Those “Cruel Nurses”

In response to the ‘Patients not Numbers’ report from the Patient’s Association, I have heard a number of pundits call for the heads of the “Cruel Nurses” who allowed the chronicled events to happen.

In reality, care in the NHS is delivered by a multitude of professional and non-professional groups, not just Doctors and Nurses. There are Social Workers, Physiotherapists and Occupational Therapists, whose responsibilities are the rehabilitation of patients and their safe discharge out of hospital. There are Domestics and Health Care Assistants, who clean the wards, dish-out the food and assist their Nursing colleagues with basic care, freeing them to deal with the mountains of paperwork which must be completed on a day-to-day basis.

Many of the failings in the report will not have been the direct failure of the Nurses on the wards, but of one or other of these related groups. However, where patients are concerned, anyone in uniform on a ward must be, by definition, a Nurse; hence, the failings of any group reflect badly on the Nursing profession.

Because modern NHS care delivery depends on multidisciplinary teams, the blame for sub-standard care rests with all members of that team, not just those of a Nursing persuasion. By making Nurses the scapegoats for wider failings, we are simply sweeping the real problem under the carpet; the NHS needs to abandon the competitive market reforms of the last decade and start working once again as a coherent team, focussed on the delivery of quality, safe care to patients.

lookafterournhs.org.uk

Medical examinations in the online world

I sat a very hard exam today, on a computer.  It’s been a long time coming: for the past four years I have been sitting exams using the Optical Marking system wherein a computer counts up all my correct (HB!) pencil marks on a piece of paper, subtracts all my incorrect ones, and then calculates my score (with the help of some statistical jigerypokery which ensures that, along with my colleagues’ results, mine fits within a suitable bell-curve which makes the university look like it’s doing its job properly).

But this morning we finally did away with analogue paper and (HB!) pencils and inputted out answers directly into the computer.  Seems like a good idea; if the papers are already marked by a computer then why not tell it your answers directly and save some trees?  Well, I’ll tell you why not: the current systems, or at least the one purchased by my university, just aren’t up to it.

The problem is that they are just too inflexible.  This morning we were sitting a timed one-hour exam on a university web-sever configured to allow us access to the questions only during an alloted period.  Then the fire alarm went off.  The little clocks at the bottom of our screens continued to count towards zero whilst we shuffled out into the fresh air.  After twenty minutes the sirens ceased and we hastily returned to our terminals.

Now, in the days of good, old-fashioned paper exams, an invigilator would have made a note of the time and asked us to down (HB!) pencils and file calmly out of the building.  On returning we could have simply resumed our guess-work with the balance of the time remaining.  Not so this morning.  Because the clocks couldn’t be stopped and the exam was only available on the server during the alloted examination period, we had to wait whilst someone hot-footed it up to the IT department and reset the exam timings.  We were then able to resume the exam…  FROM THE BEGINNING!

That’s right, we had to input all the answers we had previously entered (assuming we could remember which one’s we’d previously guessed) before we could continue with rationalising the blind stabs-in-the-dark which comprised our responses to the remaining questions.

Now, you could argue that this gave us ample opportunity to make up some time in what would have otherwise been a time-pressured exam.  You would be right to do so, because that’s exactly what it did.  And that is exactly why computer-based examination systems just aren’t worth the HTML code they’re written in.

I am all for computer-based exams (and saving trees, for that matter).  Testing in a True/False format lends itself well to online systems, but those systems need to be as flexible, or better-still more flexible than the paper they’re replacing in order to be worth the investment.  Adopting any “paperless” computer system just for the sake of it, without adequately balancing the ramifications of foregoing paper with the benefits of digitisation, is surely a recipe for disaster.

There’s a lesson in there somewhere…

The end of the road for NPfIT?

I was interested by this story on Monday.  It seems that Cameron wants to shut down a few QUANGOs if (i.e. when) he comes to power after the next general election.  In an interview with BBC Breakfast News he seemed very reluctant to commit to anything regarding NHS IT expenditure, but he made it clear the Tories were looking at it.

Given the public perception of the National Programme for IT as a complete and expensive failure (if only they could have a play with PACS), I can hardly see his “panel of experts” recommending throwing more money at the NPfIT…

Hello world!

I am (almost – one year to go!) a doctor in the NHS with an interest in the application of computing solutions in healthcare.  Implemented correctly, healthcare computing solutions have the potential to revolutionise the NHS, improve efficiency, drastically improve people’s day-to-day working lives and enhance the quality and safety of care-provision to patients.  On the other hand, if implemented haphazardly, without thought to the end-user and their workflow practices, they are doomed to costly failure.

I want to use these pages to discuss everything IT in healthcare, from national government policy, to local bright ideas.  I’d like people with knowledge, influence or simply just an interest to comment and contribute their thoughts.