NHS and new MIS and my wife the hospital doctor

[terminal7]

My wife is a senior doctor in a NHS hospital with 8 clinics a week seeing new patients and treating existing ones. She is over 65 and allowed to continue work until a full reassessment at 70 (she has annual lesser assessments). The hospital is in the process of introducing a new management information system (MIS) and all staff have to go through workshops etc before being signed off to be allowed to see patients in conjunction with using the new MIS. The developers - large US software corp - have given a short training sessions and told staff over to you to practice and you have 3 weeks to get up to scratch. The system is clearly based on entering instructions, referral letters etc in the presence of the patients. In theory this minimises the amount of time spent per patient. Of course - my wife being from the old school - wants to look the patient in the eye give them advice, comfort, understanding etc. This system is clearly US based - many of the Americanism have not been changed into English - I know an easy job - but the driving thrust if the MIS is effectively to see more patients in any given time. Let's not worry about the quality of care.

My wife is of an age that new systems are a real struggle even with changes to Word, windows Live Mail at home! I have been through the literature she was given and it is going to be a problem with staff with low aptitude to computer software programmes. I could go on about why she became an NHS doctor etc. I could go on about the mess that Capita and others have created in the past.

However my basic fear that she will not be able to cope with the new MIS. Does she have any employment protection? She is employed as a hospital doctor not a computer operator. I accept that we all have to apply ourselves to changing technology but the new MIS is clearly beyond the capabilities of some. Is she effectively being made redundant?

T7

[ReformedCharacter]

My wife is a senior doctor in a NHS hospital with 8 clinics a week seeing new patients and treating existing ones. She is over 65 and allowed to continue work until a full reassessment at 70 (she has annual lesser assessments). The hospital is in the process of introducing a new management information system (MIS) and all staff have to go through workshops etc before being signed off to be allowed to see patients in conjunction with using the new MIS. The developers - large US software corp - have given a short training sessions and told staff over to you to practice and you have 3 weeks to get up to scratch. The system is clearly based on entering instructions, referral letters etc in the presence of the patients. In theory this minimises the amount of time spent per patient. Of course - my wife being from the old school - wants to look the patient in the eye give them advice, comfort, understanding etc. This system is clearly US based - many of the Americanism have not been changed into English - I know an easy job - but the driving thrust if the MIS is effectively to see more patients in any given time. Let's not worry about the quality of care.

My wife is of an age that new systems are a real struggle even with changes to Word, windows Live Mail at home! I have been through the literature she was given and it is going to be a problem with staff with low aptitude to computer software programmes. I could go on about why she became an NHS doctor etc. I could go on about the mess that Capita and others have created in the past.

However my basic fear that she will not be able to cope with the new MIS. Does she have any employment protection? She is employed as a hospital doctor not a computer operator. I accept that we all have to apply ourselves to changing technology but the new MIS is clearly beyond the capabilities of some. Is she effectively being made redundant?

T7

I have some sympathy for your wife. I have spent a considerable amount of my working life producing software for teaching and nursing staff, many of whom are not very 'computer literate' having trained for a career before computers became common in the workplace.

Apart from the obvious requirement that the software that I have designed should work accurately and reliably I have always taken the view that the user-friendliness of the software is of absolute prime importance. I have always tried to design software that is pleasant and simple to use and have taken a great deal of care to achieve this. Many software developers, in my opinion, concentrate on functionality and pay less attention to the look and feel of the design.

I have experienced GP visits where the doc has given me a cursory glance on entering their room then looked back at their computer screen. Further conversation has taken place with the doc looking at their screen and tapping away at their keyboard with eye-contact almost completely non-existent. This is a very poor way to practice medicine in my opinion.

However, I think your wife will have to bite the bullet and do her best to become confident and proficient in the new MIS system. It takes time but I'm sure that someone like your wife who is smart enough to become a senior doctor could manage this, however much it goes against the grain.

I rather doubt that your wife has any case for constructive dismissal; new techniques, procedures and technologies develop during one's working lifetime and I expect that your wife probably appreciates the benefits of such things as MRI scanners etc. which would not have existed when she first became a doctor and it is usually an expectation that - with adequate training - the ability to adapt to new procedures is an implicit employment expectation.

