NIMM Video Featuring Dr Mark Ferrar

With IT spend at an estimated 2.5% of the total NHS budget, Atos Healthcare ( http://www.atoshealthcare.com ) hosted a seminar to discuss the benefits of the NHS Infrastructure Maturity Model™ (NIMM™). At which Dr Mark Ferrar, NHS Director of Infrastructure, Technology Office in the Department of Health Informatics Directorate, spoke about the importance of infrastructure in delivering 21st century healthcare. From the seminar, a video was developed with Mark talking about how NIMM™ has been developed specifically for the healthcare market, how it contributes to driving out inefficiencies, its importance in enabling dialogue with a business that focusses on return on investment and its role in ensuring infrastructure provides a solid bedrock on which to deliver line of business applications.

Click here to view the video.

What Does NIMM Level 5 Mean in Practice?

I had an interesting conversation last week with someone from the NHS on how to apply the 5 NIMM maturity levels to each infrastructure capability. Our discussion related to possible confusion around NIMM level 5 and how you would actually score (without published KPIs) certain infrastructure capabilities as being truly Innovative (which is the definition for Level 5).

Take Change Management as an example, I think that it is clear to most people what Change Management would be like at NIMM Level 1 (Basic), NIMM Level 2 (Controlled), NIMM Level 3 (Standardised) and NIMM Level 4 (Optimised), but, what would Change Management be like at NIMM Level 5 (Innovative)?

I have given this some thought and come to the conclusion that for me there are three equally valid approaches that you can take when scoring an infrastructure capability:

1. You could take the Level 5 tag “Innovative” literally and look for characteristics in the way you do Change Management that enable Change Management  to function itself in an innovative way

OR

2. You could look for characteristics in the way you do Change Management that enable innovation in the capabilities that consume or rely on Change Management services

OR

3. You could take the Level 5 tag “Innovative” less literally and view this as the highest level of maturity appropriate for that capability that will contribute to the IT Infrastructur’s OVERALL capability to enable innovation.

In Summary….

At an individual capability level you need to consider if the way you are delivering an infrastructure service goes beyond being optimised and is really innovative OR take a view that Level 5 being about innovation only really applies if the result of having individual capabilities operating beyond Level 5 is resulting in the IT infrastructure as a whole enabling innovation.

PS. Worrying about the finer points of scoring NIMM Level 5 is a nice problem to have

NIMM KPIs for the IT Service Desk

I have developed a set of example Critical Success Factors and KPIs for a typical IT Service Desk. These can be used during the self assessment to score the Service Desk in each of the 5 NIMM Balanced Scorecard perspectives.

To see a version of this on Slideshare follow this link: http://www.slideshare.net/andysavvides/nimm-service-desk-self-assessment

I have not included the metrics for each KPI that would be needed to determine a NIMM level 1 to level 5 score, but, most people can use their own judgment to do this.

Process Perspective

• Does the Service Desk core processes follow ITIL best practice?
• How well do other support processes integrate with the Service Desk processes?
• Are the Service Desk processes documented, accessible authoritative, generally accepted and followed?
• How mature and optimised is the automation and workflow supporting the processes?
• How mature is the management of process quality & consistency and documentation?
• Are you able to provide evidence that Service Desk processes are followed?

People & Organisation Perspective

• How well suited is the organisational structure and people readiness of the delivering organisation to ensure that the Service Desks meets its stated goals?
• Is there an agreed RASCI chart for the Service Desk (and other related) roles?
• Does the Service Desk survey end users to measure satisfaction?
• Does the Service Desk have agreed service levels with its users?
• How would you rate the end user experience, accessibility and convenience when using the Service Desk?

Technology Perspective

• How mature is the functionality provided by the technology used by the Service Desk?
• Can the technology used by the Service Desk be adapted to provide the reporting and metrics needed to manage the Service Desk Performance?
• Does the technology used by the Service Desk actually perform as it was intended?
• Does the technology used by the Service Desk follow generally accepted industry standards?
• How would you score the technology used by the Service Desk in terms of being  reliable, manageable & scalable?

Information Security Perspective

• How mature are the IT security measures in place to ensure the trustworthy delivery of the Service Desk?
• How mature is the security model for authentication for users interacting with the Service Desk?
• How quickly are security incidents directed at the Service Desk reported and investigated?
• Is the Service Desk being delivered in a way that is trustworthy, auditable and standards based?
• Is there sufficient controls and monitoring in place to enable the identification of Service Desk related security issues and incidents?
• Are lessons learned from security incidents involving the Service Desk documented and acted upon?

Business Value & Strategy Perspective

• Is the a clear and documented strategy and vision for the Service Desk?
• Is it clear to the business what the role of the Service Desk is and what service levels can be expected?
• Does the business understand the value that the Service Desk can bring and does the business actively seek to exploit this potential?
• Does the Service Desk report it’s performance using metrics and language aligned to the business to aid understanding?
• How transparent are the benefits, costs and risks associated with the Service Desk?
• Is there a standardised and mature approach in defining, measuring and managing the TCO for the Service Desk?

