Going Ballistic

At the turn of the millennium, on a summer break from university, I worked for a large insurance company.

The company had fields of warehouse space with paper files stacked up to the roof. 

Those files were the results of decades of business; records of every person or business that had used them, and all the documentation that had built up when any claim was made.

Each day we’d receive hundreds of requests for this information and it was my job to run through the warehouse to grab the right files.

Those documents then went over to a floor full of other summer interns who would type the details into a new computerised database.

Across the globe, all types of organisations were going through this process, switching from swathes of paper records to new instantaneously accessible systems.

And in the UK the biggest organisation of them all is the National Health Service, employing over a million people to deliver a service that affects the lives of every person in the land.

It was clear that somehow the NHS would also need to find a way to navigate away from hordes of unconnected documents written in the illegible scrawl of thousands of doctors, into a modern electronic and connected system.

The ambition was to ensure that every patient had an individual electronic care record which could be instantly shared between different parts of the NHS.

The challenge was huge: 

• Every region in the UK operated differently and separately.

• There were thousands of distinct clinical and administrative processes operating as a highly complex, interdependent network.

• It was a huge workforce across an array of services, everything from surgeons to health visitors, and GPs to lab technicians.

• There were 60 million patients.

• Maintaining the security for this highly sensitive data was essential.

• And all the time new technology was evolving at a bewildering pace.

In October 2002 work began and on April Fool’s Day 2005 a new agency called NHS Connecting for Health was formed to deliver the programme.

It was going to require the world’s largest non-military IT project, which was estimated to cost £2.3 billion and take three years to complete.

Richard Granger, a tough 42-year-old management consultant was put in charge and immediately became the highest paid person in government service with what eventually rose to a £285,000 salary. 

V2

As a young boy Wernher von Braun became obsessed with rocketry.

He’d been inspired by a book by an early rocket pioneer: “It filled me with a romantic urge. Interplanetary travel! Here was a task worth dedicating one's life to. Not just stare through a telescope at the Moon and the planets but to soar through the heavens and actually explore the mysterious universe.”

So even though he found subjects like maths tricky, he drove himself to gain an engineering degree and then a physics doctorate.

Throughout his studies he also worked on building and testing homemade rockets.

Then at the age of just 20 he was hired as the German Army's top civilian specialist in rocketry.

With the backing of the military he increased his understanding of rockets in the inter-war years, hoping for an opportunity and budget to build a rocket capable of reaching space. 

His chance finally came in the final years of WW2 as an increasingly embattled Germany, being pushed back by bitter fighting against the Soviets and with the citizens of their cities being bombed nightly by Allied heavy bombers, were desperate to find a new way to strike back. 

Wernher von Braun was handed a huge budget, the equivalent of $9 billion today, to build a weapon that would change the trajectory of the war. 

In the middle of 1944 his V2 rocket was ready to be tested, and on 20 June it became the first man-made object to reach the edge of space. 

Months later the weapon was ready to be used.

On 9 September 6:43 pm the first V2 launched towards London landed at Staveley Road, Chiswick, killing 63-year-old Mrs. Ada Harrison, three-year-old Rosemary Clarke, and Bernard Browning who was a Royal Engineer home on leave.

The V2 was going to be used as a terror weapon, in the hopes of demoralising the British public into submission.

It was used for terror instead of a targeted military attack, because it was incredibly inaccurate.

Ballistics 

The V2 was the first ballistic missile. 

A ballistic missile is only guided in the brief initial powered flight phase.

The rest of its trajectory is determined by the laws of classical mechanics.

Despite its complexity, the rocket still largely behaved in the same way that weapons had been operating for millennia, from stones, to arrows, to bullets, and now to rockets.

It was only as good as the initial targeting instructions it was given. 

But calculating a path to hit something 200 miles away is immensely challenging. 

The rocket would be affected by a wide variety of issues that were impossible to perfectly account for. 

Just small variations in atmospheric conditions, manufacturing inconsistencies, or just how the materials performed under extreme temperatures, would deflect the rockets away from their ideal flight path.  

Which is why the V2 was so inaccurate. 

50% of the rockets could only be guaranteed to hit within a 3.8 mile radius, and it took an 11.2 mile radius for 100% to hit. 

They could only hope to hit somewhere in half of London. 

The Germans also could not see where the rockets struck, which would have helped them improve their calculations. 

The British fed false reports through double agents nudging the Germans to adjust their focus 10 to 20 miles to the east.

That deception resulted in more than half of the rockets falling far outside of London. 

By the end of the war 1,358 V2 rockets were fired at London killing 2,754 people, almost all civilians.

The last V2 hit a house on Kynaston Road, Orpington in Kent, on 27 March 1945, killing the final civilian casualty on British soil: Ivy Millichamp who died at the age of 34 while making a cup of tea.

