It was my first day as national clinical lead for IT at the National Programme for IT. I got up at 4am and got dressed in the dark as quietly as I could, in order to avoid waking the whole house.

I got in the taxi that arrived at 4.30am and made small talk with the taxi driver while the wind screen wipers squeaked away at the freezing drizzle.

At the station I bought a return to London and a large Americano with an extra shot and boarded the train. Like the first day at big school I was both excited about the new job and also a little intimidated: no-one enjoys having their head flushed down the toilet by the prefects.

Pass words

I arrived at New Kings Beam House where I was to be based – impressive views of the River Thames and the Houses of Parliament, very intimidating.

There, I confronted by the first obstacle: I didn’t have a pass to get into the building. I managed to phone somebody who came and signed me in.

As part of my induction, I had to have my photo taken so that I could acquire a pass to access the building on regular basis.

However, I was told when I went to the relevant office that the operative who took photos and issued passes had suffered a bereavement, so I could not be offered a pass on this occasion.

Bizarrely, because of the seemingly sad circumstance – and perhaps because I didn’t want my head flushed down the toilet – I agreed to “come back next week”.

The following week I presented myself at the pass issuing office only to be told the person was off sick. I again reluctantly agreed to return a week later.

On the third occasion, I was again told I couldn’t get a pass. By now I had given up a lot of sleep and new boy or not I’d had enough. I decided to deploy the standard Dad’s Army School of Management approach to unhelpful people.

I pulled out a note book and pen and said to my obstructor: “Name?” 


“Bob what?”

“Who wants to know?”

I drew myself up to my full Captain Mainwaring level of pomposity and said: “I’m Doctor Joe McDonald, recently appointed national clinical lead for IT, and I’ve been trying to get a pass for three weeks now.

“I’m tired and a thousand quid out of pocket. So Bob, are you gonna help me get a pass or am I gonna have to tell your boss about how efficiently things are running here?”

Ten minutes later I had my pass. It took ten months to get my expenses – and to get those I had to threaten to resign.

It took a year to get a business card. I should have known how things would go for NHS Connecting for Health from these small signs.

Better still, these arrangements had to be repeated for every government building in the land. Maybe we could have just used our passports?

Needless to say I wasn’t surprised when Fujitsu wiped the floor with the organisation recently.

The meet and greet and ‘The One Thing Test’

These experiences chimed with other experiences I have had in the past, in particular in restaurants.

If an organisation can’t get one little thing right like, say, meeting and greeting you, then almost always bad food and service will dog your evening.

I have become so convinced of this that I now turn on my heel if I am ignored at the door of a restaurant for more than a few seconds.

For more complex organisations – and indeed with new staff – I regularly deploy what I am calling ‘The One Thing Test.’

The test is very simple. Ask a person or organisation to do one, clearly defined thing. If you need a person or organisation to regularly do difficult things you set the test to the appropriate degree of difficulty.

If they do the thing it is highly likely that other things can also be done. The test is passed. If the one thing is not done then it is failed and the person or organisation needs to change or be replaced.

I once worked for an organisation that took six months to provide me with a telephone for my office; needless to say that organisation failed in its wider purpose.

Passing the test – a discharge summary for the North East

I commend ‘The One Thing Test’ to you. Most recently, I posed it to a meeting of North East chief information officers and chief information officers.

I asked the March meeting of the group to select one thing to do. It opted to agree a standard discharge summary to be deployed across the North East.

Before the afternoon was out, those present had settled on a project board and plan led by CIO Mark Thomas.

Within a few months, we were able to present the results at a best practice webinar. Test passed. An effective network. We look forward to doing many more things.

Now, I am writing this on the train on my way home from an excellent CCIO Leaders Network summer school, which included a brilliant site visit to the Epic deployment at Addenbrooke’s Hospital.

The team doing the deployment are doing many more things than just one thing, but they seem to have it all under control – and clearly they have delivered before.

I am betting they will deliver again. They have already passed ‘The One Thing Test’; although not in their present trust, and not where you are, I hear you say.

Another test set – a usability survey

The summer school had an array of excellent speakers who challenged us, the attending CCIOs, on a number of issues. I in turn felt the need to challenge the CCIO Leaders Network with ‘The One Thing Test’.

But which single thing would be the best? Well, we’d all been talking about it for two days and Mark Davies, the former medical director of the Health and Social Care Information Centre, put his finger on it during his after dinner speech.

In his presentation, he described “the righteous rage of clinicians confronted with unusable systems” and the continuing challenge of usability.

So the choice in the end was easy: the one thing the network is challenged to deliver is the first National CCIO Leaders Network System Usability Survey, with sufficient rigour to allow the results to be shared without fear of contradiction or litigation.

This one thing will require considerable effort and I am not sure how it might be accomplished. But until clinicians can freely share robust information with each other about systems we will continue to get systems which provoke righteous rage.

I am confident the CCIO Leaders Network will demonstrate its ability to pass this most difficult ‘The One Thing Test’ – and when it does I hope it will be entrusted with doing more difficult jobs for NHS IT.

The next North East ‘networks of networks’ meeting will take place in Newcastle on 11 September 2014, and will include a discussion of progress on the GP discharge summary agreed at the Spring meeting. 


Joe McDonald

Joe McDonald is a practising NHS consultant psychiatrist. Over the past five years he has been an NHS trust medical director and national clinical lead for IT at NHS Connecting for Health – a stint that included 18 months as medical director of the Lorenzo delivery team!

His experiences in the National Programme for IT in the NHS have left him with a passion for usability and "end user knowledge networks.” He is the founding chairman of the National Mental Health Informatics Network. Motto: we don't get fooled again. Follow him on twitter @CompareSoftware