A Brief History of the NIMM

When I present on the NHS Infrastructure Maturity Model (“NIMM”) I find it useful to explain the background to the NIMM and the approach taken in developing it. This “History of the NIMM” helps set the context and allows people get a feel for where it is going by understanding where it came from (well thats what I hope will happen!).

When I first started working for the Infrastructure Directorate (which was part of NHS Connecting for Health), one of the tasks I was given was to find ways to help drive infrastructure standardization and promote the sharing and re-use of best practice (avoid re-inventing the wheel) across the NHS in England.

It soon became apparent that there was already a huge amount of IT best practice an technical guidance already out there that could be used to manage and deliver IT infrastructure services, the NHS itself produces guidance, there are numerous other examples such as ITIL, COBIT.. many ISO standards not to forget guidance that technology vendors develop (such as Microsoft TECHNET etc..)

So the problem as I viewed it was NOT a lack of “bottom-up” technical guidance, instead it was the need to ake a “top-down” approach in order to create a common infrastructure management language that business, IT and vendors could speak. There was also a need to create more executive level focus on the importance of infrastructure (which is mostly invisible) in delivering the IT enabled change needed to better serve the patient, clinician and tax-payer.

An intuitive maturity model that can be used as a “Management Tool” to help IT Leaders manage performance locally across the NHS seem the way to go.

It was also clear to me what the NIMM should NOT be, it should NOT be another technical tool or another DVDs worth of documents OR a complex process to “tolerated” now and then OR a “stealth auditing tool” for someone else’s benefit etc.

Rather then start from scratch, I look at a number of existing Maturity Models and decided to create a “hybrid” taking what I felt was the best from each and added a generous helping of NHS reality and NHS “business context”.

18 months on… what we have is:

• an intuitive model and guidance which relies on self assessment to ensure that the knowledge gained from using the NIMM remain locally with those that actually have to see it through
• a set of definitions of what IT infrastructure is in the NHS (covering both management and technology)
• a 5 level scoring scale calibrated for the NHS
• a set of KPIs for some capabilities which enable objective benchmarking NATIONALLY
• a balanced scorecard methodology which can be used LOCALLY self assess any infrastructure capability using qualitative measures and manage performance (obviously, these capabilities can’t be benchmarked nationally since they rely on subjective measures)
• a common language that can link IT leaders across the NHS as well as linking them to the business and IT vendors

Note: The NIMM is Trademark of the Department of Health and is Crown Copyright

IT Maturity – Mind the Gap!

Something that IT assessment tools such as the NIMM can do is identify where there are major gaps in maturity. Now this becomes very interesting when you are a service provider or shared service. I have had a number of NHS IT Directors who run a shared service ask me “at whet level should we use the NIMM?”, “should I assess my own capabilities or the capabilities of the organizations I provide service to?”. The answer really depends upon what you want to get out of the assessment.

1. If you want to benchmark and improve your own capabilities, then assessing the shared service is the way to go.
2. If you want to measure and improve the way your customers use IT services then you should assess them.
3. If you want to highlight problems you have in serving your customers do both

I worked with a large NHS IT provider who followed option 3. What they did was to assess themselves and each of their NHS customers. What soon became very clear was that the NIMM showed where there were large maturity gaps and these gaps actually accounted for why there were service issues.

For example, the provider assessed themselves as being at NIMM Level 4 for Change Management while their customers varied from NIMM Level 1 to NIMM Level 3. The NHS client organisation that was at NIMM Level 1 was the one which had major issues traceable back to a lack of change control. So while the provider was a NIMM Level 4 the Consumer was at NIMM Level 1 effectively “dragging down” the perception of the provider.

Now this is not rocket-science, however, what this does show is that using a common benchmark between supplier and consumer really helps show where maturity gaps are and helps the provider anticipate the type of problems that will result from this gap.

Hopefully the picture below shows what I mean..

Facilitating a NIMM Self Assessment

Diagnose BEFORE you Prescribe

The ultimate goal of the NIMM self assessment process is to get a common consensus on how things really are today. The people involved in self assessing (the target team) will start to form opinions individually and then as a team about what the current NIMM maturity level is, some will also start to think of how maturity can be improved.

It is recommended that someone lead the self assessment process, taking the role of a self assessment facilitator. This should be someone not directly involved in the capability being assessed, and ideally someone from the senior management team who will be a stakeholder in driving maturity improvement (the CIO should get involved in some of these self assessment sessions).

In summary, there are three phases of a self assessment:

1. Open questions — These questions allow the target team to talk openly and freely about their current capability and ways of working.

