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December 31, 2007

Bolton Care Records Pilot

Picture of laptop, chain and lock.This morning the BBC followed up previous reports on the summary care record pilot in Bolton. The piece was generally supportive, but the customary GP expressed concerns about the security of information on a national system compared to that held locally.

Such concerns are not fully addressed by technical security, as I have previously argued, secure human systems are also essential. When I was young the escapologist Harry Houdini was a hero of mine. When asked why he found it so easy to escape from the most secure of safes, he answered it was because they were designed to prevent people from getting in not getting out. Recent events show even though getting in to secure IT systems may be difficult, taking large amounts of data out is not.

People need to decide if the benefits of an online record outweigh the risks and in the Bolton pilot they can opt out if they think they do not. But eventually we should all be given sufficient information to make that decision ourselves.

Some may want their GP to be their advocate in such matters, and some may not. When I registered with my GP I was not given an option to opt out of having my information stored locally on his IT system, which at least 7 other people in the practice can access.

Also read this article in the Manchester Evening News about the theft from the Royal Bolton Hospital of patient-based information on a local computer.

I wish you a happy and successful New Year.

December 24, 2007

More Losses of Confidential Data

files.jpgThe BBC reports this morning that a number of NHS trusts have admitted losing patient-based information that seems to have been carried on CDs and memory sticks.

It's a sad indicator of the sophistication of UK healthcare IT that it still needs to transfer confidential data by what the US calls "sneaker net" and has only recently been able to transfer computer records electronically between GP practices.

Higher levels of technical security on the planned National Care Records Service should make NHS data more secure, but, as I have said before, technical security takes us only so far and must be underpinned by secure human processes. Recent events suggest we have some way to go.

Not a long way to go to Christmas day, though, so I wish you a joyful and peaceful time.

December 23, 2007

It's in the Cantenna

I have asserted the rapid adoption of wireless technologies will be a potent force for change in healthcare. In South Africa only 1 in 100 have broadband and remote areas may not even have telecommunications.

An episode of the BBC's ClickOnline this morning described how an AIDS clinic in the rural community of Peebles Valley is exploiting wireless to improve care. Clinic and a hospice are several kilometres apart and find it hard to communicate because of the hilly terrain. They have solved this problem by using a network of antennae inserted into tin cans, which focus the full power of the wireless transmissions giving the WiFi network added range.

Nurses and doctors now access the patient database and communicate using Voice over IP (VOIP).

Read the full article on the BBC site.

December 12, 2007

Sign Health

Picture of Sign.SignHealth helps GPs to communicate with deaf patients who use British Sign Language (BSL). Also a team of interpreters work at partner company SignVideo and can be booked by a GP's receptionist. The basic SignHealth programme gives immediate access to BSL translations using short video clips.

Here is a guide to BSL. No doubt someone will tell me the picture is American Sign Language :(

December 08, 2007

Healthcare IT is Not an Intervention

Picture of an abacus.In a previous entry I drew an analogy between developments in weaving and the introduction of IT into healthcare. In Jacquard's Web I read:

“The real problem was that the drawloom was not a machine at all. Instead, it was only a device for facilitating the manual weaving of patterns or images in the fabric...”

Facilitating the manual weaving... The status of Healthcare IT is somewhere between an abacus and a calculator. This is why I find it interesting when academics and others claim there is little evidence of its value.

Some of you may remember a controversial study on the introduction of a CPOE system that suggested it had led to a sharp increase in mortality. You can follow the resulting exchange by following the links here. When the dust settled the most satisfactory explanation for the study's results was the system had been used and implemented poorly.

John Glaser's article IT is Not an Intervention summarises the situation nicely. At this stage in its evolution, healthcare IT does not carry out direct, independent patient care. Its success depends on a complex of factors, not least of which is the competence of the people implementing it.

December 07, 2007

Got Them Healthcare Blooze: motivation the rock’n’roll way

Picture of leaping guitarist.It's been a while since Peter wrote for FHIT, but he's back. You can also read some of his previous entries. Let's rock!

‘I was looking for a job, then I found one. Heaven knows I’m miserable now’. How often have you heard these words for real in the workplace? Poor morale and motivation account for massive waste in effort, costs and profits in even the most successful organisations. So what can Morrissey, Minztberg, Meatloaf, Maslow, Motorhead, Madonna et al teach us about how to create a work climate and culture that rocks? In the book ‘Sex, Leadership and Rock’n’Roll’ I explore classic ideas about motivation through a rich mix of great academic thinking ‘tamed’ with the pithy wisdom of rock and pop culture. Let’s start with a look at the Blues.

