The Whole Arc: What Two Conferences in One Week Told Us About Transformation Now
By David Nicholson & Henry Darch
In the space of a single week we spent time at two very different conferences.
European Healthcare Design in London, where the conversation was about healthcare infrastructure, design, estates, pathways, digital and the future of hospitals. And HLTH Europe in Amsterdam, where the focus was AI, data, investment, vendors, innovation and the pace at which the technology market is moving.
They felt very different, but, they were not separate conversations. Together, they said something important about where healthcare transformation is now. The work is no longer about choosing between buildings or technology, strategy or delivery, policy or adoption. The real work sits in the join between them and that is where Tektology spends most of its time, we often call that the messy middle.
Healthcare’s hardest problems are rarely neat. They are not just digital problems, or estates problems. They are not just workforce, funding, clinical, operational or policy problems. They are messy problems because its all of those things tangled together.
That is why the response has to be woven through the system rather than placed on top of it. Digital and data matter, but not because technology is the answer on its own. They matter because they help make the true system visible.
They help connect people, pathways, places and decisions. They help leaders understand the art of the possible, and they help turn capital investment into a lever for real transformation rather than simply a way of replacing old buildings with new ones.
European Healthcare Design: capital, care and capability
The theme at EHD this year was Agile, Not Fragile, and it was a good frame for the week.
The conversations around the ambition, scale and direction of travel for the New Hospital Programme were genuinely impressive. It was also great to see so many European, Australian and Canadian colleagues in attendance alongside the UK contingent. Different countries, different systems, different funding models, but many of the same questions.
How do we use major capital investment to change care, not simply rebuild facilities?
How do we make sure new hospitals are not just better versions of old ones?
How do we connect national ambition to what has to change locally, in pathways, rooms, workflows, behaviours and operating models?
How do we harness the power of good design and innovation to promote care outcomes and the health of citizens?
For Tektology, EHD is really about the digi-physical. Not digital as a separate workstream, and not buildings as the whole answer, but the alignment of estates, clinical pathways, operational models, data and digital capability.
Our CEO David Nicholson had the privilege of presenting with Christine Chadwick from Archus and Kirsten Reite from Kirsten Reite Architecture on moving from fragmented data to actionable insight in regional infrastructure planning. Kanika Goel, our UK Associate Director, was with us across EHD as well, and brought a valuable perspective to the discussions which were practical, delivery-focused and always connecting the digital and operational questions back to what actually has to change for clients.
The session drew on work across Canada and Australia, but the challenge is very familiar across health systems. If leaders cannot see capability across a network, it is very hard to make good decisions about investment, access, service roles, workforce, resilience or long-term value. That is not just a data issue, it is a transformation issue.
A hospital, a community site, a diagnostic hub, a virtual service, a digital front door and a regional care model are not separate ideas. They are parts of one system. The problem is that health planning often still treats them separately, and then asks why the transformation is hard to deliver.
Capital can be one of the strongest levers we have to change that. Used well, it can reshape pathways, workforce models, patient experience, digital maturity, operational flow and the balance between hospital, community and home. Used narrowly, it can lock old models into expensive new infrastructure.
That was also the thread through the New Hospital Programme session David chaired on digital transformation and data-enabled design, with Sarah Thomas, Eamonn Gorman, Ben Raybould and Jamie Clegg. The conversation was not about technology for its own sake. It was about what it takes to create intelligent hospitals: hospitals where the building, the pathway, the data, the operational model and the people using them are designed together from the start.
That is the shift from “digital in the building” to a genuinely digi-physical model of care.
The transformation gap
Another important conversation during the week was a roundtable with NHS schemes and the New Hospital Programme on the transformation gap, organised by our friends and colleagues at IMPOWER Consulting, including Samuel R. and Kate Shields. Bec Trude from Carmichael Digital was part of that discussion too, and is now working closely with Tektology across the UK and Australia.
The phrase “transformation gap” is useful because most people working in major programmes recognise it immediately.
The policy direction can be right. The case for change can be strong. The business case can stack up. The technology can exist. The capital can be committed. And still, the actual change in care can be much harder to achieve than the programme language suggests.
Because transformation does not happen just because a strategy says it should. It happens when people work differently, pathways change and operational models change. When clinical teams, estates teams, digital teams and executives are working from the same view of the future. When benefits are designed into delivery, not searched for afterwards. When the rooms, systems, workflows and behaviours all point in the same direction. That is often the difficult middle. It is also where the work becomes most important.
HLTH Europe: the market is moving, but the problem still comes first
If EHD was about capital, design and system transformation, HLTH Europe showed the other side of the arc: the technology market moving at extraordinary pace.
AI was everywhere. So were data platforms, automation, imaging, diagnostics, ambient technologies, digital front doors and new investment models. There is real innovation in the market, and there are capabilities now becoming practical that would have felt some way off only a few years ago.
But the most useful conversations were not the ones that started with a product. They were the ones that started with the problem.
The art of the possible is important. Health leaders do need to understand what is emerging, what is maturing and what can now be done. But technology only becomes useful when it is connected to a real setting, a real workflow, a real adoption challenge and a real human need.
AI is the obvious example. It is now part of almost every serious conversation about productivity, safety, diagnostics, administration, workforce support and clinical decision-making. But AI strategy cannot be something written after the market has already shaped the answer. And procurement cannot do the work of transformation.
