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The NHS
and Business Architecture
      Philip Veasey – Ealing LINk

UNICOM Enterprise Architecture Forum, London, March 2012
Curing the NHS

Symptoms            Diagnosis




Treatment          Prescription
Symptoms

                   Horror Stories
• Lost body

• Lost referrals

• The staff were wonderful – really?
Symptoms

             Political football

• Change initiative exhaustion

• Choice

• Not even trying to design
Symptoms

                        Close-up
• Too much perception management, not enough
  performance improvement
• Specific patient journeys optimised at expense of overall
  coordination system
• Restricted access to business architecture information – if it
  exists!
• Empire building
• Technology before process
Axum Change Framework
• Identify the stakeholders
• Determine which capabilities                Stakeholders
  they expect                                 Capabilities

• Determine processes that can                  Process
  deliver the capabilities
                                              Organisation
• Plan changes to:
    –   Culture




                                    Co
                                                 Culture




                                                                  gy
                                     m
                                      pe




                                                              olo
    –   technologies




                                         te




                                                             n
                                         nc




                                                          ch
                                           ies




                                                       Te
    –   people organisation
                                                             © Copyright Axum Ltd. 1995


    –   competencies
   that will be needed to support
   the processes
Diagnosis
• No shared picture to support communication
  and cooperation:
  – Please let’s have pictures
  – The one picture I have – governance
• No management of complexity:
  – No design to reduce it
  – No record of it
  – Lost opportunities for integration
• Non-cooperative stakeholders
NHS Governance
Prescription
               Business architecture
• Must be genuine:
   – Based on detailed knowledge
   – Boxes and arrows meaningful
• Process before people organisation structures
   – Effectiveness and efficiency before empire building
• Process before technology:
   – Business architecture before technical architecture
• Reducing complexity:
   – Recursive structures
   – Configurable business modules
   – Designed language of the future
Prescription
                        Pitfalls
• Complexity Management:
   – Natural selection is a cruel master. We escape it by
     designing

   – Limits of design. To be recognised but not used as an
     excuse for no design

• Knowledge hoarders
• Treating modelling as trivial
Prescription

               Process modelling
• Needs to be creative, use top designers
• Model the whole industry or marketplace. Hugely
  complex in the case of the NHS
• Use Role Activity Diagrams (RADs - see last four slides)
  for process architecture
• NHS has a special need to trace accountability and
  responsibility rigorously
Example of an Industry Model
        - The TV Industry -
A Process Architecture using RADs




            – Top Level –
Prescription

                    Policies

• No integration without investment in
  adequate corporate memory (so you know
  how to unpick it if necessary)
• Ignore politicians as far as possible
• Open information
Treatment
• Over to you:
  – If you work with NHS, press for Architecture
  – Join LINks
• Ealing LINk:
  – NWL NHS Integrated Care Pilot - RADs
  – WikiArch ?? Extension to other orgs
Advantages of RADs

• Capture coordination

• Easily understood

• Usable from high to low level modelling

    “Nothing else comes close in reflecting the
     nature of processes involving humans.”
Capture coordination

• Emphasise visibility of interactions between roles - getting these right is the
  heart of business process design. Most process failures are failures of
  coordination.
• The RAD “interaction” is directionless. It allows the initial modelling of
  shared activities without any assumption of the logical ordering of the parts
  played by different roles. Very useful in modelling enterprises and
  marketplaces with many stakeholders (such as airports or NHS).
• Give roles high visibility, making their level of abstraction easier to manage.
  This makes the eventual mapping of process through to concrete
  organisation much easier.
• When a model is expanded (drill down), it is an interaction that gets
  modelled in greater detail not just an activity that has been arbitrarily
  assigned to just one role.
Easily understood
• Are nearly always understood quickly and easily by
  business users.
• Downward arrow of time helps to tell the story
• They allow parallel activities within roles to be seen with
  great clarity. This is partly because of adjustable width
  “swim lanes” and partly because the refinement construct
  allows the “shape” of the process to emerge.
• More than one box representing the same role, and
  containing activity, can appear on a single page. Again the
  “shape” of the process is clearer.
• These constructs also makes good use of space on the page
  allowing more of the story to be visualised in one eyeful.
Usable from High to Low Level Modelling
• Very easy to use for current process
• With right approach, give the best process architectures
• Allow the modelling of the dynamic creation of process instances,
  allowing the relationship of case processes and case management
  processes to be accurately modelled.
• According to the use the diagram is being put to, RADs allow state
  changes and sequencing logic to be identified as completely as is
  helpful.
• Can be developed, if appropriate, to a rigorous definition of a
  coordination system that is convertible to executing code.
• If systems are modelled as roles, provide an excellent way of
  designing the scope of Use Cases and demonstrating how they
  relate to the process.
Philip Veasey is a specialist in business architecture in which
capacity he has helped organisations in many fields including:
insurance, healthcare, aviation, local government, television and
Government agencies.

