Fitness For Purpose When There Are Many Different Purposes: Who Are Electronic Patient Records For?

The use of the electronic patient record in supporting e-health care pathways

Abstract:
Electronic patient record systems serve many purposes for many different kinds of users. Four case studies are reported of the use made by healthcare staff of electronic patient record systems that supported healthcare pathways. The results demonstrate that the systems fit the purposes of strategic and managerial users of the record, but they are problematic as tools for use by the frontline staff delivering care. As a result, these staff frequently resort to workarounds to accomplish their work goals. An analysis of the design processes that created these systems shows that the specification of the systems was based on strategic and managerial requirements and there was no formal assessment of the needs of frontline users. Efforts to address the needs of frontline staff in the provisions of electronic systems were most often made after the main system was implemented.

Sage Journal Link

Eason K.D. and Waterson P.E. Fitness for purpose when there are many different purposes: who are electronic patient records for? Health Informatics Journal 20 (3) 189-198 1460458213501096

How to Fail When Introducing Electronic Technologies into Organisations

The challenges of large scale IT projects viewed through the National Programme for IT – NPfIT

Abstract:
The history of computer applications is littered with examples of large and expensive IT systems failing when they were implemented in organisations. This paper illustrates how this happens by describing the case of the NPfIT, the National Programme for IT, in the UK National Health Service. It was introduced with a great fanfare in 2004 to standardize electronic patient records across the NHS and was ‘dismantled’ in 2011 having cost somewhere between £12 and £20 billion.

The paper concludes this programme encountered major problems because it adopted a top down, technocentric approach that led to a ‘one size does not fit all’ response from health agencies of widely different types. A major lesson is that these developments have to be treated not just as technical developments but as sociotechnical developments, i.e. the organisational and technical changes have to be treated in parallel and as interdependent entities. The paper offers six principles for the implementation of new technology into organisations that may improve the chances of users being able to harness the potential of new technology.

IEEE Explore Link

Eason K.D. How to fail when introducing electronic technologies into organisations. Proceedings of DESE 2016 (Developments in eSystems Engineering’, Liverpool September

 

Local Sociotechnical System Development in the NHS National Programme for Information Technology

National Programme for IT Electronic Health Records – User Perspectives

Abstract:
The National Programme for IT is implementing standard electronic healthcare systems across the National Health Service Trusts in England. This paper reports the responses of the Trusts and their healthcare teams to the applications in the programme as they are being implemented. It concludes that, on the basis of the data available, it is likely that the emergent behaviour of healthcare staff will serve to minimise the impact of the systems. The paper looks at the opportunities within the programme to undertake local sociotechnical system design to help staff exploit the opportunities of the new electronic systems. It concludes that there are opportunities and offers one case study example in a Mental Health Trust. However, it concludes that there are many aspects of the technical systems themselves and also of the approach to implementation, that limit the opportunities for local sociotechnical systems design work.

Local Sociotechnical System Development in the NHS National Programme for IT Ken Eason

Springer Link

EASON K.D. Local sociotechnical system development in the NHS National Programme for Information Technology, Journal of Information Technology 22 (3) 257-264

Action Learning across the Decades: Case Studies in Health and Social Care Settings 1966 & 2016

Comparison of the Hospital Internal Communications (HIC) project of the 1960s with the Better Outcomes for People with Learning Disabilities (BOLDTC) project in 2016 and their use of action learning approaches

Purpose – The purpose of this paper is to explore how action learning concepts were used in two healthcare projects undertaken many decades apart. The specific purpose in both cases was to examine how action learning can contribute to shared learning across key stakeholders in a complex socio-technical system. In each case study, action learning supported joint design programmes and the sharing of perspectives about the complex system under investigation.

Design/methodology/approach – Two action learning projects are described: first, the Hospital Internal Communications (HIC) project led by Reg Revans in the 1960s. Senior staff in ten London hospitals formed action learning teams to address communication issues. Second, in the Better Outcomes for People with Learning Disabilities: Transforming Care (BOLDTC) project, videoconferencing equipment enabled people with learning disabilities to increase their opportunities to communicate. A mutual learning process was established to enable stakeholders to explore the potential of the technical system to improve individual care.

Findings – The HIC project demonstrated the importance of evidence being shared between team members and that action had to engage the larger healthcare system outside the hospital. The BOLDTC project concerned the continuing relevance of action learning to healthcare today. Mutual learning was achieved between health and social care specialists and technologists.

