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Winning Ways: transforming healthcare using IT

I am a big fan of Idries Shah’s tales of the Sufi wisdom of Mulla Nasrudin. Here is one of my favourites:

One night a neighbour found Nasrudin down on his knees looking for something under the street light: "What have you lost, Mulla?"

"My key," said Nasrudin.

After a few minutes of searching, the other man said: "Where did you drop it?"

"By my house."

"Then why, for heaven's sake, are you looking here?"

"There is more light here."

A veteran of a Hospital Process Redesign, I remain an advocate of transforming healthcare with IT. So, I enjoyed consultant vascular surgeon Simon Dodds’ book Three Wins, which recounts his experience at the Good Hope Hospital, Sutton Coldfield, UK of developing the Leg Ulcer Telemedicine (LUTM) Service.

Leg ulcers mainly affect the elderly, and the annual costs of treatment are in the region of £600m. The high cost is mainly due to the need for redressing by community nurses.

LUTM is a secure electronic clinical-record system that allows the storage and processing of colour images. Community nurses use LUTM software to monitor the colour and size of ulcers from the digital images. Measurements over time can assess the effectiveness of treatment and allow future management to be planned. Nurses can also refer a patient to a specialist, transferring images at the same time.

Furthermore, a randomized trial showed using the LUTM system reduced the time from referral to attendance at an outpatient clinic and improved rates of healing at 12 and 24 weeks.

Impressive stuff!

Simon’s approach to change is closer to the “harder” end of systems-based change methods. I would like to have read more on the human dynamics of process changes, which I have found to be the most challenging.

He does spend time explaining how Belbin’s roles apply to the various stages of transformation and explaining Maslow and Herzberg’s theories of motivation.

However, as someone who sits uncomfortably between a Plant, a Shaper and a Monitor-Evaluator by Belbin’s reckoning, I am sceptical of categorisation as a tool.

I am similarly uneasy when it comes to theories of motivation. Herzberg’s theory is attractive in its simplicity, but his conclusions were based on samples selected from engineers and scientists, and, therefore, may not be applicable to the kaleidoscopic variety of workers in the NHS. I like models of motivation as a starting point, but to treat everyone as an individual.

The study shows impressive improvements in patient care, but I would be interested in hearing from Simon if he thinks the well known Hawthorne Effect* may have played a part, because it would have been impossible to blind nurses to the fact they were using LUTM.

But enough management speak. Despite my reservations on how well the method would apply on a large scale, Three Wins is a book for inspiration and practical application.

Simon Dodds and team have spread their light on a specific area of the NHS and systematically improved it. Other areas remain in darkness. But the key is out there for those who look for it: systematic soft change underpinned by hard IT.

*The Hawthorne effect - an increase in worker productivity produced by the psychological stimulus of being singled out and made to feel important.


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Hi Colin, you make a very good point. Did that fact that we made the "workers" feel important improve their "productivity"? Well, it I will firstly state for the record that works for me! It is called being valued - a rare commodity in the modern NHS it seems. But this is the emotional answer, the scientific answer is that we conducted a randomised controlled trial where the only difference between the trial and the control groups was the use of the LUTM system - and showed a 25% reduction in cost of treatment that extrapolated to the UK would be £150m cost savings per annum. Three years after LUTM was introduced the community nursing teams are still using it and still insisting that, despite the very tight financial climate in the NHS, they don't want to go back to the "old days". What better recommendation can I offer?

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