Posts

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.

A Socio-Technical Approach to Evidence Generation in the Use of Video Conferencing in Care Delivery

Evidence of outcomes across multiple uses of video conferencing in health and social care delivery – a socio-technical perspective

Video conferencing in care delivery telemedicine socio-technical v-connect Adam Hoare

Use of Video Connection Platform in Multiple Verticals of Care Delivery

Abstract:
Care and support services need to respond to the rapidly changing demands of the population and available resources. The authors will present evidence that video conferencing can underpin many of the aspirations for future care delivery. However, if the necessary scale and pace are to be achieved a new model for evidence generation needs to be found. Using the experience of deploying video across health and social care a new model of evidence generation will be proposed based on a socio-technical approach where complexity and human capabilities are features of the intervention. A practice-based approach utilising action research will be used. The model will focus on four dimensions that are key to the success of an intervention using video: Practice, Outcomes, Technology and Evidence. Addressing the interactions between these four dimensions promotes a system that can evolve services that, in cooperation with the video technology platform, can satisfy changing care demands

The effects of current economic and demographic pressures on care and support systems are well documented. The need to do more with less is an established requirement of new models of care. However, there are significant barriers to the innovation of new ways of working in care delivery. Some of these barriers will be described through the experiences of one of the authors (AH) in deploying video conferencing to support people in their own homes or in a care environment.

The current use of video in care delivery is predominantly clinician-to-clinician communication between care organisations. Established examples are stroke or cancer networks. When developing a strategy for deploying a video intervention targeted at people in a residential environment it soon became clear that there was not a precedent to follow. In terms of Porter’s Five Forces the intervention was neither a new entrant to an industry that already exists or a substitute for a current product. Clearly any adoption of the video approach was going to disrupt internal systems in the care organisation and result in changes to practice. From a resources and capabilities point of view any strategy to deploy video requires close collaboration between the resources of the care organisation and the video service provider. This is a challenging engagement for care providers as they are more accustomed to transactional approaches where products or services are bought to a specification. Hence, each video deployment required sensitivity to the resources and capabilities of the customer and a collaborative approach to lowering the barriers to use of the technology. For example, modifying the user interfaces of the video conferencing equipment could lower some barriers and this has been done extensively to improve the experience of the people receiving care and of the clinicians providing it.

A further challenge to any deployment of video conferencing is the initial modelling of the economic benefits. As each deployment creates a network of contacts there is no template for a specific intervention. Within health care, each disease, e.g. diabetes, has its own ‘silo’, i.e. has its own care pathway, its own specialists, seeks its own technical support and is evaluated in terms of its ability to meet disease-specific outcomes. Engaging with a particular silo is very dependent upon the context of the engagement and each deployment raises its own challenges. Therefore, before video can be deployed in the residential environment its benefits and cost effectiveness within current siloes of care have to be proved.

IGI Global Link

Hoare, Adam and Ken Eason.  A Socio-Technical Approach to Evidence Generation in the Use of Video Conferencing in Care Delivery. IJSKD 6.2 (2014): 36-52. Web. 2 Nov. 2017. doi:10.4018/ijskd.2014040103

Afterword: The Past, Present and Future of Sociotechnical Systems Theory

Introduction:

Afterword: The Past, Present and Future of Sociotechnical Systems Theory Ken EasonIt is a rare privilege to have been the inspiration behind the production of this collection of papers and I warmly thank all of the contributors, especially Patrick Waterson, for reminding me of so many debates and giving me so much to reflect upon. I was especially pleased to find such a strong theme running through these papers, a theme that has been an obsession for me for over 40 years: sociotechnical systems theory. Throughout my career I have been concerned with systems approaches in ergonomics because they enable us to recognize that people at work often engage in tasks as part of a complex system and this has profound effects on them and their task performance. Of all the systems approaches that are available I have found sociotechnical systems theory the most powerful way of explaining systems behaviour and the most useful in designing new systems. My aim in these pages is to use the insights that the authors in this volume have provided to reflect on what has been important to me about sociotechnical systems theory, on where this approach is in the present day and what contribution it might make in the future.

Sociotechnical systems studies 1970-1990

I was very fortunate in the 1970s to work with Lisl Klein and Harold Bridger who were at that time stalwarts of the Tavistock Institute of Human Relations in London, widely acknowledged to have been responsible for the development of sociotechnical sys- tems theory. The theory was developed to explain the human and organisational ramifications of the introduction of mechanization into coal mining, weaving and other industries. By the 1970s it was computer technology in all its forms that was beginning to have a major impact on work systems and when we started the HUSAT (Human Sciences and Advanced Technology) Research Group at Loughborough University, so graphically described by Tom Stewart and Leela Damodaran (Waterson, Stewart and Dam- odaran, this volume), it was natural for me to apply sociotechnical systems concepts in order to understand the impact of this new technology on people at work. At that time the main issue was that this technology was being used via ‘remote terminals’ linked to mainframe computers by ‘naïve users’, i.e. people who were not computer professionals, and these new users had to adapt to the unfriendly, rigid and literal ways in which computers operated. This started a major programme of work to render these devices easy to use for their new users leading to the ‘user friendly’ graph- ical interfaces used by most of the population today. My preoccu- pation, however, was that within each organisation there were different kinds of users whose work roles and tasks require specific service from the computer system. As a consequence we were soon writing papers about the needs of different kinds of computer user and my contribution to an early issue of this journal was a paper on ‘the manager as a computer user’. Sociotechnical systems theory, because of its emphasis upon the way technical and human resources are deployed to serve the needs of a collective task, was particularly well suited to examining how effectively the task needs of each user were served by computer systems and in most cases we found they were very badly served with the result that many systems were either rejected or ‘worked around’.

Science Direct Link

Ken Eason, Afterword: The past, present and future of sociotechnical systems theory, In Applied Ergonomics, Volume 45, Issue 2, Part A, 2014, Pages 213-220, ISSN 0003-6870, https://doi.org/10.1016/j.apergo.2013.09.017.