Aligning Digital Transformation Across NHS Wales

NHS Wales: Digital System Blueprint, Ways of Working Framework and System Design Authority

The Client’s Position

NHS Wales had ambition at the national level, but ambition alone doesn't translate into delivery if the system underneath it isn't aligned and able to act together. However strong a national strategy or plan might be, without system change below Welsh Government level, digital transformation activity risked continuing in a fragmented way, with siloed duplication and it not being given proper prioritisation.

What Tektology Contributed

We were engaged to organise the system for delivery beneath Welsh Government level, work that went well beyond architecture. The Digital System Blueprint set out a shared system view: what needed to change across NHS Wales, how the different parts of the system fitted together, where responsibilities sat, what the major dependencies were, and how national ambition could actually translate into coherent delivery on the ground.

Alongside the Blueprint, our Ways of Working strand went deeper into the human factors sitting underneath all of this. Through extensive engagement, workshops and consultation across Health Boards, Trusts, Welsh Government and Special Health Authorities, we surfaced the behaviours, relationships, assumptions and tensions that were actually getting in the way of delivery: places where people saw their roles differently, where authority and accountability had become blurred, where work got stuck between organisations, and where the formal model on paper didn't match what was really happening in practice. The point was never to tell people how they should work. It was to understand why the system was behaving the way it was, make those issues visible, and then work alongside the people inside the system to change them.

That combination produced four things: the Digital System Blueprint itself; the Ways of Working; a practical, real action plan; and the beginning of a System Design Authority, established to hold the work together, manage cross-system issues, and provide a route for decisions and dependencies that couldn't be resolved within any single organisation. The Target Operating Framework is the newest part of this work, and where the System Design Authority now sits. We developed the initial conceptual model, deliberately rough, to help people see and test the shape of the future system. We're now moving from that conceptual model into the detailed work needed to populate it properly: roles, responsibilities, authority, interfaces, governance, processes, and the relationships between Welsh Government, Digital Health and Care Wales, Health Boards, Trusts and Special Health Authorities.

Outcome

NHS Wales now has a shared Digital System Blueprint, agreed Ways of Working, a practical action plan, and a System Design Authority operating within an emerging high-level operating framework to support implementation. The Target Operating Framework is being developed further, to the level of detail needed to make the model genuinely operational, work that continues as an active engagement.

Our Perspective

The underlying lesson holds across all of his work, transformation doesn't happen because people are handed a strategy or told what to do. It takes making the system's real issues visible, setting out what actually needs to change, and then co-designing with the people inside that system to make lasting change.