Incident: NHS Abandons Choose and Book Electronic Booking System.

Published Date: 2014-05-10

Postmortem Analysis
Timeline 1. The software failure incident of the NHS electronic booking system, Choose and Book, occurred around 2016. [26583]
System 1. Choose and Book system [26583]
Responsible Organization 1. The NHS staff and management responsible for implementing and maintaining the Choose and Book electronic booking system [26583].
Impacted Organization 1. Patients 2. Doctors 3. NHS 4. Department of Health 5. GPs 6. Taxpayers 7. National Audit Office 8. House of Commons' public accounts committee 9. Labour government 10. Tory MP and former GP Sarah Wollaston 11. Una O'Brien, the permanent secretary at the Department of Health 12. Commons select committee on health 13. Coalition government [Cited from Article 26583]
Software Causes 1. Lack of user adoption and satisfaction with the Choose and Book system among doctors and patients [26583] 2. Complexity and time-consuming nature of the Choose and Book system, making it difficult for doctors to use during appointments [26583] 3. Inadequate technology infrastructure and design of Choose and Book, leading to inefficiencies in the appointment booking process [26583]
Non-software Causes 1. Lack of user adoption: Many doctors and patients did not use the Choose and Book system, leading to its eventual replacement [26583]. 2. Complexity and time-consuming nature of the system: Choose and Book was found to be complicated and time-consuming for both patients and doctors, affecting its effectiveness [26583]. 3. Technology literacy and access issues: The system was more suitable for patients who were good with technology, potentially excluding those who were less tech-savvy [26583]. 4. Inadequate training and support: Doctors often did not have enough time to log on to the system during appointments with patients, indicating a lack of sufficient training or support for users [26583].
Impacts 1. The software failure incident of the NHS electronic booking system, Choose and Book, led to inefficiencies in the healthcare system, as highlighted by the drop in its use by doctors and patients [26583]. 2. Patients and doctors found Choose and Book complicated and time-consuming, indicating a negative impact on user experience and efficiency [26583]. 3. The failure of Choose and Book to achieve its intended purpose of speeding up the appointment process and cutting paperwork resulted in wasted resources, with 1.6 million patients failing to turn up for appointments in 2012-13, costing up to £225 million [26583]. 4. The decision to replace Choose and Book with a new e-referral system reflects the significant impact of the software failure, as the NHS aims to address the shortcomings and improve the electronic referral process [26583].
Preventions 1. Conducting thorough user testing and gathering feedback from both doctors and patients during the development and implementation phases of the software [26583]. 2. Providing adequate training and support for users to ensure they are comfortable and proficient in using the software [26583]. 3. Ensuring that the software is user-friendly and intuitive, especially for individuals who may not be as tech-savvy [26583]. 4. Implementing a phased rollout plan to address any issues or concerns before full deployment [26583]. 5. Regularly monitoring the usage and effectiveness of the software to identify any early signs of dissatisfaction or low adoption rates [26583].
Fixes 1. Conduct a thorough analysis of the reasons behind the low adoption rate of the Choose and Book system by doctors and patients to understand the specific usability issues and address them in the new e-referral scheme. This analysis should involve gathering feedback from users and incorporating their suggestions into the new system [26583]. 2. Implement comprehensive training programs for both healthcare providers and patients to ensure they are proficient in using the new e-referral system. This training should focus on simplifying the process and addressing any technological barriers that users may face [26583]. 3. Ensure that the new e-referral system is user-friendly, intuitive, and efficient to encourage widespread adoption among healthcare professionals and patients. This may involve conducting usability testing, incorporating best practices in user interface design, and optimizing the system for ease of use [26583].
References 1. House of Commons' public accounts committee 2. NHS England 3. Meg Hillier, Labour member of the committee 4. Department of Health 5. National Audit Office 6. Tory MP and former GP Sarah Wollaston 7. Una O'Brien, permanent secretary at the Department of Health 8. Commons select committee on health 9. Various doctors and patients 10. £12bn project launched in England in 2002