Can’t buy me love?
Most Blues songs begin: ‘Woke up this morning’ and then move on to motivational problems such as ‘The landlord wants to repossess my home’ or ‘My woman left me’.

In the modern workplace, you cannot have a Blues that goes ‘Woke up this morning, the server was down’ or ‘Woke up this morning, I got a good HR manager who self actualises me!’

Quite surprisingly, this cheesy contrast makes a great deal of practical sense. Frederick Herzberg pointed out the difference between those factors that merely remove dissatisfaction at work, e.g. pay, administration, supervision (called dissatisfiers) and those factors that encourage job satisfaction e.g. responsibility, advancement etc. (called satisfiers). Just think about those ‘fly like an eagle’ motivational posters in some hospital corridors. Yes, they are cheap, but they do not create workplace satisfaction.

Many reward systems only focus on removing dissatisfaction - it’s no surprise that they fail to motivate – just try doubling someone’s salary and notice how long they work twice as many hours! As Prince said ‘Money don’t buy you happiness, but it sho’ ‘nuff pays for the research.’ i.e. inadequate pay dissatisfies, but no amount of pay will produce long term job satisfaction. This is especially true for Generation Y and beyond, who crave much greater things from work today. Companies such as First Direct, B&Q and Prêt à Manger have learned this point well and surpass others with people who bring their heads, hearts and souls to work. The NHS is well positioned to offer people some Herzberg satisfiers e.g. career development, intrinsic job satisfaction etc.

Key point:review Hertzberg’s model in the book and ask yourself ‘How does our motivational strategy line up with his findings?

River deep, mountain high
Coming back to our Blues examples, repossession of the home and losing one’s lover are located towards the lower levels of Abraham Maslow’s hierarchy of needs i.e. shelter and belonging. Maslow crucially pointed out that there was a hierarchy of needs from physiological through to ego and self actualisation. So we really cannot have a Blues that starts ‘Woke up this morning, I got a good manager, who sets meaningful performance goals and leverages my talent in ways that provide long term career development tailored to my talents’ unless the basics are also in sufficient supply. As an aside, the lyric does not scan well either!

Key point:HR needs therefore to be not only strategic and visionary but also tactical and detail conscious in the way it motivates staff.

I want it all and I want it now
In a culture of mass individualisation, employees expect to be treated as individuals, yet many HR systems tend to treat them as a collective in the interests of fairness, equity and conflict avoidance.

Key point:personalisation is the key to individual motivation. This requires motivational systems that are responsive both in speed and flexibility. Ask your HR people to tell you how the HR system achieves these ambitions.

We gotta get out of this place
Blues can take place in New York City, but not in Newark. Hard times in Minneapolis or Canterbury is probably just clinical depression. Chicago, St. Louis, and Kansas City are still the best places to have the Blues, not York, Bath or Slough. You can’t have no Blues in a shopping mall. The lighting is all wrong.

The physical and psychological environment are important components of motivation. Although working conditions are a Herzberg dissatisfier, poor working conditions really make for poor performance and, more importantly, these things are not so expensive to put right. Companies that recognise the contribution of the built environment on performance include Pfizer. However, as I pointed out earlier, décor is cheap but insufficient if people feel unable to do a good job. Furthermore, a pleasant work environment is no substitute for the least expensive and most effective motivator – behaviour that encourages others to give their all, which leads us to our last point…

I’d do anything for love, but I won’t do that
I did a gig with Lorraine Crosby, who sang on Meatloaf’s classic song, but failed to discover what ‘that’ is in the context of the song, so we’ll concentrate on the ‘love’ part… Praise is the least expensive but highest value motivator. It merely takes time and must come from the heart.

Key point: the built environment helps people to feel good about work, but how people behave is crucial to long term motivation. Find ways to spot people doing things well and let them know about it.

You can buy Peter Cook, MD, Human Dynamics's book: Sex, Leadership and Rock’n’Roll – Leadership Lessons from the Academy of Rock.

He is also speaking at a conference for the NHS Innovation Institute HR Network Scotland Conference on February 14 2008.

December 03, 2007

Where the Horlicks is Sweet

Picture of the sea.This weekend I went on a nostalgia trip back to the North East of England and sat for an hour in the Rendevous Cafe sipping coffee and contemplating the incoming North Sea. The feel of the Cafe is encapsulated in a poem by local poet Julia Darling, who died in 2005 after a fight against cancer and a photograph of her drinking coffee on her final visit hangs on the wall. Throughout her illness she promoted poetry for its healing properties, particularly in this collection of poems which I have.

"Poetry should be a part of every modern hospital, not just as something to keep patients amused. It's a powerful force, which can help us through the darkest times."

The rising tide of technology will wash away much that is commonplace in tackling illness, but the role of the human spirit will stand.