Even with that toll the weapon was a failure, it didn’t terrorise the British public into submission and it made no impact on the outcome of the war. 

The biggest loss of life were the 12,000 concentration camp prisoners who died while being forced to produce them.

“The rocket worked perfectly, except for landing on the wrong planet.” - Wernher von Braun

Guided

After the war Wernher von Braun and his team were transported to the USA.

He ended up as the NASA engineering program manager and the chief architect of the Apollo Saturn V - the rockets that would take man to the moon. 

As the rockets developed they began to operate very differently.

They were no longer ballistic, instead they were now guided.

Today’s rockets control their trajectory throughout their flights.

They use inertial navigation, GPS, sensitive instruments for atmospheric and mechanical changes, live communication with other sources, adjustable wings, and react immediately through onboard computers that recalculate and adjust trajectories live. 

With the ability to adjust on the fly, instead of hoping to hit a vast city, today’s guided missiles can target specific buildings. 

And modern space rockets can even land themselves inside a 10m radius on a small floating platform. 

“When my information changes, I alter my conclusions. What do you do, sir?” - John Maynard Keynes

Lean Systems

If you are building a new system, organisation or product you have two options. 

Option one is to treat it as a ballistics challenge. 

Before you start you try to anticipate all of the possible issues and outcomes to create the perfect strategy to achieve the target.

It’s the classic top-down approach. 

The problem is, like the V2 faced, the real world is a wicked environment.

The situations most systems face are incredibly complex with too many variables for the designers to successfully account for. 

So the chances of falling short of the target and failing are high.

“We face a difficult challenge: the more complex and elusive our problems are, the more effective trial and error becomes, relative to the alternatives. Yet it is an approach that runs counter to our instincts, and this is the way in which traditional organisations work.” - Tim Harford, Adapt

“Trying to predict the future is like trying to drive down a country road at night with no lights while looking out the back window.” - Peter Drucker

Option two is to treat it as a guided challenge.

Again you try to anticipate the perfect solution, but now you get started then adjust and adapt as you go. 

You use a bottom-up approach and embrace lean methodology. 

Described by Eric Ries in his book The Lean Startup, this is a development approach that prioritises continuous validated learning over leaps of intuition.

It was designed for startup businesses, but the principles are true for any new project or system.

You start with the simplest system you can, what he calls a Minimum Viable Product, to test your hypotheses rapidly. 

And you adapt as you go based on feedback, to refine or pivot your strategy, until you achieve a successful solution. 

“Think big. Start small. Scale fast.” - Eric Ries

Going Ballistic 

So how did the Connected for Health project go?

Four years after starting, and one year after it was initially expected to finish, two of the four IT contractors had dropped out and the project estimates had overrun by £10 billion.

The Public Accounts Committee laid a lot of the blame at the door of Richard Granger, the highly paid civil servant leading the project: “He set up a top-down, centralised approach to programme development along with a survival of the fittest approach to managing the four main IT suppliers for NPfIT. Some think his mis-management was of treasonable proportions.” 

In 2007, one year after the revelation of the cost increase, he was forced to resign saying, "I am proud of what has been achieved by the team I established following my appointment in October 2002. I passionately believe that the programme will deliver ever greater levels of benefit to patients over the coming years.”

It didn’t.

The whole project was abandoned in 2013 at an estimated cost of over £12 billion.

The technology was out of date by the time it was cancelled and almost none of what was built was ever used.

The Public Accounts Committee concluded that, "this saga is one of the worst and most expensive contracting fiascos in the history of the public sector."

Today the ambition of a huge centralised solution has been gradually filled by a network of connected, simpler systems.

And they were mostly designed from the bottom-up.  

Gall's Law: “A complex system that works is invariably found to have evolved from a simple system that works. The inverse proposition also appears to be true: A complex system designed from scratch never works and cannot be made to work.”

"Perfect is the enemy of good." - Voltaire

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Harford, T., “Adapt: Why Success Always Starts with Failure”, Hachette (2011)

Ries, E., “The Lean Startup: How Today's Entrepreneurs Use Continuous Innovation to Create Radically Successful Businesses”, Portfolio Penguin (2011)

Campion-Awwad, O., Hayton, A., Smith, L., Vuaran, M., “The National Programme for IT in the NHS - A Case History” University of Cambridge MPhil Public Policy (2014)

Public Accounts Committee, “The National Programme for IT in the NHS: an update on the delivery of detailed care records systems”, (2011)

Written evidence from K2 Advisory, “National Programme for NHS IT”, Session 2010-12 

Granger, R. “Personal statement regarding Richard Granger”, press release (2007)

Gall, J., “Systemantics: How Systems Work and Especially How They Fail”, Times Books (1977)