We need good NHS doctors that care for their patients and I hope that she can adapt to the new system. I can only offer encouragement to persevere and suggest that she will likely become more content with it in time.

RC

[patrickmacqueen]

However my basic fear that she will not be able to cope with the new MIS. Does she have any employment protection? She is employed as a hospital doctor not a computer operator. I accept that we all have to apply ourselves to changing technology but the new MIS is clearly beyond the capabilities of some. Is she effectively being made redundant?

I think she would have a hard time being made redundant. I did see this definition of indirect discrimination
Indirect discrimination is when there’s a practice, policy or rule which applies to everyone in the same way, but it has a worse effect on some people than others.

The best practical advice for your wife might be for her to talk to the BMA - this is presumably a large part of what they are there for.

[midnightcatprowl]

She is over 65 and allowed to continue work until a full reassessment at 70 (she has annual lesser assessments).

Just to say that at 68 I am in your wife's age group, so please think about my comments against that background.

Of course - my wife being from the old school - wants to look the patient in the eye give them advice, comfort, understanding etc.

Well I think you'll look far and wide for patients who don't prefer doctors who actually pay attention to them rather than to their computer screen! There is an interesting series of programmes on TV on some on demand channel or other called 'Don't tell the doctor' which are sort of 'reality' programmes based on the idea that younger adults don't tend to consult doctors, because they are embarrassed about the issues which concern many young adults and/or don't think their doctor will take the issue seriously and/or they simply can't get an appointment with their GP. The theme of the programme is that the doctor will come to you instead and all the four doctors are young (and all of them, two female, two male, remarkably good looking but that is TV for you). It is fascinating to watch young doctors interacting with young patients and all of them in the age group which appears to have been born with smartphones welded into their palms or at least had them so welded at puberty, yet the consultations involve no screen use at all just very intense, pleasant, understanding, inter-personal interaction with hugely sympathetic doctors. Some of the patients end up being given quite complicated medical treatment but it is difficult not to suspect that the remarkable recovery rate is not, at least to some degree, due to the sheer understanding and concern they get in the consultations! So maybe your wife is not 'old school' at all, just a good doctor and maybe she needs to be fully aware that this is all to do with medical competence and nothing to do with age.

This system is clearly US based - many of the Americanism have not been changed into English - I know an easy job - but the driving thrust if the MIS is effectively to see more patients in any given time. Let's not worry about the quality of care.

Well yes indeed and I'l come march with you any time against the degrading of the NHS and the giving of contracts to the incompetent. I'll say no more to avoid political discussion which would take this thread off course! BUT I would just say that it is a mistake to get hung up on things like Americanisms. They should of course have put their programme fully into standard UK English but all of us hear and deal with Americanisms all of the time - in films, in TV programmes, in books, and so on. It may be irritating in a professional context but no intelligent person should be unable to deal with it and your wife, by definition, is an intelligent person.

My wife is of an age that new systems are a real struggle even with changes to Word, windows Live Mail at home!

Sorry but in your concern for your wife you are actually being ageist! There is nothing in your wife's age that prevents her from learning new skills - in fact if she couldn't she would be a terrible risk as a doctor as being a doctor is all about acquiring new information and techniques and building on experience as you go along. Aged 68 and without ever having had any training in IT, it would never occur to me that I could not learn any new system. I might curse the bad design of the system, I might question the wisdom and motivation of the system, but I'd be grossly offended if anyone suggested I couldn't learn how to deal with the wretched thing! I think this may be the basic issue. I probably have no more actual knowledge of anything IT related than your wife but I do have a conviction that as an intelligent well educated person I can crack anything new. To me the whole point of being educated is that it gives you the skills to ride over new stuff as you go along. I work now in volunteer roles and just recently a younger and much more IT expert member of one of my teams had to suddenly drop out because of illness and family problems. That person had in recent times set up and maintained a new website on our behalf. So now I'm maintaining it (and hopefully gradually developing it too). The first week was a steep learning curve and I'm still learning, though the curve is less steep, but it never occurred to me that I couldn't do it, just that I had to work at it and think about it, and read anything about it I could find until I could. I don't think about my age. I think that I've always been good at learning stuff, and even if what I have to learn is not what I'd have chosen to learn, I'm convinced that I can.

