Archive for the 'Diversity & Equality' Category

The power of stories

Here’s a wee story:

at a recent consultation event shortly before the implementation of a major revamp of one of our call & recall (screening) systems, a GP pipes up with a question. He works in an area where a sizeable proportion of his patients – for a variety of reasons – don’t tend to interpret the arrival of an official brown envellope in the same way as ‘the rest of us’. So he’s arranged that, alongside sending the letter out, the practice calls the patient being invited for screening, to explain & coax them into coming along.

[The new system dispatches the letter from a central location, gaining a variety of technical and technological efficiencies as a result].

He asks “can his practice be sent their patient letters, so while they forward the notes,  they can contact the patients concerned?”. The presenters of the new arrangements have a wee huddle, and come back with “hmmmn, sorry that can’t be done”. Thinking on his feet, the GP asks “can you let me know that you’re sending the letter out, so that my practice can at least try to coincide our call with the arrival of the note at the patient?” The presenters have another wee huddle, and the answer’s the same…”sorry”.

This seems to have the implication that patients who maybe can’t read, or don’t speak English, or are maybe spooked by official-looking correspondence, end up dis-advantaged.

But the point of this is not to point a finger at those involved, rather to ask a little about what sort of learning can be done from stories like this. How to translate a story into a more general lesson? In the IM&T world, there’s also the burden of the tendency to take things literally. I don’t think that this so much about humans becoming infused with the machines’ literal-mindedness, as about working in a culture where everyone bangs on about ‘delivery’ all the time. When this is wrapped up in procedures and techniques, the last thing that it is sensible to do is to query and seek to re-interpret what’s to be ‘delivered’. Far better (as in ‘career-enhancing’) to take it literally. But this gets in the way of learning from experience – which surely involves re-interpretation, I wonder?

Anyone hearing this sort of story may have a number of reflections, including:

  • there but for the grace of god go the rest of us;

  • we should talk to people more about what new systems are intended to do;

But will general reflections like these help them (or, more likely, others) avoid making a similar (not the same) mistake next time?

Of course, this is scarcely new – one only has to think ‘the oral tradition’ to remember that people have been passing on knowledge via stories for hundreds and thousands of years. But how does it work, in the mind of the listener or nowadays reader and viewer – how does the story transfer into changed behaviour in different contexts? Surely this will have been researched – must have a hunt about.

One thing is sure: we need to provide ways of capturing these stories and sharing them – plenty of tools available for that.

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Diversity, Equality, Impact Assessments & eHealth

Just off to a session tomorrow with folk on ‘what sort of Impact Assessment?’ should be applied to eHealth, re E&D. Hope to avoid begging too many questions – there’s always the risk of taking the question too literally and diving straight to forms design. There’s a good deal to clarify first, including:

what is eHealth? In the NHSScotland context this might include:

  • A strategy – which might or might not be equality-promoting, in terms of its assumptions, discussions, recommendations?

  • A varied set of IM&T programmes (which have lifecycles and are at various points or milestones on these)?

  • A set of teams (e.g. SEHD, Deloitte’s, NISG, ISD, Health Boards, others e.g. ATOS)?

  • A set of Governance arrangements (e.g. Committees, sub-committees, groups of various kinds, all of which are inhabited by people and which work in particular ways)?

where’s Equality & Diversity at? For example:

Only once we’ve got a little clarity on these points is it sensible to look at what ‘Impact’ is, how best to assess it, and when?

We have a starting point – (see attached file) the NSS Impact Assessment Checklist (IAC) as revised using the one from SAMH – thanks to Charlie McMillan of SAMH for sharing his draft checklist, with its equal treatment of positive and negative impacts. But there’ll be a fair bit to work on…

equality-diversity-impact-assessment-format-charlie-mcmillan-converted-to-nss-28-may-07.doc

Diversity & Equality & eHealth

Information Services here has an Equality & Diversity Information Programme (EDIP) going on. In NHSScotland we don’t really collect terribly much Diversity information just now, so we’ve not enough way of knowing whether or not our health services are structured and delivered in a culturally-aware fashion. The EDIP is intended to make a start on remedying this, by doing things like talking with members of diverse ‘Diversity’ groupings about their experiences of healthcare, & also designing E&D (or D&E) data-sets, etc etc – read the EDIP material for a much better summary, anyway.

Of course there remain the (small, sure) tasks of actually embedding theses data sets within the major NHS patient systems, persuading healthcare practitioners to collect the relevant data, and thereafter to use it sensitively in their dealings with patients. To name but three – there are bound to be more.

Perhaps eHealth might have a part to play here? One could imagine, within an endeavour that may seek to actualise the vision of a joinedy-up health record that’s managed jointly by the NHS and the patient concerned, that patients themselves could create this E&D data? There’s also the question of the presentation and handling of the data within day-to-day healthcare. It’s not really as simple as an On/Off thing, after all. I might want my ethnicity recorded in my health record, but do I always want it to be a factor in my care? I can imagine there might be times when I think it’s irrelevant, and to have it dragged into the transaction might be patronising or annoying. So there might be useful work to do around how the data is used within day-to-day practice, and how technology (I nearly used ‘affordances’ there, blimey) might or might not support what’s required.

The ‘involvement’ work that I’ve referred to elsewhere needs in part to be based on conversation pieces, and perhaps work like this could be one of these? We might touch on this when looking at building in E&D Impact Assessments into eHealth governance…

‘Re-energising’ Diversity & Equality

Went to a Departmental training day on this on Wednesday, and came away not quite sure what I thought of it all. We were – I think – working on working with things like values, spending a good part of the day on the stuff that happens under the surface of the organisation.

There were some striking individual components within the session, for example

  • the Disability Alliance(?) DVD which neatlyturned the tables on an able-bodied young man;

  • the ‘Baron & Baroness’ fairy tale & decision-making game;

  • the Morris Massey values material.

But if you followed the logic of this latter material, well the people who work here are all over 21 (more or less) so their value systems will be more or less fixed, and the only suggested approach to really changing these is to provide the experience of some sort of ‘significant emotional event’. Along with the obvious ones like death & divorce, or the birth of a child (none of which is really in the gift of an organisation like ours) the training material also suggested that an SEE could also be ‘something that really strikes a chord, such as a training course’. Hmmmn…

Indeed the DVD did I think approach this – the quality of the silence that followed it gave an indication of that. But maybe we somehow bottled out after that. Anyway, we ended up with more of the same old same old, really, discussing action plans, impact assessments, & the like.

Of course, rather than re-energising as in moving on to the next level of endeavour, we could have been re-energising ourselves to do what we should have done already – like draft Impact Assessments, Equality Schemes, etc. etc.

 Who knows.


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