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June 25, 2007

Evolution and Revolution

Picture of cogsWhile in a secondhand bookshop at the weekend I picked up John Gall 's book Systemantics. In it he describes the seductive nature of systems, which promise to do a hard job faster and more easily, but once set up take on their own life, growing and encroaching and eventually even opposing their own function.

Technological and demographic forces mean heathcare systems like the NHS cannot avoid major disruption. But, in another small book, Bodil Jonsson says: "All disruptive changes have at least one effect: they upset people."

Perhaps with that in mind both the Secretary of State for Health, Patricia Hewitt, and the Leader of the Opposition, David Cameron, speaking at last week's NHS Confederation Conference in London tried to soften the blow. Mr. Cameron promised "evolution not revolution". Though the phrase has a nice rhetorical ring, it means more change. Bodil Jonsson also says: "The most effective way of changing the future is to create a new system of thought." Perhaps that's what healthcare needs.

June 17, 2007

Thin Ice

Picture of a husky.Hindsight being a perfect science, I can see why Richard Granger, Director General of NHS IT, seemed more relaxed than I have seen him before at the presentation the other day. Times Online reports he is moving on by the end of this year.

Mr. Granger's most quoted comment likens the NPfIT's suppliers to huskies pulling a sled. The weaker dogs would be shot and fed to the rest to sustain them and as an example. Certainly, some well-known huskies are gone, Accenture and IDX being two. Lead dogs have also fallen to the back of the tugline. But will the remaining huskies survive the departure of the sled driver? And will they be challenged by new teams pulling different sleds? We'll see.

June 13, 2007

Past and Future

dinosaur.jpgWatching BBC's The Apprentice yesterday was like witnessing a flock of newborn mammals being ambushed by a pack of corporate dinosaurs. Fortunately, "alpha female" Katie dented the onslaught by telling Sir Alan Sugar what he could do with his job. Enough of Jurassic age recruitment techniques.

Health IT conferences in the UK are in a period of evolution. Attendances have fallen, probably not helped by the troubled and uncertain progress of NPfIT. I attended the Smart Heatlhcare 2007 exhibition yesterday. It was a large conference with exhibitors ranging from furniture and office equipment to IT and telecomms suppliers; though I am not sure the mix of suppliers and attendees was entirely felicitous.

I also attended talks by BT's Patrick O'Connell and Connecting for Health's Richard Granger. Mr. O'Connell told us the differences between projects, programmes and large programmes and Mr. Granger seemed in fine fettle as he summarised the achievements of the National Programme for IT. He even had a sideswipe at his old sparring partners the GPs, by suggesting a difference in their enthusiasm for the Choose and Book system, which supports patient choice, and the Quality Management and Analysis System, which supports their income.

June 03, 2007

Electronic Empathy: computers can care

Man using a computer.TV psychiatrist Professor Raj Persaud reports* the National Institute for Health and Clinical Excellence (NICE) has recommended making computer-based treatments for anxiety and depression more widely available. He argues this may be seen as another effort to reduce cost rather than meet patient needs. After all, patients want to be seen as individuals and prefer a person to a chip.

I’m not so sure.

In 1995 while researching for a MBA I came across some relevant research into the use of expert systems (considered part of artificial intelligence). Many patients who had consulted an expert system called ELIZA that did little more than ask reflective questions—for example: “Tell me more about…” or “What do you mean by..?”—responded positively. One woman left in tears saying she had never before met someone who understood her so well. Try some therapy from ELIZA.

In 2004 Whitfield and Williams asked: If the Evidence is so Good, Why Doesn’t Anyone Use Them? Surprisingly only about 5 percent of cognitive-based therapists were using computer-based self help as an alternative to face-to-face contact.

Today, if it comes to a choice between a highly personalised computer program, available day and night with no waiting list or 40 minutes with a busy human practitioner, I know which I prefer, Professor Persaud.

*Health Service Journal, 24 May 2007