In an astute article in BMJ Careers May 2013 by Yasmin Akram, a specialist trainee GP registrar in year 2 in the West Midlands Deanery says that the “Slow uptake of innovation in the NHS heaps frustrations on working doctors” and then “looks at the health services exasperating technological failings.
She divides the acceptors of innovations into five groups:
Innovators, Early adopters, early majority, late majority, and laggards.
She says that “Unfortunately, most people in the NHS are, in my opinion, laggards. There seems to be a major reluctance to take up any new technologies and, more importantly, to move on from dated ways of working. I agree that “if it isn’t broken don’t fix it”, but the NHS is broken.”
…and then she goes on to give examples, and quotes Neame R – Smart Cards – the key to trustworthy health information systems. BMJ 1997; 314: 573
Commissioning groups would like real-time accurate information, especially regarding referrals and patient notes. Any business needs this, from the high street shop to petrol distributer and the pharmaceutical company. The NHS Trust Management and the DOH are managing blind without this. The history of government IT systems is one of persistent failure. They have made the mistake of trying to take giant strides forward rather than incremental steps. General Practices have wonderful IT systems and information, and there is no reason why this should not be available in Hospitals, and then updated by them. The barriers to change are that GPs are reluctant to change their systems, and that there is no thought given to persuading and compensating them if they do change. If a region chooses one GP IT system, and uses it for Out Of Hours and Casualty cases then any GP without it will soon move to it. The opportunity to have their notes updated for them is too good. There will be computer hygiene and confidentiality issues but nothing that cannot be overcome.
IT leads in the Health Service and other government departments are usually forgiven their sins, and the recent removal of the BBC digital project manager is refreshing. The way to success in IT whilst reducing risk is incremental improvements, with backup ability to reverse a few steps if needed. Evolution rather than revolution. But the culture of the NHS rewards revolutionary strategic managers with promotion before their work can be criticised, and gives no incentive to the operational managers (More appropriately called administrators?) to take risks. They are therefore unenthusiastic.
Yasmin is right, and more: it is a disgrace that my practice (By no means the first) computerised in 1985 and yet the Hospital Service has yet to do so in any way meaningful to patients.
Command is getting people to go the way you want them to go – enthusiastically. Gen. William Westmoreland.
“Confidence in nonsense is a requirement for the creative process.” -=- M. C. Escher