Colin JervisColin Jervis
Director, Kinetic Consulting

An ageing population, a shortage of qualified staff, better informed patients, Gershon efficiency savings and the creation of a patient-led service mean the NHS is heading for unprecedented change. To cope, a dramatic reframing of healthcare delivery may be needed, in which NPfIT must play a fundamental part.

But overlaying 21st-century technology on a 20th-century organisation will not yield transformation. That needs changed mindsets, innovative thinking and the creative application of IT. In other words, NPfIT’s centralised information must catalyse devolved innovation.

Structural change

It is impossible to imagine information-rich industry sectors such as hotels, banking or travel functioning without IT. They have applied it to reducing costs, reconfiguring operations and improving standards of customer service.

Though information is the basic currency of patient-clinician encounters, healthcare has been remarkably slow to embrace IT. It has been used to improve care on a particular ward or in a specialty or department. Few of the improvements have been dramatic.

In the NHS, there are no examples of wholescale organisational and inter-organisational change. Though exemplar sites with electronic patient records can point to qualitative benefits and a few quantitative ones – such as those arising from electronic prescribing – the NHS has mainly applied IT to improving existing processes, rather than transforming them.

By deploying a range of essential systems and the Care Record Service, NPfIT has the potential to catalyse organisational change. The Spine in particular promises an unprecedented means of sharing information between care settings. However, is there a risk that centralised IT systems might hinder innovation and change by embedding existing practice?

Information as a tool

Independent healthcare consultant Jana Dale thinks not. Jana participated in hospital process redesign at a large acute NHS trust in 1996. “If an IT system has rich enough functionality, people should not feel constrained by it," she explains.

"The system can still be applied in a way that would suit them and their circumstances and would support the particular way they choose to work. For example, patients can be admitted by a centralised department or on wards. Patients could even ‘check-in’ themselves.”

In addition, the structured information NPfIT could provide would also support evidence-based change by correlating clinical, financial and management information. In the NHS such correlation is usually tenuous – which makes decision making difficult.

For example, the hospital process redesign in which Jana took part recommended the division of planned and unplanned care. “When we analysed actual activity data the variation in unplanned care admissions was very small,” she explains. “Surprisingly, planned care admissions varied much more. The planning process itself seemed to introduce variation and activity peaks.”

A central information core could supply the base for devolved technical and operational innovation – perhaps fitting better the diversity and plurality of the NHS.

Care provision models

Because changing people, culture and processes is hazardous, the success of dramatic change is uncertain. Remember healthcare innovations we now take for granted, such as surgery, antisepsis, angioplasty, anaesthesia and outpatient surgery, were all in their time resisted by established leaders and institutions.

By driving the free flow of information across disciplinary and organisational boundaries, IT is capable of driving innovation. Accordingly, many institutions, consultants and change experts assure us NPfIT will transform healthcare delivery. Fewer tell what it will transform to.

Perhaps that is no surprise. No blueprint exists for wholesale change in healthcare; indeed, no single model may be universally applicable. In “Crossing the Quality Chasm: a new health system for the 21st century” the Committee on Quality of Health Care in America at the Institute of Medicine says: “It would be neither useful nor possible for us to specify in detail the design of 21st century health care delivery systems. Imagination and pluralism abound at the local level in the nation’s health care enterprise.”

If – as seems reasonable – this statement also applies to the UK, the NHS may progress by local creativity and innovation. But to do so, NHS staff must be skilled, supported and motivated.

Driving change

Many systems and methods of organisational change exist. Applied to the NHS, these sometimes tend to normalise rather than disrupt, so processes may become more efficient, but rarely more effective.

Fortunately, the NHS has lived with change almost since its foundation – so systems and methods are not always needed. NHS staff can be taught skills such as analysis, flowcharting, brainstorming, visioning, role playing and managing change. In fact, the NHS Modernisation Agency has already trained a range of staff in such skills.

Moreover, successful organisational change in the NHS is usually internally driven, with strong leadership and commitment from the top. This makes change more successful and less prone to rejection.

To meet the imminent challenges the NHS faces, NPfIT, Modernisation and Agenda for Change must be joined up and used as a unique opportunity to create new models of care delivery. Then, rather than being seen as an optional extra, IT may at last become fully embedded in healthcare.

Colin Jervis
Director, Kinetic Consulting