If you're a hospital leader, I can guarantee that you have too many digital projects and not enough capacity to deliver them.
I know of one large hospital group in the UK, in response to pressure from particular board members, that has put all its resources into ambient voice technology (AVT) to reduce outpatient waiting lists. Admittedly, this is a government priority. Yet meanwhile, doctors and nurses are suffering burnout because the basic technology they use every day is shoddy and outdated; the EMR is hard to maintain or improve; hardware is falling apart; flow through critical areas causes ambulance queues and corridor care. The safety of patients remains in jeopardy.
AVT feels like a triumph of urgency over importance.
You may recognise something similar: leadership competition and corridor politics stretch an IT team across too many initiatives. Projects that started with genuine enthusiasm are quietly shelved mid-implementation. The foundational work – the investments that might actually transform patient care – are not getting done. Thankfully, there is an alternative.
What follows is a description of a horizon-scanning process, which you can use to cut through this complexity. It’s a process we have proven and repeated in multiple hospital groups. It creates clarity and alignment – ensuring investment decisions are taken objectively and are focused on strategy, not personal whim.
The process is rapidly repeatable, allowing for flexibility in the face of increasing change.
The outcome is a prioritised list of digital projects, properly assessed, ranked, costed and defined, which you can then use to communicate with staff and negotiate fairly between colleagues.
Your real problem isn't ideas – it's choosing between them
Let’s examine the problem in more detail.
One thing is for sure: we don't need more innovation proposals. And you probably don’t need clarity on the major problems you need to solve.
Currently, many of your hospital’s decisions are reactive. A clinical director sees impressive software at a conference. A vendor offers a free pilot. A competing hospital launches a new patient app. Each proposal arrives with a compelling business case. Each one, considered in isolation, seems reasonable. But collectively, they overwhelm your hospital's ability to execute and they are difficult to defend or explain.
The consequences are predictable: senior staff are in conflict; implementation teams are stretched thin; change fatigue takes hold of clinical and operational staff; and there is a growing cynicism about ‘transformation programmes’. Overall, there is a sense that despite constant activity, your hospital isn't actually transforming. Perhaps most damaging, your hospital never develops the institutional muscle for disciplined management of its portfolio of digital investments. So the cycle repeats with each budget year.
There's a further consequence that receives less attention. When you do finally decide to invest, procurement becomes harder than it needs to be. Without clarity on how projects fit together, you struggle to articulate a vision to stakeholders. Vendors become frustrated. Time and money is wasted buying ‘stuff’ that the hospital doesn’t need or can’t use.
And without business cases grounded in the hospital’s strategy, you end up defending individual purchases rather than presenting a long-term investment programme.
What you need is a reliable method to decide which innovations actually matter for your hospital, and which ones – however appealing – should wait or never happen at all.
Creating a repeatable and structured way to prioritise
A horizon scan provides exactly that discipline. The concept is straightforward: systematically identify what's possible, assess what's valuable for your hospital specifically, evaluate what's genuinely feasible given your constraints and create a prioritised roadmap you can actually deliver.
The process begins with people. You will need input from leaders across all clinical and operational functions – not just the higher-ups. It is often the middle managers that know where the real problems lie. I would recommend casting this net as wide as possible by undertaking 1–2 hour interviews with as many people as possible. You can increase reach by using small groups and, of course, using online meetings.
This wide engagement serves two purposes: it brings to the surface all the problems, desires and projects-in-progress that might otherwise remain invisible. It allows you to document every single digital project your organisation might fantasise about – and understand the reasons for wanting it.
Most importantly, this process means that leaders believe someone is listening. If their favoured project is on the list, but is not judged a priority, they are likely to accept that. Believing that no one heard them is a recipe for disillusionment, resistance and backsliding.
Overall, this interview stage builds goodwill and consensus — both of which you'll need later when implementation begins.
The Horizon Scan Process: Eight Stages
1. Engage stakeholders – Conduct structured interviews with leaders across clinical and operational functions to surface project ideas and understand organisational priorities.
2. Gather and filter ideas – Compile potential projects from interviews and market intelligence, removing options that are obviously impractical or too immature for near-term consideration.
3. Score for value – Assess each project against value criteria: strategic alignment, clinical impact, expected return on investment, reputational benefit and policy alignment.
4. Score for feasibility – Evaluate implementation factors: speed, technical complexity, process readiness, skills availability, investment required and leadership commitment.
5. Categorise by priority – Plot projects into four quadrants: strong cases (high value, high feasibility), bold moves (high value, lower feasibility), quick wins (lower value, high feasibility) and projects to deprioritise.
6. Sequence into horizons – Organise priority projects across three timeframes: immediate action, next year and longer-term initiatives requiring further assessment.
7. Validate with leadership – Present the prioritised portfolio to senior leaders for challenge, refinement and consensus-building before finalising the roadmap.
8. Plan for implementation – Define measurable results, establish governance structures, resource your programme management office and align the portfolio with organisational themes and values.
How to score your projects so that decisions hold
Gathering ideas is the easy part. The harder challenge is structured prioritisation. This requires a framework that is defendable.
My recommendation is that you need to assess each potential project against two dimensions: Value (V) and Feasibility (F) – i.e. what are the benefits, and how easy will they be to deliver.
You should decide for yourself the components of this scoring system and their relative weights.
For Value, I would recommend giving the majority of the weight to whichever strategy framework the hospital has already developed. (Remember that annual report? It’s time to dust it down!)
