Unrealistic and shifting timetables, lack of consultation and communication with NPfIT managers, and lack of perceived short term benefits have affected staff morale in trusts tackling IT modernisation, according to research published in the British Medical Journal today.
The research recommends that National Programme for IT’s (NPfIT) managers should prioritise strategies to improve communication with, and to gain the co-operation of, front line staff.
The qualitative research conducted at four acute NHS trusts in England concludes that sociocultural challenges to implementing the NPfIT are as daunting as the technical and logistical ones and that senior NHS staff feel these have been neglected.
One manager interviewed for the study said: "The communication has been appalling, absolutely appalling. They’ve done some wonderful events, and I’ve met some people who are great, NPfIT, who are very facilitative and very enabling, and the next week you’re told you’re not allowed to talk to them."
Dr Vivienne Nathanson, the British Medical Association’s head of science and ethics, commented: "The BMA has long been concerned about the need for NPfIT to engage properly with clinicians or risk failure. The lack of engagement and consultation with the medical profession was wholly inadequate in the early stages of development but NHS Connecting for Health, who are developing the new IT system, has more recently made significant progress in its efforts to involve NHS staff.
“Large-scale public IT projects do not have a good track record in the UK and so it is paramount that the NHS learns the lessons of history and engages wherever possible with the frontline staff who will be using the new systems to deliver better patient care."
The study conducted by researchers at the London School of Hygiene and Tropical Medicine’s department of public health and policy, was based on case studies and in-depth interviews with senior trust managers and clinicians, including chief executives, directors of information technology, medical directors, and directors of nursing.
The four trusts studied were chosen to reflect a range of characteristics – differences in size, number of sites, performance indicators, and financial situation – and were at various stages of implementing electronic health records.
Results from the research showed the process of implementation had been suboptimal, leading to reports of low morale by the NHS staff responsible for implementation.
“The overall timetable is unrealistic, and trusts are uncertain about their implementation schedules. Short term benefits alone are unlikely to persuade NHS staff to adopt the national programme enthusiastically, and some may experience a loss of electronic functionality in the short term,” say the researchers.
Discussing the results the researchers say: “The NPfIT promises far reaching benefits for patients and throughout the NHS. The immediate hurdle is the disruption and change that NHS staff must undergo during implementation of the NPfIT. Persuading people that ‘it will all be worthwhile’ is at least as great a challenge as the technical one.
“Doubters need to reflect on alternatives. Not investing in IT is not an option. The choice lies between a centralised approach like the national programme or more piecemeal local solutions.
“The benefits of the former are potentially much greater, but realising these benefits depends on procuring systems that work and managing their implementation without alienating staff. It is in these areas that our study has identified room for improvement.”
In their conclusion the researchers recommend that NPfIT headquarters urgently revisit its priorities, managing the changes in working practices in addition to the technical challenges.
They say: “The NPfIT is likely to succeed or fail according to the groundswell of opinion, as well as its technical performance (unless the latter is catastrophic). Over the next five years, the NPfIT implementation will be seen either as a glass half full or a glass half empty…senior managers responsible for the NPfIT need to ensure that NHS staff see the glass as half full.”
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