Originality/value – This work draws together the socio-technical systems tradition (considering both social and technical issues in organisations) and action learning to demonstrate that complex systems development needs to be undertaken as a learning process in which action provides the fuel for learning and design.

Action Learning across the Decades: Case Studies in Health and Social Care Settings 1966 & 2016 HIC BOLDTC Ken Eason

Emerald Insight Link

Eason K. D. Action learning across the decades: case studies in health and social care settings 1966 and 2016 Leadership in the Health Services, 30(2) 118-128
https://doi.org/10.1108/LHS-11-2016-0057

Productivity? – Don’t Just Fund the Technology Phil! A response to the budget of the 22nd November 2017.

By Dr. Adam Hoare

The Organisation for Economic Co-operation and Development has downgraded its 2017 growth forecast for the UK to 1.5% from a 1.6% estimate made in September, making Britain the weakest economy in the G7. The office for budget responsibility had taken the rosy view that after 2008 UK productivity growth would return to previous levels of around 2% It has now admitted, after years of getting it wrong, that it is likely to sit around 1.3-1.5% until 2020. Last week’s budget reverberated with the recurring issue of low productivity growth. The solution presented was an industrial strategy. Something that had fallen out of favour as Government interference.

The announcements based on borrowing came thick and fast:

  • Digital skills and startup funding to reinvigorate the UK’s waning productivity.
  • £3 billion to cushion the landing of a potential hard Brexit, the chancellor said: “This Budget is about much more than Brexit. For the first time in decades Britain is genuinely at the forefront of this technological revolution. Not just in our universities and research institutes, but this time in the commercial development labs of our great companies, and on factory floors and business parks across this land. But we must invest to secure that bright future for Britain.”
  • Last year’s £23 billion National Productivity Investment Fund was to provide £31 billion in funding over six years, compared to the originally planned five. R&D to receive another £2.3 billion investment, under the government’s Industrial Strategy aim to ramp up R&D spending to 2.4% of GDP.
  • To double the number of tech startups founded in Britain with the goal to see one created every half an hour.
  • A £10 million Regulators’ Pioneers Fund to help regulators find new ways to bring emerging tech – AI and 5G – to market.
  • Tech City UK, to be rebranded as Tech Nation, a body with a remit to spend £21 million on developing the UK’s various startup hubs.
  • In a bid to tackle the UK’s stark digital skills gap, the chancellor also outlined fresh cash to retrain people and provide a greater focus on maths and computing for children and teenagers.

The idea of a strategy and a long list of funding opportunities for new technology seems to overlook some very important evidence. Figures for various IT projects (some of the figures originating from the National Audit Office no less) demonstrate a persistent gap between the projected benefits and the reality:

  • Child Support Agency – £500m estimated loss;
  • DEFRA Rural Repayments Agency – £130m estimated loss;
  • Inland Revenue NIHS – £3-4 billion estimated loss;
  • Magistrates Court LIBRA – £232 million estimated loss;
  • HM Prison Service C-NOMIS – £690 million estimated loss;
  • Fire and Rescue FiReControl – £469 million estimated loss;
  • NHS NPfIT – £20 billion estimated loss.

As we borrow money to fuel a technological “hail Mary pass,” it would seem a good time to think about why we fail to convert so many such passes to a touchdown. The Bayswater Institute has been extensively involved in embedding and evaluating digital technologies in health and social care over several decades. Over the last decade alone there have been hundreds of initiatives to improve productivity in care provision by elevating the use of technology to 21st century standards. Although there has not been an overall assessment of the impact of these initiatives the experience of care provision points to low impact from these initiatives. From seeing these projects from the inside, we have developed a level of understanding of why they struggle – and it is not the technology. Two things work against the use of technology in many of these scenarios:

  1. The technology does not exist in isolation it is part of a system that involves the people using it and the people receiving services. If it does not work for them it is not productive.
  2. Where there is an increase in productivity it usually means a single person can handle more work or the workforce can be reduced. This inevitably generates resistance.

Both of these challenges are rooted in social science and the interface between people and technology. Understanding these sociotechnical systems is essential in successfully capturing the benefits the technology can bring. Looking back over the announcements we cannot see where this is mentioned. Throwing money at the technology and expecting social transformation is an interesting approach but the evidence is – it has been done before and it will fail.

A third issue that recurs in productivity considerations. To know a system is more productive than it was before it must be measured in a meaningful way. This links back to point 1 above. If it works for the professional but not the citizen – it does not work. Hence, the outcomes of productivity must include social value and social impact otherwise public money is spent on making the system happy and the service recipient unhappy.

