Transcript Ken Eason (505 kb)

Local Solutions to National Change
Ken Eason
The Bayswater Institute
9 Orme Court
London W2 4RL
Emeritus Professor
Loughborough University
The NPfIT Strategy
The aim
Shared electronic healthcare records across England in order to
improve the co-ordination of healthcare delivery
The plan
Standard, inter-operable systems used by all Trusts delivered by
a small number of consortia
The implementation
- Roll-out across all Trusts in a 10 year period
- Replacing existing systems
- Trusts to pay local implementation costs
Implications for the Trusts
CfH
Suppliers
Diversity of Trusts
• Type
• Size
• Healthcare Practices
• Installed technical systems
• Location
Problems as Trust’s assimilate
NPfIT applications
Trusts
Issue
Royal Marsden
Care Records will not
support research
London Mental Health Trusts
Care records not fit for
mental health - interim
system needed
St. Mary, Sidcup
Slow system delaying
patient care
Wirrell
New system means a step
back in sharing records
Nuffield Orthopaedic
Out patient records lost
West Midlands
Smartcards not usable in
A&E
Jonathan Michael ‘one size fits all’
Two local requirements
• Recognising diversity
- tailoring systems to meet local needs
• Recognising it is a sociotechnical change and
not just a technical change
– developing local working practice to use the
technology for better healthcare
A ‘local sociotechnical systems
design’ strategy
Turning ‘push’ into ‘pull’
• Treat IT implementation as a sociotechnical design process
• The work practice implications are not fixed: local design
opportunities
• Exploit the flexibility of the technical systems for local customisation
• Help local staff to:
• identify specific benefits they can realise (develop a ‘pull’)
• work out a local design plan to realise the local benefits/minimise
the costs and risks
• find an evolutionary path to achieve progressive exploitation of
new technical capability
Eason K.D. (2005) ‘Exploiting the potential of the NPfIT: a local design approach’
BJHC&IM 22.7 14-16
Sociotechnical issues to address
when implementing electronic
healthcare records
• Matching the records to the healthcare practice
• Collecting data from patients at source
• Including unstructured clinical data
• Changing roles and responsibilities
• Matching access rules to working practice
e.g. how to support team work?
Implementation Practices
What is needed?
What is in place?
Local Sociotechnical design
Change Management
• Focus on creating ‘transitional
opportunities’ to experiment with
new healthcare practices
•
Rapid ‘roll out’
•
Technical implementation
• Participation of all stakeholders
•
‘Good practice’ in electronic
records usage
• Evolutionary development of
new ways of working
•
Limited support for the adoption
of new working practices
Local sociotechnical design within the
current programme
Some opportunities but:
– Technical system constraints
– Beliefs about ‘good practice’
– Rapid implementation limits local design work
– Focus on technical installation
National programmes and
sociotechnical design:
The way forward?
• Technical design: ‘minimum critical specification’
• Protocols for sharing data
• Local organisations to select suppliers
• Local ‘sociotechnical change’ teams to include
all stakeholders
• Create opportunities for learning and experimentation
• Recognise and support emergent behaviour and
evolution of new working practice