Software Taxonomy of Faults

Category Option Rationale
Recurring one_organization, unknown (a) The software failure incident of dropping the Choose and Book electronic booking system for outpatient appointments in the NHS is an example of a repeated failure within the same organization. This incident adds to the list of IT failures in the NHS, where attempts to implement efficient IT systems have encountered delays and cost overruns [26583]. (b) The article does not provide specific information about similar incidents happening at other organizations or with their products and services.
Phase (Design/Operation) design, operation (a) The software failure incident related to the design phase can be seen in the case of the NHS electronic booking system, Choose and Book. The system was introduced by the Labour government with the aim of enabling patients to select hospital appointments conveniently with their GPs. However, the system faced issues as not all outpatient appointment slots were available on it, limiting its usefulness. Many patients and doctors found Choose and Book complicated and time-consuming, with Tory MP Sarah Wollaston mentioning that the system suited patients good with technology but not those who were less tech-savvy. This indicates a failure in the design phase where the system did not adequately consider the user experience and ease of use [26583]. (b) The software failure incident related to the operation phase can be observed in the low usage of the Choose and Book system by doctors and patients. Despite being designed to speed up the appointment process and cut down on paperwork, the system faced challenges in adoption. Many doctors did not have time to log on to the system during appointments with patients, indicating operational difficulties in integrating the system into their workflow. This lack of operational efficiency contributed to the failure of the system, as highlighted by the drop in usage by doctors and patients [26583].
Boundary (Internal/External) within_system (a) The software failure incident related to the NHS electronic booking system, Choose and Book, can be attributed to factors within the system. The article mentions that the system was not being used by many doctors and patients, with only half of GPs utilizing it. Additionally, it was noted that not all outpatient appointment slots were available on Choose and Book, limiting its usefulness. The decision to replace Choose and Book with a new e-referral scheme indicates internal issues with the system's functionality and user adoption [26583].
Nature (Human/Non-human) non-human_actions, human_actions (a) The software failure incident related to non-human actions in this case is the failure of the electronic booking system for outpatient appointments, Choose and Book. The system was quietly ditched by the NHS due to a drop in its use by doctors and patients, limitations in available appointment slots, and complexities that made it time-consuming and not user-friendly for many patients and doctors. The replacement system, e-referral, is aimed at having 100% electronic referrals within the next five years to cut out errors [26583]. (b) The software failure incident related to human actions involves the introduction and subsequent failure of Choose and Book, which was designed by the Labour government to speed up the process of outpatient appointments and cut out costly paperwork. However, the system was not widely adopted by doctors and patients, with many finding it complicated and time-consuming. The decision to drop Choose and Book was criticized as another NHS "cock up" by a Labour member of the committee, highlighting the human factor in the failure of the system [26583].
Dimension (Hardware/Software) hardware, software (a) The software failure incident related to hardware: - The article mentions that the NHS is replacing the electronic booking system, Choose and Book, with a new e-referral scheme using different technology [26583]. This indicates that the decision to replace the software system was influenced by hardware-related factors, such as the need for updated technology to improve efficiency. (b) The software failure incident related to software: - The article highlights various issues with the Choose and Book system, such as limited availability of outpatient appointment slots, complexity, and time-consuming nature, which led to its low usage by doctors and patients [26583]. These factors point to software-related issues within the system itself that contributed to its failure.
Objective (Malicious/Non-malicious) non-malicious (a) The software failure incident related to the NHS electronic booking system, Choose and Book, does not appear to be malicious. The failure was primarily attributed to issues such as lack of usability, limited availability of appointment slots, complexity, and time-consuming nature of the system. There is no indication in the article that the failure was due to any intentional harm caused by individuals. The decision to replace Choose and Book with a new e-referral system was driven by the system's inefficiencies and lack of widespread adoption by doctors and patients [26583]. (b) The software failure incident can be categorized as non-malicious as it stemmed from challenges in usability, functionality, and adoption rather than any deliberate actions to harm the system. The issues with Choose and Book, such as its complexity, limited availability of appointment slots, and lack of widespread use by doctors and patients, point to a failure in meeting the intended objectives of the system rather than any malicious intent [26583].
