Leaning into digital: Start with the work, not the tool

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At the Collaborative Aotearoa conference in Ōtautahi Christchurch at the end of March 2026, I spoke about something I’ve been reflecting on for a long time: how we make better decisions about digital and AI in healthcare.

After many years working with technology across the sector, one pattern continues to show up.

Technology doesn’t solve problems.

Of course tech can improve things, sometimes dramatically. But in practice, what it often does is amplify whatever process already exists. When the underlying work is well designed, technology helps it run better. When the process is inefficient or unclear, technology simply makes that inefficiency more visible, and often more expensive to live with.

That’s where many digital initiatives begin to struggle.

Starting in the wrong place

In most organisations, the conversation begins with technology. People ask which system they should choose, which vendor is best, or whether it’s time to move platforms. These are familiar questions, and they feel like progress, but they often come too early.

Before any of that, there are a few things that need to be clear. What are we actually trying to achieve? What problem are we trying to solve? What would success look like in practice?

When those questions aren’t answered properly, decisions become harder than they need to be. The organisation ends up navigating options without a clear sense of direction. People get caught up in the excitement of what look like great options in the demos, but even a well-executed implementation can land as a disappointment.

Part of the reason this happens is that technology is easy to see. It can be demonstrated, compared, and evaluated. Processes are different. They sit inside everyday work, often invisible until something goes wrong. They vary across teams and organisations, and they’re rarely documented in a way that reflects how things actually happen.

So it’s understandable that people reach for the visible part first. It just doesn’t lead to good outcomes.

What leaders are balancing

When I talk to healthcare leaders, the concerns are usually consistent. They’re thinking about complexity, risk, and cost.

Will this make things harder to manage? Will it work reliably? Is it worth the investment?

Those concerns are well founded. What’s interesting is how often they’re made worse by starting with the technology.

When a system is introduced without a clear understanding of the work it’s meant to support, the solution tends to become more complicated than it needs to be. Organisations narrow their choices to systems they already know. The underlying complexity of the process remains unexamined, and when issues surface after go-live, the system takes the blame.

I’ve seen situations where a new platform is introduced and suddenly every problem is attributed to the change, even though those problems were already present. The difference is that they’re now more visible.

When the system shapes the work

There’s a subtle shift that happens when technology leads the conversation. Instead of designing the work and selecting tools to support it, organisations begin adjusting their processes to fit the system.

Over time, that creates friction. Extra steps appear. Manual work persists where it could have been removed. Staff develop workarounds to get things done. The system becomes something people work around rather than something that supports them.

At that point, the focus has shifted. The organisation is no longer optimising how care is delivered or how work flows. It’s optimising how to live with the system.

Technology can’t correct that. If anything, it reinforces it. The same applies to newer tools, including AI. These tools are powerful, but they rely on the structure around them. If the process is unclear or inefficient, the output will reflect that.

The hidden cost of decisions based on price

Cost is always part of the equation, and it should be. But focusing too heavily on upfront price can lead to decisions that are more expensive over time.

The impact shows up in less obvious ways. Extra handling steps that never quite go away. Tasks that remain manual even after digitisation. Small inefficiencies that accumulate across teams and over months. These are rarely captured in a business case, but they shape the day-to-day experience of staff and patients.

A more useful way to approach it is to consider whether the system genuinely solves the problem within the constraints you have. That balance matters more than selecting the lowest-cost option.

At the same time, many organisations continue to rely on systems that are clearly past their prime. Not because people are unaware of the limitations, but because the alternative feels uncertain. Change introduces risk, and in healthcare, risk is taken seriously - as it should be.

That tension between staying with something familiar and moving toward something better is one of the defining challenges in digital decision-making.

Returning to first principles

What I described in my presentation is often referred to as Lean thinking, although the label matters less than the approach. It begins with understanding how work actually happens. Where time is lost. Where effort doesn’t add value. Where complexity has built up over time without being questioned.

From there, the work can be redesigned into something simpler and more effective. Only then does it make sense to introduce or change technology.

This doesn’t require large-scale transformation to begin with. In many cases, small, consistent improvements compound into meaningful change over time. It also requires a willingness to challenge assumptions. Some of the most persistent inefficiencies in healthcare are not complex problems—they’re simply things that have been done the same way for a long time.

A perspective for leaders

For those leading organisations through digital and AI decisions, a few ideas are worth holding onto.

Clarity about the work comes first. Without that, technology decisions become speculative. Well-designed processes reduce complexity, lower risk, and make better use of investment. And ultimately, it’s people and processes that determine whether something works. Technology supports that, but it doesn’t replace it.

Digital and AI tools will continue to evolve quickly. That creates opportunity, but it also increases the need for discipline.

The organisations that benefit most won’t be the ones that adopt the most tools. They’ll be the ones that understand their work well enough to choose the right ones.

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