital control centre concept is work in progress. I am certain it will deliver sustainable benefits, hopefully before my 70th birthday. I am a few decades away so I’m not being unrealistic.

I’ve included my digital operating model concept below for those who are interested. Please feel free to comment and get in touch to let us know if you want to be part of the conversation to bring sustainable change to the health sector. Also, we are interested to know if this type of material is helpful, or what other topics you would like to hear about. If not, I am always happy to return to my day job, saving the NHS a little bit at a time in whatever way I know how.

Contact Qian:


     +44 (0) 7767 471 712

Meet the author

Zhiqian Huang

Zhiqian Huang

Qian is an experienced operational and turnaround expert. She is passionate about making sustainable change for her clients and is a strong advocate for incorporating technology enabled solutions. Her operational and 'hands-on' approach allows her to work closely with… Read more »

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