Intent (Poor/Accidental Decisions) poor_decisions (a) The software failure incident related to the NHS electronic booking system, Choose and Book, can be attributed to poor decisions made in its design and implementation. The system was introduced by the Labour government with the intent to speed up the process of outpatient appointments and cut down on paperwork. However, it faced challenges as many doctors and patients found it complicated and time-consuming. Additionally, the system was not being utilized by all GPs, limiting its effectiveness. The decision to replace Choose and Book with a new e-referral scheme highlights the failure of the initial system due to poor decisions in its development and deployment [26583].
Capability (Incompetence/Accidental) development_incompetence, accidental (a) The article mentions several instances where the software failure incident related to the Choose and Book electronic booking system for outpatient appointments in the NHS can be attributed to development incompetence. The system was not being used by many doctors and patients, with some GPs not liking it and not all appointment slots being available on it, limiting its usefulness. Additionally, the replacement scheme was being considered to have additional features and be available on mobile apps, indicating a lack of foresight in the initial development of Choose and Book [26583]. (b) The software failure incident can also be attributed to accidental factors. The article highlights that the system was quietly dropped, with even most of the NHS being unaware of it. This lack of communication and transparency around the decision to replace the system with a potentially more expensive one suggests accidental mishandling of the situation, leading to the failure of the Choose and Book system [26583].
Duration temporary The software failure incident related to the NHS electronic booking system, Choose and Book, can be considered as a temporary failure. This is evident from the decision to replace Choose and Book with a new e-referral scheme by 2016 due to a drop in its use by doctors and patients, as well as the system not being used by many doctors and patients [26583]. Additionally, the article mentions that the replacement scheme would have additional features and would be available on mobile apps, indicating a transition to a new system rather than a permanent failure of the existing one.
Behaviour crash, omission, timing, value, other (a) crash: The software failure incident related to the NHS electronic booking system, Choose and Book, can be categorized as a crash. The system was quietly ditched after facing difficulties in its implementation and a drop in usage by doctors and patients. It was not able to fulfill its intended function of enabling patients to select hospital appointments efficiently, leading to its replacement with a new system [26583]. (b) omission: The failure of the Choose and Book system can also be attributed to omission. Many doctors and patients did not use the system, indicating that it omitted to perform its intended function of facilitating outpatient appointments effectively. Additionally, not all outpatient appointment slots were available on the system, limiting its usefulness and leading to its eventual replacement [26583]. (c) timing: The timing of the software failure incident can be considered in the context of the system performing its intended functions too late. Despite the initial aim of speeding up the appointment process and cutting out costly paperwork, the Choose and Book system was not able to achieve this goal effectively. Patients and doctors found it complicated and time-consuming, indicating a delay in the system's performance [26583]. (d) value: The failure of the Choose and Book system can also be related to the system performing its intended functions incorrectly. The system was supposed to enable patients to manage their appointments efficiently, but it was found to be cumbersome and not user-friendly for many individuals. This incorrect performance led to dissatisfaction among users and ultimately the decision to replace the system [26583]. (e) byzantine: The software failure incident does not exhibit behavior related to a byzantine failure, which involves inconsistent responses and interactions within a system. (f) other: The software failure incident can be categorized under the "other" behavior as well. The system's failure can be attributed to a combination of factors such as lack of user adoption, complexity, inefficiency, and cost overruns. These factors contributed to the overall failure of the system to meet the expectations and requirements of the NHS, leading to its replacement with a new system [26583].

IoT System Layer

Layer Option Rationale
Perception None None
Communication None None
Application None None

Other Details

Category Option Rationale
Consequence unknown (a) death: There is no mention of people losing their lives due to the software failure incident in the provided article [26583].
Domain health (a) The failed system, Choose and Book, was related to the healthcare industry as it was an electronic booking system for outpatient appointments within the NHS [26583]. (m) The failed system was not related to any other industry mentioned in the options.

Sources

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