It was 2001 and I’d picked a terrible time to pivot my firm, Step Two, from being a software development company to a pure-play consultancy. It was just after the dot-com crash and work was thin.
That year, our first and only new client was John Hunter Hospital, located two hours north of Sydney. The hospital was part of the public hospital district, which encompassed 15,000 staff across three major hospitals and a pile of other smaller locations.
They had an intranet that they’d been managing as flat HTML, and it actually wasn’t bad. To this day, it stands as one of the better-managed sites, which was a testament to the intranet team.
The team saw that there were bigger needs to be met, however, and the starting point was to understand staffing needs and challenges. I invented a research methodology, which ultimately became the foundation for the next decade’s worth of work.
What we uncovered remains powerful to this day. While much has changed in the last 15 years, a lot hasn't.
The best part of the engagement was spending time with nurses in wards. They were 100 percent busy every day, providing the majority of medical services to patients (doctors are wrong in thinking that they’re the most important staff). Nurses wrote rough notes as they went, and then at the end of the day they typed up details into the three duplicate medical systems that were in use.
At no point in the day did they have access to a PC. Yes, there was a single shared PC in the corner of each ward, but the nurses would get in trouble if they were seen using it (the nursing team leaders saw this as wasting time).
An Early Example of Design Thinking
If there was important new information, they would (maybe) be told at the beginning of their shift. They would also take home copies of key documents, which they’d read after dinner.
Despite these daily challenges and the exhausting pace, the nurses were practical and highly engaged. They knew their job was hard, and they were keen for any improvement that might help them deliver better patient care.
Outside of the hospitals, it was no easier. Physiotherapists and other allied health professionals worked out of small clinics. Like the rest of staff, they had no internet access at work. They talked about stopping off at the local library in order to access the information they needed to do their job. They also discussed the challenges of working in isolation, with few opportunities to share ideas or resources with their peers.
Despite these challenges, remarkable innovation was underway, even in those early days. Alongside our engagement, they were running the "Maggie project," which involved walking a fictional 80-year old patient (Maggie) through her interactions with the hospital.
Today, we would call this a design thinking project based around personas, with an overall focus on the digital workplace. The results were remarkable from the outset, slashing the waiting times in intensive care by showing the many inefficiencies that could actually be easily resolved once they became clear.
Frontline Worker Challenges Remain the Same
This year, we’ve returned to hospitals, working with another public health district in Australia, and a private hospital network in New Zealand. Needless to say, many challenges remain, some old and some new.
Staffer now have access to the internet (phew), but mobile access is now the frontline of the digital workplace in hospitals. Few staff have been given mobile devices, intranets aren’t yet mobile-enabled, and Wi-Fi coverage in hospitals is patchy.
It’s clear that the future of medical care will be digital, with staff using devices that provide an electronic patient record plus supporting artificial-intelligence-guided advice. The challenge (and opportunity) is to work out how to get there as quickly as possible during this time of transition.
Nurses remain as — or more — busy. While their focus remains on patient care, it’s clear that they are also information workers. Their challenge is to keep up-to-date on changing procedures and new equipment, despite busy days and limited digital access.
To understand and address these needs, proper field research remains vital. This enables project teams to uncover the realities of how the staff works, and to look for alignment with organizational priorities. (As a side note, it’s fascinating to see that the article I wrote in 2005 on conducting needs analysis remains every bit as valid today.)
No Industry Is Immune to Digital Transformation
Digital transformation is affecting every industry and the changes are biggest in those firms that have extensive field or frontline staff. In too many organizations, customer-facing staff remains disenfranchised, with only second-class information access compared to desk workers.
Hospitals are complex environments with many changes happening in parallel and enormous resource constraints. The same can be said, however, in many other industries, including airlines, government agencies and financial services firms.
Over the 15-plus years that have passed since that first hospital, I’m pleased to see intranets evolve from dumping grounds of content into modern sites that better support staff needs. The rapid evolution of the digital workplace is also heartening, as are the growing roll of hospital winners in the Intranet and Digital Workplace Awards.
There’s still much work to be done. And if there’s a single take-away from that first hospital, it’s this: Spending time with staff members who do the key work uncovers powerful stories that can drive change. It’s these stories that ultimately underpin our future digital workplace visions and the journey we are all taking to a digital future.
I’m looking forward to another 15 years in this space, spending time in hospitals and other fascinating work environments.
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