Headlines: April 5th, 2004

Management of change in the health service is running up against people problems. A survey by the Royal College of Nursing found that almost three quarters of nurses were not consulted about the introduction of electronic health care records. A report by the British Medical Association says changes to service delivery are being resisted by sceptical staff in the NHS, particularly doctors and managers.The RCN survey found that around seven in ten nurses believe that electronic appointment booking, records, prescriptions and ordering or reviewing diagnostic information are important projects and crucial to improving patient care. Nearly as many consider spending several billion pounds on IT are a good use of NHS resources. But only 8 per cent of nurses believe they have had adequate information about these developments.

Alison Kitson, Executive Director Nursing, at the RCN, said: “Clearly nurses can see huge improvements in patient care with the introduction of electronic systems and their direct involvement is crucial. So far, the majority of our members have not been consulted, which in a context where contracts have already been awarded to IT providers in England, is problematic.”

User influence on the technology developments in the NHS was stepped up recently with the appointment of Professor Aidan Halligan as joint Director of the National IT Programme. He will lead on work to engage doctors and other clinicians to ensure NHS IT is user friendly and supports the Government’s top priority of putting the interests of patients first.

The report from the BMA’s Quality and Safety in Health Care journal suggests that a range of factors are causing all levels of staff to be sceptical and resist change, with doctors and senior managers being particularly hard to convince. Too many organisational targets to be met are leading staff to be ‘contextually’ sceptical about service delivery change. Managers and clinicians view the latter as merely a ‘diversion’ from the delivery of targets, states the report, which they see as their main priority.

Both doctors and even administrative staff fear losing autonomy and having their roles changed. Many feel this resistance to change has been built up over a long period as staff have become settled in their ways: In some cases, staff had spent years developing processes and systems that were felt to suit them and their patients, to contemplate change was admission that existing arrangements were insufficient.