The advantage of these types of questions is that they pose no boundary for the first part of the self assessment; these kinds of questions should help the target team explore and probe how they currently do things from many different angles.

2. Control questions — With these questions, the facilitator starts to guide the self assessment towards a conclusion on the current NIMM maturity level. During this phase, ideas will start to surface on possible ways to improve maturity (write these down!).

3. Confirmation questions — These questions aim to establish agreement or consensus amongst the target team on the current NIMM maturity level along with ideas for initiatives that will improve maturity.

As one well respected CIO said to me, “The key benefit of this self assessment tool is not so much the endpoint that you reach but the journey you have to undertake to get there.”

Good luck self assessing.

CIOs Get you Infrastructure Right BEFORE You Start Driving Business Innovation!

I sometimes come across examples where an organisation deploys innovative technology in an attempt to drive business innovation, however, all too often, this innovation places demands on the infrastructure which is way ahead of the actual infrastructure maturity curve. I was listening to a project manager describing a project in an NHS hospital where voice recognition technology had been deployed and integrated into a radiography system. This was a natural and bold next step beyond digital dictation.

This new technology enabled radiographers to review images and directly dictate a diagnosis or analysis of the image which is automatically converted into text by a remote recognition server and attached back into the patient’s notes. Now as you can imagine this innovative use of technology speeds up dramatically the cycle time from when a scan is taken to when the consultant or doctor gets the results and analysis back from radiography. This project also generated substantial cost saving from admin overhead and increased radiographer efficiency.

When asked if the clinicians preferred the new system or working with the old dictation system, the response was that the physicians preferred the new voice recognition system, except for when the network was “jammed”. This network “jamming” frustrated the users who often reverted back to the old system and caused a loss of confidence in the technology and IT department.

So what exactly causes the network to jam? Is it lack of capacity, a cabling problem, an application server failing, a router or switch failing, the end user’s PC hanging? Some set of conditions is occurring which is causing the end users to feel that the network has jammed. How mature do you think the infrastructure is (NIMM or indeed any other maturity model) if this jamming is a regular occurrence and going un-checked?

So, while applauding the innovative use of voice recognition software, I do wonder if this innovation is sitting on an immature infrastructure which is causing a perception that IT is only OK when the network isn’t jammed.

As I always say, get your infrastructure to a “standardised” or even better “optimised” level of maturity BEFORE you make significant investments in innovative technology or business innovation. If you don’t get infrastructure maturity “baked-in” then your projects to drive innovation will fail or become incredibly expensive.

Infrastructure Maturity Mapped to TCO

One of the things I am really keen to do is show how improving infrastructure maturity impacts Total Cost of Ownership (TCO) and the ability to generate ROI (return on Investment) from infrastructure investments.

I came across some research from Gartner where they compare Desktop TCO against various levels of “management”. The management levels they use are broadly similar to Levels 1, 2, 3 & 4 of the NIMM.

While direct costs remain fairly constant across the maturity levels, the indirect costs come down quite significantly as your infrastructure maturity improves.

In summary (my interpretation),

Going from NIMM Level 1 to NIMM Level 3will reduce Desktop TCO by approx 21%.

Going from NIMM Level 1 to NIMM Level 4 will reduce Desktop TCO by approx 42%.

Assuming that this trend will follow through to other parts of IT Infrastructure (Network TCO, Mobile TCO…) then there is a compelling TCO case to drive infrastructure maturity as well as the improvements in service and end user satisfaction.

Pilot Version of the NIMM Profiling Tool has been Released

The NIMM Profiling tool and NIMM Balanced Scorecard I have developed for the NHS is now available for testing within the NHS. The tool is intended to help NHS organisations self assess maturity against a set of suggested Infrastructure Capabilities using the NIMM levels and the NIMM balanced scorecard method. The self assessed scores are not nationally benchmarkeable since they rely on subjective self assessment, however, if the NIMM balanced scorecard guidelines are followed, it is possible to arrive at a meaningful score which can be used locally to plan and measure improvements in infrastructure maturity.

This is currently only available internally to the NHS on N3, here is the url.

http://nww.pspg.nhs.uk/iPSPG/iPSPG%20Artefacts/NIMM%20Profiling%20Tool%20Pilot%20Version%200.43.zip

Infrastructure Balanced Scorecard – Technology Perspective

When using the Infrastructure Balanced Scorecard (IBSC) to score an infrastructure capability from a technologyperspective, you should consider the following and score using the NIMM scale of 1-5:

• How mature is the functionality provided by the technology?
• Does the technology follow generally accepted industry standards?
• How mature and transparent is the ability of the product used to tolerate and recover from component and environmental failure?
• How well does this technology contribute to maintaining an integrated and standardised IT infrastructure?

Consider the following qualitative measures when scoring a capability against this perspective:

• Dependable, manageable & scalable
• Ease of acquisition, deployment, integration and disposal