Once upon a time I was the Medical Director for a project in the National Programme for IT, called Lorenzo.

Lorenzo was to be an electronic patient record system to cover both general practice, Acute Hospitals and Mental Health services across the North Midlands and East of England. Massive.

The project was already in trouble when I joined and I was sent to India, where the software was being developed, to review its progress. I visited the multi-story office block in Chennai where I was told in a PowerPoint presentation that we had 2,000 people working on the project. This rang alarm bells for me.

At the outset of my IT career, my friend Darren McKenna made me read Fred Brooks’ seminal work on software development, The Mythical Man Month, in which he described what we now know as Brooks’ law. This states ‘the more developers you throw at a project, the more delayed it will become.’ I felt a rising sense of panic – not least as a taxpayer – as the presenter revelled in the scale of the project.

My eye was drawn to the lift that served the boardroom. A smartly dressed lift attendant operated the lift. He was assisted by another man who sat beside him on a stool who ran errands for the lift attendant and brought him regular cups of tea. Even the lift attendant had an assistant! I started to hyperventilate.

Project budgets can obviously be too small, but it struck me they could also be too big. I thought I knew something about people as a psychiatrist, but I hadn’t experienced the warping effect that huge sums of money could have on human behaviour. And with NPfIT’s £12 billion on the table you can warp space-time. You can make fat Geordie middle-aged psychiatrists sexually irresistible to software sales staff.

I reported my fears back to my Masters in London. I felt the project was doomed. It was simply too big. Yes, projects can fail because they are too big. Indeed all NHS national IT projects are almost by definition too big. When a project is really big and has a lot of money spent on it, eventually it enters the ‘too big to fail’ phase and can only be cancelled by a change of government who can blame the previous one for the waste of money.

There is a Goldilocks principle at work. I recently co-wrote an academic paper on this subject in collaboration with two genuine academics Margunn Aanestad and Louise Wilson. Proper intellectuals. Learn more about ‘Goldilocks and the Installed Base’.

It is this thinking that underpins my joining SARD as Medical Director. We are a Goldilocks sized company with a Goldilocks sized number of developers producing just-right modules, big enough to solve your problem and small enough to fit together in a way that can be replicated, indeed cultivated across the NHS. You probably already have our appraisal and revalidation module, but we can do so much more and in particular we can help make job planning a meaningful exercise rather than a paper chase.

We are improving NHS IT one module at a time. If you’d like to join the cultivational, modular revolution drop me a line joe.mcdonald@sardjv.co.uk.

Attend our next webinar held the first Thursday of the month, every other month. Email vicki@sardjv.co.uk to book.