He has worked as an independent consultant since he left ICL in
1993 where he led the Business Reengineering programme.

Email: pveasey@axumbpm.co.uk

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The NHS and Business Architecture 5.0

  • 1. The NHS and Business Architecture Philip Veasey – Ealing LINk UNICOM Enterprise Architecture Forum, London, March 2012
  • 2. Curing the NHS Symptoms Diagnosis Treatment Prescription
  • 3. Symptoms Horror Stories • Lost body • Lost referrals • The staff were wonderful – really?
  • 4. Symptoms Political football • Change initiative exhaustion • Choice • Not even trying to design
  • 5. Symptoms Close-up • Too much perception management, not enough performance improvement • Specific patient journeys optimised at expense of overall coordination system • Restricted access to business architecture information – if it exists! • Empire building • Technology before process
  • 6. Axum Change Framework • Identify the stakeholders • Determine which capabilities Stakeholders they expect Capabilities • Determine processes that can Process deliver the capabilities Organisation • Plan changes to: – Culture Co Culture gy m pe olo – technologies te n nc ch ies Te – people organisation © Copyright Axum Ltd. 1995 – competencies that will be needed to support the processes
  • 7. Diagnosis • No shared picture to support communication and cooperation: – Please let’s have pictures – The one picture I have – governance • No management of complexity: – No design to reduce it – No record of it – Lost opportunities for integration • Non-cooperative stakeholders
  • 9. Prescription Business architecture • Must be genuine: – Based on detailed knowledge – Boxes and arrows meaningful • Process before people organisation structures – Effectiveness and efficiency before empire building • Process before technology: – Business architecture before technical architecture • Reducing complexity: – Recursive structures – Configurable business modules – Designed language of the future
  • 10. Prescription Pitfalls • Complexity Management: – Natural selection is a cruel master. We escape it by designing – Limits of design. To be recognised but not used as an excuse for no design • Knowledge hoarders • Treating modelling as trivial
  • 11. Prescription Process modelling • Needs to be creative, use top designers • Model the whole industry or marketplace. Hugely complex in the case of the NHS • Use Role Activity Diagrams (RADs - see last four slides) for process architecture • NHS has a special need to trace accountability and responsibility rigorously
  • 12. Example of an Industry Model - The TV Industry -
  • 13. A Process Architecture using RADs – Top Level –
  • 14. Prescription Policies • No integration without investment in adequate corporate memory (so you know how to unpick it if necessary) • Ignore politicians as far as possible • Open information
  • 15. Treatment • Over to you: – If you work with NHS, press for Architecture – Join LINks • Ealing LINk: – NWL NHS Integrated Care Pilot - RADs – WikiArch ?? Extension to other orgs
  • 16. Advantages of RADs • Capture coordination • Easily understood • Usable from high to low level modelling “Nothing else comes close in reflecting the nature of processes involving humans.”
  • 17. Capture coordination • Emphasise visibility of interactions between roles - getting these right is the heart of business process design. Most process failures are failures of coordination. • The RAD “interaction” is directionless. It allows the initial modelling of shared activities without any assumption of the logical ordering of the parts played by different roles. Very useful in modelling enterprises and marketplaces with many stakeholders (such as airports or NHS). • Give roles high visibility, making their level of abstraction easier to manage. This makes the eventual mapping of process through to concrete organisation much easier. • When a model is expanded (drill down), it is an interaction that gets modelled in greater detail not just an activity that has been arbitrarily assigned to just one role.
  • 18. Easily understood • Are nearly always understood quickly and easily by business users. • Downward arrow of time helps to tell the story • They allow parallel activities within roles to be seen with great clarity. This is partly because of adjustable width “swim lanes” and partly because the refinement construct allows the “shape” of the process to emerge. • More than one box representing the same role, and containing activity, can appear on a single page. Again the “shape” of the process is clearer. • These constructs also makes good use of space on the page allowing more of the story to be visualised in one eyeful.
  • 19. Usable from High to Low Level Modelling • Very easy to use for current process • With right approach, give the best process architectures • Allow the modelling of the dynamic creation of process instances, allowing the relationship of case processes and case management processes to be accurately modelled. • According to the use the diagram is being put to, RADs allow state changes and sequencing logic to be identified as completely as is helpful. • Can be developed, if appropriate, to a rigorous definition of a coordination system that is convertible to executing code. • If systems are modelled as roles, provide an excellent way of designing the scope of Use Cases and demonstrating how they relate to the process.
  • 20. Philip Veasey is a specialist in business architecture in which capacity he has helped organisations in many fields including: insurance, healthcare, aviation, local government, television and Government agencies. He has worked as an independent consultant since he left ICL in 1993 where he led the Business Reengineering programme. Email: pveasey@axumbpm.co.uk