eHealth and the culture of the NHS IT community

A quiet (spear-carrier’s, merely, possibly) welcome for the appointment of Alasdair Bishop’s appointment as Head of Change & Benefits in the SGHD eHealth team. I hadn’t seen him for quite a while until just recently, when we met at a workshop considering the potential scope of the eHealth Improvement Programme – on the basis of what he was forcefully and effectively arguing for there, I think I may have an idea of his views on things like focus, and the setting of priorities…!

However, perhaps some interesting cultural challenges are available? I thought I’d replay an email I drafted following the event.

I began by thinking of the eHIP in terms of a ‘business opportunity’ but came to realise that this needs more nuance.  

There’s a risk as well as an opportunity (as in SWOT, somewhere): if the eHIP is really well integrated with the other health improvement and change initiatives around, e.g. the Improvement Service Team – as it should be – ICT has had a history of being rather cloth-eared about things like culture, the dynamics & demands of change tools like PDSA etc etc….then over the piece, it may drive a wedge through the existing eH community.

I perceive this being broadly comprised of three (stereotype-warning!) groups:

  •  Those who work in NHS IT as a branch of the IM&T industry (procurement, machine-running & contract management with ATOS or whoever, keeping the infrastructure going etc etc.) – quite a bloc of staff, and plenty in senior Health Board IM&T mgt;
  • Those whose home discipline. is Project/Programme Mgt – could next month be at home helping put in a retail system, say – smaller numbers;
  • Those who enjoy working in public service, who aren’t clinicians, and who are too restless or otherwise don’t fancy ‘status quo managementt’, and have found a space in IT project management & learnt about it as they go along – a reasonable number of these, mostly locally

For the Change & Benefits team, maybe some utility in a little quiet sociological analysis (a.k.a. skills audit, or something?) to underpin resource/org’l planning?

When the going gets tough, or arduous over time, then I wonder whether inhabitants of any of these three groups are likely to gravitate to their own home territory (comfort zone)…? At the scoping workshop, quite a few of us tended to default to talking about IT rather then service change, for example.

If we are going to be ruthless and focus down on just a few real priorities (e.g. single sign on) then the going will get tough – apart from anything else, there are fewer places to hide if it’s not going well. Most of us are subject to, but also indulge in, what might be called ‘chronic agenda shuffling’ (I call mine ‘occupational hobbies’ – things I can turn to when the main priorities are delayed, not going well, or when I just fancy a bit of displacement activity). Keeping all these plates spinning is a full-time and absorbing activity, and who can blame us for not making progress with all those Good Ideas listed at the beginning of the Electronic Clinical Communications Initiative, it’s all we can do to keep the plates in the air. There’s also an element of it being more congenial to grumble about something than actually fix it – you know how it is.

All this stuff is normal organisational survival tactics/behaviour. Signing up at a workshop to being radical/focused won’t make normal life go away back at base the day after.

But back to Alistair. He is the only person I know in this domain who has actually done this focusing, with it’s attendant No Place to Hide risks, with CHI. Maybe there are more lessons to learn from his personal experience. He’ll be in a good position to pass them on.

Good luck Alasdair!

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