You will also likely want to add weight to clinical impact, return on investment, reputational impact and, where relevant, any competitive advantage. Consider adding some weight to national or regional policy and to regulatory requirements.
While Value is about outcome, Feasibility is about speed and cost.
How quickly could you implement this? How complex is the integration with your existing clinical and administrative systems? Do you have the processes in place to support it? Do your people have the necessary skills, or will you need extensive training or recruitment? What investment is required – not just purchase price, but total cost of ownership? And critically, does this initiative have genuine leadership commitment?
To make this consistent, we recommend using a rubric that allows you to make fair and reasonable comparisons. We use a 1–5 scoring system for each of the factors. For costs, for instance, 1 (lowest score) would be anything requiring a full tender process and more than $1m. A score of 5 (best score) would be something that could be paid for out of a departmental budget. By doing this, you ensure that any arguments are based around words and figures, not just emotions.
Imagine your explanation to a champion: “Your project scored lower on feasibility due to integration complexity. While clinically valuable, it also ranked below other projects on speed of implementation and was only moderately aligned to the strategy”. So much better than, “I’m afraid the board didn’t really like it”.
Turning your scores into a usable roadmap
At the end of the scoring process, you’ll have two numbers, I would advise expressing these as two percentages and ideally normalising them to maximise spread and avoiding clustering. Let’s call the eventual scores V% (for value) and F% (for feasibility).
You can then add dividers both horizontally and vertically to give you four categories:
1. Strong cases — high value and high feasibility with high S. These are your clear priorities; they deliver strategic benefit and your hospital can realistically implement them.
2. Bold moves – high value but more difficult to deliver. These deserve attention, but may need preliminary work to improve their feasibility before you commit substantial resources. Perhaps the technology needs to mature, or your hospital needs to build capabilities first
3. Low-hanging fruit – easier to deliver but lower in strategic value. These have a role: use them to demonstrate progress, build confidence in your transformation programme and develop your implementation capabilities.
4. Deprioritised — this category matters more than leaders often recognise. Name these projects explicitly. Communicate that they're not proceeding. Stop them consuming leadership attention, IT planning time and the mental energy of staff who wonder whether their pet project might still happen.
My recommendation is to take the Top 10 (highest strength) from the first two of these categories – strong cases and bold moves – along with another Top 10 low-hanging fruit.
That gives you 20 projects to deliver – some of which you may already have started or may be nearing completion.
I would recommend that you give yourself a time horizon of 2 to 3 years to deliver them.
That’s 7 to 10 new projects each year.
This may not sound like a lot, and you might reasonably expand this if you can find resources for all of them. But crucially, a list of 10 projects is achievable. A list of 70 is not.
With this list, everyone will know what they are doing, how they are contributing, and why.
Why your roadmap will fail without attention to implementation
Sadly, that is not the end. It is, if you’re fortunate, the end of the beginning. But what comes next is undoubtedly more difficult, namely implementation. As Machiavelli famously said: “There is nothing more difficult than putting in place a new order of things”. Our long experience of implementing both in healthcare and other industries tells us that you need five things to make that list workable.
1. Define results, not activities. For each project define a result that matters to the people it affects.
There is much talk of ‘targets’ and ‘KPIs’ in this world. I agree that these are important concepts. But I would advocate a clear single-measure approach to success. Patient satisfaction target, reduction in harm, better outcomes, improvements in staff experience — all of these create meaning. Projects need meaning that can be measured.
2. Establish structure. Deliver using cross-functional teams.
Each project needs a steering group with members drawn from every area affected by the change. These groups need clear reporting lines to executive oversight –typically a technology council or transformation board. Without this accountability structure, ownership dissolves and projects drift. Making such groups work is also hard but, in my experience, necessary.
3. Invest in project management. Without good project management, you’ll be lost.
You need a properly resourced programme management office that minimises (rather than creates) bureaucracy, ideally staffed by clinically qualified staff. Discipline matters. And so does visibility. Without this infrastructure, you'll return to scattered efforts within months.
4. Create coherence through themes. Group your projects into categories that resonate.
Using overarching themes will bring disparate projects together. These could be strategic or driven by importance: patient experience, operational efficiency, clinical quality, workforce development. These will coordinate your efforts in the minds of those you have to connect. Themed programmes feel like a shared direction.
5. Attend to the culture of change. Leadership matters.
The approach and style of change determines whether people engage constructively or resist. Work with the leadership team to generate the positivity and clarity of purpose and you’ll find the discretionary effort that will carry you through the difficult times. Sustainable transformation requires engagement, not mere compliance. And that requires leadership.
Make this a capability, not a one-off exercise
Let’s return to the problem. Too many projects, not enough resource. As technology changes, more ideas and more opportunities will surface, which means the horizon scan needs to be repeated.
I recommend, therefore, that you clearly document the methodology you have adopted. Retain your scoring frameworks and rubric for future use. Schedule regular portfolio reviews, perhaps quarterly, to reassess priorities as circumstances evolve. Run the whole process again next year. It gets quicker and easier each time.
Healthcare technology won't stop advancing. Your strategic priorities will shift as your hospital's context changes. New opportunities will emerge while others become obsolete. When the next compelling technology appears – and it will – you'll have a systematic way to assess it against existing commitments rather than starting the prioritisation conversation from scratch.
I recommend you build a systematic approach that turns portfolio chaos into managed transformation. The methodology exists and it works.
The choice is yours.