The better question is not “what AI should we buy?” It is: what work are we trying to change, what burden are we trying to reduce, what decisions are we trying to improve, what risks are we prepared to manage, and what will it take for people to actually use this well?
Paul Styler, our UK Director was also at HLTH, and across the two days the themes that kept coming to the fore were practical ones. Funding is a live issue everywhere. Organisations can see the opportunity, but they need credible ways to fund the work: through existing programmes, better business cases, benefits-led investment, partnership models or closer alignment between capital, operational and digital spend. Adoption is live everywhere too. Staff do not need more technology dropped into already pressured environments. They need tools that make sense in the work, reduce burden, support care and are governed properly.
And the system question kept appearing. National programmes, regional systems and local organisations all need to connect. A national digital ambition only matters if it can be translated into local reality. Local innovation only scales if it is aligned to architecture, governance and repeatable delivery models.
That is why we spend time with vendors understanding their products better, while remaining consciously vendor neutral, we need to understand where the market is going and what is becoming possible. But our starting point is always the client’s setting, their people, their operating model and the outcomes they need to achieve. Not a solution looking for a problem.
The conversations that travel
One of the things that makes events like these worthwhile is the conversation you did not plan to have.
Walking through the Leeds innovation area at HLTH, David saw his friend Herko Coomans from the Dutch Ministry of Health, Welfare and Sport. Herko has done exceptional work internationally across digital health policy, interoperability, standards and the practical use of digital health to improve care. It was a fantastic catch-up, and it brought back some important memories.
Tektology first worked closely with Herko through the International Policy Forum at MedInfo in Sydney, and then again through another International Policy Forum at the ICT&health conference in Maastricht in May 2024, hosted with the Dutch Ministry. Those forums were not narrowly about standards or technology. They were about international healthcare policy: how countries can improve access to care, improve the quality of care, support more connected systems, and recognise the role digitally enabled citizens can play in their own health and care.
That is the bigger story.
These conversations helped build momentum around how policy, standards, trusted information and digitally enabled citizens can come together in practical ways.
The later use of patient summary information for Hajj pilgrims is one example of that kind of work becoming real. Participating countries showed how essential health information could travel safely with people moving across borders at enormous scale. What started as an idea, led to meaningful action soon thereafter.
That is why seeing Herko again reminded us that this work compounds! A conversation in Sydney leads to another in Maastricht. A policy discussion about access, quality and citizens becomes part of a wider international movement. A standards conversation becomes a practical use case for people travelling across borders. A relationship formed through one piece of work becomes the basis for another.
Herko’s work in this space has been outstanding. So has the work of many others in that wider community, including Rachel Dunscombe, as well as Dr Louise Schaper, David Roberts, John Hoddinott, Beatriz Catarino, Kanika Goel, Joshua Roberts and Shalini Sood from our own extended team, who each played roles across the Sydney and Maastricht events.
The important things often do not arrive fully formed. They grow through relationships, policy work, shared ideas, careful implementation and people staying with the problem long enough for it to become useful.
Relationships are part of the work
Across the week we also caught up with colleagues, clients and friends past and present from across the NHS and beyond: Lesley Dwyer, Ed Prosser-Snelling; Lisa Cooke and Jonathan Gardner from Norfolk; the Cwm Taf team Stuart Morris, Katrina Percy and Matthew Walker from NAPC; David Champeaux and Michael Watts; and colleagues from Australia, the United States and Canada.
Healthcare transformation is not delivered by a strategy, a technology purchase or a capital project alone. It is delivered through trust, shared context, judgement, timing and the ability to work with people inside the complexity of their own setting. That is why the two conferences felt connected.
EHD showed the importance of capital, design and infrastructure as levers for transformation. HLTH showed the pace of technology, AI and the digital market. The more interesting work sits between them: helping systems understand what is possible, what is useful, what is fundable, what is adoptable and what will actually change care.
What we are taking away
Two conferences, two distinct conversations, and one connected message. Healthcare transformation is not singularly a clinical agenda, an estates agenda, a workforce agenda or a technology agenda. It is all of those things woven together. Capital matters because it can reshape care, not just rebuild facilities. Digital and data matter because they help make the system visible, connected and adaptive, not because technology is the answer on its own. AI matters, but strategy has to come before procurement. Funding matters, because ambition has to become deliverable. National programmes matter, but only when they connect to local adoption.
And people matter most of all, because transformation is ultimately about changing how people work, decide, collaborate and care. None of this is new. But the urgency around it is sharpening, and the patience for words-on-a-page strategies is running out. Both EHD and HLTH pointed to the same conclusion: the systems making progress are the ones moving from the document to the delivery. That is where the work is now, and that is why Tektology exists. If any of these themes are live in your own system, we would be glad to talk.
David Nicholson is Global CEO of Tektology, where he works with governments and health systems on large-scale transformation at the intersection of capital, digital and operating model redesign. Alongside his role at Tektology, he is Chair of the Independent Digital Group and a member of the Independent Technical Review Panel for the UK's New Hospital Programme. He brings deep experience from senior roles across public administration, including Deputy Secretary positions in health, social care, justice and central government in Australia.
Henry Darch is an Associate Director at Tektology, based in the UK, where he leads business development and works with healthcare organisations on the practical realities of transformation. He joins from SmartCo Future Health, with earlier consulting experience at SmartCo Consulting and Archus across operational improvement, estates and infrastructure, and digital delivery.