We spend much of our time providing summative evaluations of where the barriers and challenges are in technology projects that are trying to embed into practice. We have a special interest in formative evaluations of interventions where we can draw on our experience and anticipate some of the problems ahead of the development and have the opportunity to have an impact on the NAO estimated loss. If the focus remains on the technology and not the combined scoiotechnical system the return on investment is likely to be negative. The last thing that Phil wants.

Wisdom in Groups

We are thrilled with the uptake of Wisdom in Groups (WiG) places for April 2018 – we are now fully booked for April 2018.
Which begs the question, should we run another WiG in the Autumn of 2018? Please do let us have your view (contact us here) – you never know we may have two events to talk about in 2018!
Look out for news of future events – please contact us if you would like to attend.

Understanding Stakeholder Participation in Research as Part of Sustainable Development

A paper reporting on the use of Triple Task in participating in research as part of the EU POINT project

Abstract:
Participation is often presented as a ‘good’ thing and a fairer way to represent views and opinions outside narrow confines of interest and expertise. However, the roots of participatory approaches within research contexts are deep and numerous twists and turns demonstrate a confused and possibly confusing morphology with significant gaps and weaknesses.
In this paper ‘via the medium’ of the POINT (Policy Influence of Indicators) research project we trace elements of the recent history of group participation in sustainable development and the emergence of focus on four areas, most significantly how participatory methods are used. In the absence of strong evidence to contrary we suggest that the issue of how participants engage in participation remains a significant weakness for the field. In order to counter the apparent gap we suggest that a certain degree of structure and process can provide the oeuvre of participatory approaches with a higher degree of transparency in the research process and, by focus on the use of a method called Triple Task, group participatory events can be encouraged to yield greater insights into the workings of groups of all kinds.

Science Direct Link

Bell, S., Morse, S. and Shah, R. (2012). Understanding stakeholder participation in research as part of sustainable development. Journal of Environmental Management. 101, pp. 13 – 22.

Policy Influence of Indicators (POINT) EU FP7 Project

The demand for and supply of indicators for environmental and sustainability policies have increased during the last decades. Main drivers behind this trend include a wish from international institutions to compare the environmental or other performance across countries and sectors, a need to satisfy transparency and accountability requirements in policy performance evaluations, and a call for general information and communication with the public on sustainable development and the state of the environment.

But are such indicators actually used in policy processes and do they have any influence on policy outcomes? These were the key questions posed in the EU FP7 project POINT – Policy Influence of Indicators.
The POINT project began in 2008 with the aim of exploring the use and influence of indicators broadly with the area of sustainable development policies as its main focus. A number of case studies were conducted, covering indicators in sector integration, indicators for sustainable development and also composite sustainability indicators, such as the Ecological Footprint (EF).

EU CORDIS Project Description

Project Overview

Transdisciplinary Sustainability: The Council for Frontiers of Knowledge

This paper represents an overview of the various transdisciplinary domains of interest to a number of Directors of the Council for Frontiers of Knowledge

Extract:

More about this organisation shortly; in this brief introduction I want to set out the scope and vision of this paper. Many agencies exist – charitable, public sector and private – with a mission to improve the flow and uptake of ideas, innovations and useful practice across borders. This journal regularly publishes papers, which describe organisations and agencies that develop themes of knowledge transfer and sustainable intellectual practice. The CFK is one such agency. As will be shown, the CFK is no silver bullet to all the issues that beset the continent, nor is it attempting to confront or engage with the plethora of political and ethical concerns that beset development more widely. CFK is concerned with ideas. This paper contains an overview of the various trans-disciplinary domains of interest to the Directors of the CFK in partnership with some of their African colleagues and an insight into how this work is being applied. In a series of vignettes the key interests of some of the CFK Directors are elaborated and the overall mission of the CFK is revealed. Each article in the collective and synthetic piece can be seen as an observation from a particular edge of human understanding. Together they combine to form a braided strand with common yet distinct threads.

