Information is good
When — or if — the world thinks about the Wessex Computer Project, it is
usually in the context of the unfavourable opinion of it expressed by the
Parliamentary Committee on Public Accounts.
There is a certain wry pleasure to be derived from the fact that two
major components of the project subsequently obtained major awards in
national IT competitions.
What is not generally appreciated, however, is the genesis of the
project: it sprang from the realisation that the effective management of the
Health Service could only come from appropriate (and appropriately
segmented) information; information that could only flow from a massive IT
investment.
In today’s climate, that realisation may seem quaintly naïve: is not the
Service awash with statistics, flooded with illustrations of progress
towards the latest round of targets? That indeed is the case, but it is an
illusion, which serves only to demonstrate a profound misunderstanding of
the proper way to manage the NHS, or indeed any large organisation.
To manage the NHS, or any of its constituent parts, effectively, there
needs to be a clear view about where the organisation is to go, and the
components critical to that task.
Information — rapid and regular — is the key to the formation of that
view, and to monitoring progress in achieving it. And, to be effective, that
information must be available for every component that contributes to the
whole. Finally, and fundamental to the whole of the process that is sketched
out above, is the need for a genuine understanding of how the organisation
works.
Many of the current national targets do not appear to demonstrate that
understanding of the whole: rather, by concentrating on one or other major
feature (waiting times are a case in point) to the neglect or exclusion of
the whole, they are, in the terms of industrial processes, sub-optimising
performance. In times of stress for the Service — indeed at any time — this
is bad news.
Some might argue that the concept of information set out in the
paragraphs above is unduly industrial. The articles in this issue of the
Journal, however, show that the model applies equally well to
large-scale epidemiology and to clinical investigation.
In her article, Professor Denise Lievesley, Chief Executive of England’s
Information Centre for Health and Social Care, addresses the role and
capacity of information at national level. She describes the need to
determine the existence and quality of relevant data, to assess whether
there are gaps that need to be filled, and to decide on how to improve the
accessibility and usefulness of data thus collected. This follows exactly
the model already described, and the monitoring of progress is to be
achieved by making the information held more widely accessible. Scrutiny of
this sort can only improve the quality of vital data. Payroll is a classic
example of this truth, since all its results are carefully scrutinised at
least once a month!
In his article, Alaric Cundy, drawing on a lifetime of experience in NHS
information at hospital, regional and departmental levels, reflects on
progress that has been achieved over the last 40 years in the constructive
use of information in the management of the NHS. He describes the barriers
that it was possible to overcome as technology advanced, but he describes
also the barriers that still remain — among them the fact that “targets
applied to the NHS have encouraged a short-term ‘quick-fix’ approach to some
very real problems ... rather than encouraging the development of a proper
understanding, leading to lasting solutions”.
In their article, Muhammed Saeed and his colleagues describe the results
of a survey of carotid duplex reporting, using computer-based communication
and reporting systems. Their work showed that, even within a single
ultrasound department, reporting was variable, and they postulate that a
fixed format of requesting and reporting might help to minimise quality
variation. In this conclusion, they confirm one of the basic tenets of
informed data collection: the achievement of agreed definitions and format.
In the late 1970s and early 1980s the Steering Group on Hospital
Information, chaired by Mrs Körner, laid out some basic principles for NHS
data systems, including reducing the burden for frontline staff and ensuring
that systems produce data that is of value at all levels of the
organisation.
The Information Centre for Health and Social Care has precisely the same
objectives — thus on the one hand testifying to Mrs Körner’s perspicacity,
and on the other showing that in this vital area it is sadly necessary
continually to repeat what constitutes good practice.
The capacity of today’s information systems is infinitely greater than
those of 30 years ago. The basic lessons of relevance and utility, however,
remain the same. We must not forget them.
Michael Fairey |
