Bridging the Gap: A SocioTechnical Reflection on Digital Transformation in Public Services

The following blog was written based on questions and prompts following the HETT Leaders' Summit session 'People or Productivity: NHS Transformation in a Constrained System'.

Across government and healthcare, digital transformation is often spoken about as if it were a matter of simply deploying ‘better’ technology. But anyone working inside these systems knows the reality is far more complex. We are navigating a landscape where financial constraints collide with rising expectations, where national ambitions meet local realities, and where the pressure to modernise runs up against deeply embedded organisational structures. 

From a sociotechnical perspective, none of these tensions are surprising. Public systems are intricate ecosystems: people, technologies, relationships, processes, cultures, and infrastructures all interact in ways that cannot be changed by software or IT solutions alone. What we’re really confronting is not a “technology problem”, but a challenge of designing the fit between all these elements. 

I was a panellist at the recent HETT Leader’s Summit in discussion with Dr Alec Price-Forbes (National Chief Clinical Information Officer, NHS England) and Dr Shanil Mantri (CCIO, BSW ICB), where we tackled the question: “Productivity or People? NHS Transformation in a Constrained System”. We had fabulous audience engagement, capturing over 40 audience questions. What struck me was how often these questions revealed symptoms of deep sociotechnical misalignment; and when explored together, I believe they reveal a set of shared concerns about capability, coherence, and the human realities of change. 

Standardisation vs. Local Context: A Persistent False Choice  

One of the biggest frustrations raised by audience members through the poll questions we posed, was the wide variation in processes between GP practices, hospitals, and different parts of the system. If large retailers can standardise their processes nationally, why can’t the NHS? 

The immediate answer is that healthcare and public services simply hold a level of complexity - clinical, operational, organisational - that makes rigid standardisation counterproductive. But this doesn’t mean variation should be unbounded. What we often miss is the distinction between standardising the rails and dictating the journey. 

From a sociotechnical standpoint, the most resilient systems are often those that are tight on the nonnegotiables - things like data definitions, safety requirements, interoperability standards - and loose on the workflows that must flex around local teams, staffing, estates, and patient populations. This “tightloosetight” model can allow national consistency where it matters most, while enabling the essential adaptability that frontline services rely on. 

When we treat every variation as a problem, we misunderstand its purpose. Local adaptation is often how the system stays workable. The goal shouldn’t always be to eliminate it entirely, but to ensure it sits on standardised foundations. Without those foundations, frontline staff bear the cognitive load of workaround after workaround - documentation fragments, multiple logins, mismatched systems, and endless translation between processes. Good digital transformation can reduce that friction and make it more manageable, but it doesn’t erase legitimate variation entirely. 

Documentation Isn’t Bureaucracy, It’s a Safety System  

One of the strongest concerns raised was the lack of digital documentation standards, and the burden this places on frontline staff. Without consistent, usable documentation, new technologies can increase, not reduce, stress and risk. 

But again, this isn’t just an operational problem, it is a sociotechnical one. Documentation is a bridge between people and technology; it shapes how systems are understood, enacted, and sustained. When documentation is fragmented, outdated, or inaccessible, staff are forced into improvisation. That improvisation absorbs time, attention, and emotional bandwidth; resources that frontline teams simply do not have to spare. 

Treating documentation as a product rather than a compliance exercise changes its role entirely. When it becomes a living, owned, versioncontrolled asset, supported by design standards, common templates, and automated publishing, its purpose shifts from “administrative overhead” to “operational clarity”. It becomes a core part of the sociotechnical infrastructure of safety. 

The Talent Problem Isn’t About Salaries - It’s About the Work Environment  

Another recurring concern was how public systems can retain technical talent when the private sector pays more. It’s tempting to frame this as purely a budgetary question, but again, the sociotechnical lens reveals something deeper. 

The diligent professionals that characterise our NHS rarely leave because of pay alone. They leave because they cannot do their best work. They report a struggle against layers of governance, opaque decision-making, outdated tools, slow procurement, and the sense that the system itself is hostile to experimentation or a perception of ‘risk’. 

Retention, therefore, becomes less about matching salaries and more about designing an environment where people feel they can build, learn, and grow; where they are empowered, and trusted. If clinicians and allied health professionals are spending more of their time battling process than they are helping their patients, then no amount of belief in mission can compensate for that. 