In the introductory piece Atkins Katusabe and Pamela Weathers set out the history of the CFK and place its origin and intention in the contemporary era. Simon Bell and Stephen Morse using the CFK community itself, discuss the potential for participation to be made more inclusive and the outcomes to be evidence-based. Dermot Diamond addresses the twin issues of sensing technologies for health diagnostics and distributed environmental sensing and describes how CFK can foster the inclusion of more African researchers. Jenny Emnéus, Filipo Bosco and Cecilia Agrell discuss a unique programme of mentoring – instigated within the CFK and beginning to show powerful outcomes. Anthony Guiseppi-Elie and Francis Moussy then focus on medical diagnostics and discuss the potential for use in the largely low income countries of Africa. Jim Lynch describes research in technologies for monitoring and assessing de-forestation and, building on this, the current Chair of the CFK Board of Directors, Fionn Murtagh, discusses the role of Information and Communication technologies as both a challenge to, and an indicator of, development in Africa. PK Nair takes up the synthetic theme of this article in his piece which promotes the integrated nature of agro-forestry as key to Africa’s productive sustainability. Finally, Pamela Weathers and Alice Amoding consider the value of Artemisia annua and the effect of this important medicinal plant in terms of its potential impact on the cultivation of food crops in developing countries that are prone to malaria.

Cecilia Agrell, Simon Bell, Filipo Bosco, Dermot Diamond, Jenny Emnéus, Anthony Guiseppi-Elie, Atkins Katusabe, Jim Lynch, Stephen Morse, Francis G. Moussy, Fionn Murtagh, P. K. R. Nair, Pamela J. Weathers . (2014) Transdisciplinary Sustainability: The Council for Frontiers of Knowledge. International Journal of Transdisciplinary Research. 7, 1, pp. 1-26

Link to PDF

The Council for Frontiers of Knowledge

Teaching Environmental Management Competencies Online: Towards Authentic Collaboration?

Abstract:
Environmental Management (EM) is taught in many Higher Education Institutions in the UK. Most this provision is studied full-time on campuses by younger adults preparing themselves for subsequent employment, but not necessarily as environmental managers, and this experience can be very different from the complexities of real-life situations. This formal academic teaching or initial professional development in EM is supported and enhanced by training and continuing professional development from the major EM Institutes in the UK orientated to a set of technical and transferable skills or competencies expected of professional practitioners. In both cases there can be a tendency to focus on the more tractable, technical aspects of EM which are important, but may prove insufficient for EM in practice. What is also necessary, although often excluded, is an appreciation of, and capacity to deal with, the messiness and unpredictability of real world EM situations involving many different actors and stakeholders with multiple perspectives and operating to various agendas. Building on the work of Reeves, Herrington, and Oliver (2002), we argue that EM modules need to include the opportunity to work towards the practice of authentic activities with group collaboration as a key pursuit. This paper reports on a qualitative study of our experiences with a selected sample taken from two on-line undergraduate EM modules for second and third year students (referred to respectively as Modules A and B) at the Open University, UK where online collaboration was a key component. Our tentative findings indicate that on-line collaboration is difficult to ensure as a uniform experience and that lack of uniformity reduces its value as an authentic experience. Whilst it can provide useful additional skills for EM practitioners the experience is uneven in the student body and often requires more time and support to engage with than originally planned.

Open University Link

Bell, S., Lane, A., Collins, K., Berardi, A. and Slater, R. Teaching Environmental Management Competencies Online: Towards authentic collaboration? European Journal of Open Distance and e-Learning. 20, 1, pp. 22 – 44

DPSIR = A Problem Structuring Method? An Exploration from the ‘‘Imagine’’ Approach

Abstract:
The Drivers, Pressures, State, Impact and Response or DPSIR framework has been with us for over a decade now and it is widely used as a means to assess and measure and, eventually provide a guide to managing the environment. With its repertoire of diagnostic and analytical components the DPSIR can be argued to be a Problem Structuring Method or PSM. Criticisms of the framework abound but it has a resilience which is noteworthy. Some argue that DPSIR, by its nature, is a narrowly formulated, engineering device, incompatible with the multiple perspectives which human interaction in global ecology requires. Is there a value in DPSIR being more flexible in expression and experience of users? In this article it is shown how the DPSIR framework was applied within a multi-methodology approach called Imagine in a number of coastal management projects around the Mediterranean and in other contexts. The article argues that DPSIR, whilst admittedly limited in its scope and approach can, if applied in a participatory and systemic multi-methodology, combine with other tools and help to create outcomes of value to local populations.

DPSIR Framework Simon Bell

Science Direct Link

Bell, S. (2012). DPSIR = A Problem Structuring Method? An exploration from the ‘‘Imagine’’ approach. European Journal of Operational Research. 222, pp. 230 – 360.