I don't want to upset you but my advantage may be that for the last couple of decades plus a bit I've been a single person household and I have no children. So anything I want to do online I've had to learn, set up, and operate for myself. So I do! Sorry but I get totally exasperated by other women in my age group - particularly highly educated women - who allow their spouses or off-spring to do everything IT related for them and so become progressively unable to do it for themselves. You learn best not by rote but by encountering and having to overcome problems. When long ago I brought my first hard disk free Amstrad computer home, there was no one else to make it work but me, so I did even if I tore some hair out along the way. Sometimes too it is the case that sympathetic spouses and off-spring actually assist their wives and mothers into being incompetent in anything IT related by doing it all for them, just as traditionally many wives have left their bereaved husbands high and dry by doing all the cooking and shopping and housework for them while they were still alive.

However my basic fear that she will not be able to cope with the new MIS. Does she have any employment protection? She is employed as a hospital doctor not a computer operator. I accept that we all have to apply ourselves to changing technology but the new MIS is clearly beyond the capabilities of some. Is she effectively being made redundant?

No she's not. Sorry again but is your basic fear actually being transmitted to your wife? There can be few professions requiring such insight and intelligence on a daily basis as is required of a doctor or at least of a good doctor. Why can't this ability be applied to learning this new system poor quality though it may be?

I have some sympathy for your wife. I have spent a considerable amount of my working life producing software for teaching and nursing staff, many of whom are not very 'computer literate' having trained for a career before computers became common in the workplace.

However, I think your wife will have to bite the bullet and do her best to become confident and proficient in the new MIS system. It takes time but I'm sure that someone like your wife who is smart enough to become a senior doctor could manage this, however much it goes against the grain.

Absolutely, let's concentrate on the 'smart'! Let's also be realistic. As a business owner before I retired aged 66 and now in a particular volunteer role aged 68 I constantly meet people who feel that because they trained for a career before computers became common in the workplace or in volunteer roles that it is impossible for them to deal with IT related stuff. Yet the same people probably grew up in homes where a car was an unimaginable luxury as would have been flying on a holiday abroad or dealing with the most basic of TVs, yet you'll find all the same people driving without even thinking about it, flying off on holidays and fiddling about with the remote control for their flat screen TV and using 'on demand' TV without giving it a second thought. Basically it is a mindset.

I rather doubt that your wife has any case for constructive dismissal; new techniques, procedures and technologies develop during one's working lifetime and I expect that your wife probably appreciates the benefits of such things as MRI scanners etc. which would not have existed when she first became a doctor and it is usually an expectation that - with adequate training - the ability to adapt to new procedures is an implicit employment expectation.

Absolutely. As I worked well over retirement age myself and now do voluntary work if not on a full working week basis then on what amounts to pretty much a four day week basis, I just had and now have to keep up and once you've persuaded yourself you can it is actually very enjoyable to do so.

We need good NHS doctors that care for their patients and I hope that she can adapt to the new system. I can only offer encouragement to persevere and suggest that she will likely become more content with it in time.

Yes we need good doctors like your wife! You need to persuade her to take sufficient time out to really work on learning the new system however much she loves or hates it. You need to convince her that she absolutely CAN do it. In the end the people who can't get to grips with the new system will resign or retire or be otherwise disposed of which means their voice will not be heard. People such as your wife who learn to deal with the new system are much greater agents for change if they then campaign for better systems.

[quelquod]

Oh yes!
Have a rec!

[kiloran]

I have been through the literature she was given and it is going to be a problem with staff with low aptitude to computer software programmes.

T7

I used to define and train quite complex systems and business processes in a global company.
If a trainee did not understand, I took that as a fault of the trainer, not the trainee.

Your wife's problem is probably not your wife's fault

--kiloran

[kiloran]

I have been through the literature she was given and it is going to be a problem with staff with low aptitude to computer software programmes.