NHS leaders who create “golden paths” i.e. clearing away needless bureaucracy, protecting time for learning, and providing clear career progression, signal that the organisation does understand what good technical work requires. These shifts reshape the sociotechnical system around the work rather than around the hierarchy - and that is often what keeps talent in the building. 

Why Transformation Feels Like an AddOn, Not a Profession  

A common frustration across many organisations - and one the NHS knows all too well - is that transformation is often treated as something people should squeeze in around their day jobs. It becomes an “add‑on”, an extra meeting, a parallel task that somehow has to be done alongside the real work. This isn’t simply a resourcing issue; it’s a structural misunderstanding of what genuine transformation requires. 

We know that technology alone does not transform a system. The “National Programme for IT” (NPfIT) in 2002 stands as a powerful reminder: it was one of the most ambitious digital programmes ever attempted in healthcare, yet it faltered not because the technology was inherently flawed, but because the programme underestimated the social, organisational, and behavioural dimensions of change. It treated digital modernisation as a technical deployment rather than a systemic reconfiguration. Local workflows, professional identities, user needs, organisational cultures, and the messy realities of clinical practice were not meaningfully integrated into the design. The result was predictable: resistance, workarounds, delays, and a system that was technically impressive on paper but unworkable in practice. 

We still risk repeating those same mistakes whenever we bolt transformation onto existing responsibilities and hope the system can absorb it. Digital change in healthcare requires coordinated shifts in processes, behaviours, roles, and decision‑making. When no one has the capacity or remit to hold that whole system together, transformation becomes fragmented and fragile. Everyone owns a tiny piece, but no one owns the connective tissue. 

Socio‑technical systems theory reminds us that successful change must be embedded, not appended. Planning, adoption, operational readiness, and workflow redesign must be part of the new system’s architecture from the start, not hurried through at the end or delegated to overstretched teams. Without this integration, organisations naturally snap back to their previous equilibrium - the gravitational pull of “the old way” - no matter how advanced the technology appears. 

Transformation succeeds when it is treated as real work, with real roles, real authority, and real capacity behind it. And crucially, when organisations recognise that technology and people are not separate domains to be managed independently, but are two halves of the same system. We need to design for that interdependence, if we are to avoid the mistakes of NPfIT and build transformations that actually take root. 

The Real Work of Digital Transformation  

Reading across all the questions, a single theme emerges: our biggest challenges are not technological at their root. They are systemic. They come from misalignments between the technical layers of our organisations and the human, organisational, and cultural layers that interact with them. 

In our research in the Surgical Observatory theme of the NIHR HealthTech Research Centre for Accelerated Surgical Care, we show through our research that digital transformation isn’t just “implementing tech”. It is the work of redesigning those interactions; and of building systems where the technology, the people, the processes, and the institutional structures reinforce one another rather than compete for dominance. 

It requires us to ask different questions: 

- What friction are we inadvertently creating for staff? 

- Where have we standardised the wrong things? 

- Where are we asking people to bridge gaps that the system itself should handle? 

- How do we design environments where technologists - and all staff - can do their best work? 

- Is technology the right answer to this problem? Do we really understand what is happening etc etc?  

When we understand digital transformation as a socio‑technical endeavour, the path forward becomes clearer. The real task is to shape the relationships between technology, people, workflows, governance, and culture so they reinforce one another rather than pull in different directions. Transformation takes hold when these elements are designed to fit together deliberately, thoughtfully, and with a genuine appreciation of how complex systems behave in practice. That is where coherence emerges, and where change becomes something organisations can sustain rather than endure.

Dr Helen Hughes (she/her/hers) is an Associate Professor at Leeds University Business School. She is a Chartered Occupational Psychologist and Director of the Leeds Behaviour Lab, a purpose built facility for behavioural science. Helen’s research is interdisciplinary, and specialises in understanding behavioural dynamics within complex socio-technical systems. She has applied this expertise in sectors ranging from aerospace engineering to healthcare, and is currently leading the Surgical Observatory workstream of the NIHR funded Surgical Health-Tech Research Centre at the University of Leeds. Her research is published in international journals and edited books, and has been featured by media outlets including the BBC, Forbes, the Financial Times, and the Guardian.