T7

I used to define and train quite complex systems and business processes in a global company.
If a trainee did not understand, I took that as a fault of the trainer, not the trainee.

Your wife's problem is probably not your wife's fault

--kiloran

I should perhaps add that we did not let IT people train the end-users. We defined some capable end-users as trainers and they were trained intensively. The trainers then trained the end-users, being able to put the system in the right context for the end users.

--kiloran

[terminal7]

Firstly thank you all so much for your constructive replies. In these days of division, it is re-assuring that there are those that freely give of their time and provide honest advice.

There are 2 issues - (i) my OH's ability - indeed willingness - to tackle and possibly successfully operate the new MIS (ii) the rationale behind the introduction of such complex systems when there are overt signs of administrative staff being underworked/underemployed at many levels and medical staff often being stretched beyond endurance.

I accept that my wife should be treated like everyone else (irrespective of age or seniority) and be expected to adapt her working practices to changing computer software requirements as decided by the hospital/NHS. She is in contact with the BMA - as kindly suggested - and I will post the feedback in due course. The design of the software is US grounded and I would suggest is more in tune with health care in the USA. Furthermore, the implementation is hampered by time (hence budgetary) limitations imposed upon the external consultants. Indeed, the straight jacket imposed on consulting medical staff to conduct the orchestra and play the first violin at the same time will inevitably lead to reduced 'care'. In effect more patients being seen but receiving lower standards of 'care' and treatment. Many branches of medicine really do require eye contact, a reading of body language etc. The disgraceful conduct of some GPs referring patients without foundation, the gaming of the system by patients and the funding restrictions combine into a perfect storm of a very heavy time component to sort out the human element in a consultation. Spending 15/20 minutes of a 30 minutes consultation inserting data into a computer is not conducive to achieving health care objectives even though productivity goals may well be achieved. I could go on - i.e. reference has been made above to GPs looking almost totally at a screen. Bottom line is that after 40 years serving the public in major London teaching hospitals this is likely to be the (heavy) straw that broke this camel's back. My OH and I know many other instances - not MIS related - where top class staff migrate more and more to the private sector, emigrate and/or take early retirement.
Clearly this response is straying beyond legal matters - apologises.

Just a short elucidation of the second point. The administrative staff have a key role in the NHS. However the decreasing role of medical staff in the strategic operation and decision making has resulted in MIS's combining the obvious overall need for EHRs/EMRs that effectively reduce the workload on the admin of each department whilst increasing the workload on the medical staff. I will say no more unless others wish to discuss this element.

Thank you for listening

T7

[88V8]

I echo what Kiloran said about training. Train some 'key users' then let them train their teams.

My GP has been complaining for years about being ruled by the computer. But now he is so fluent that during the (ten minute) consultation, he can tick the nannying boxes, and talk simultaneously.

In my time, the typing pool vanished. Typists had to become computer operators. Then executive secretaries vanished and executives had to do their own typing. Learn Excel. Create presentations. A better use of their time? Hmm. But it happened, and one had to deal with it.

The next medical change will be AI. Many medical staff doubtless will be aghast..

I can understand that at her age - my age - your wife may not like change. Perhaps she could spend a few years in private medicine before she retires, where a more leisurely and traditional way of work pertains.

But the idea that change equates to redundancy, sorry, it ain't so.

V8

[terminal7]

The next medical change will be AI. Many medical staff doubtless will be aghast..

Just read about a dying patient in the States being confronted by a 'robot' with screen entering his hospital room and a live picture of a doctor pops up and informs him that the tests show that his lungs are completely shot and he has just a few days to live. He died the following day.

T7

[kiloran]

The next medical change will be AI. Many medical staff doubtless will be aghast..

Just read about a dying patient in the States being confronted by a 'robot' with screen entering his hospital room and a live picture of a doctor pops up and informs him that the tests show that his lungs are completely shot and he has just a few days to live. He died the following day.

T7

Artificial maybe, but it sure ain't intelligence

--kiloran

[quelquod]

Artificial maybe, but it sure ain't intelligence

--kiloran

No, not ‘Artificial’, ‘American’.
Sadly we do seem to import both their good and bad ‘Innovations’.