It is important to consider the questions raised related to technology, learning, and related policies and processes.
Where learning does not happen and knowledge is not shared, the lack of organisational learning may manifest itself as ignorance and risk. This became apparent at the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis, 2013) which has subsequently led to the HSE has charging Mid Staffordshire NHS Foundation Trust under:
Section 3(1) of the Health and Safety at Work etc Act 1974 states that every employer has a duty to conduct his undertaking in such a way as to ensure, so far as is reasonably practicable, that persons not in his employment who may be affected by the conduct of his undertaking are not as a result exposed to risks to their health and safety.
The HSE has charged Mid Staffordshire NHS Foundation Trust following a thorough and comprehensive investigation into the circumstances of four deaths of patients under its care.
Wayne Owen, HSE Principal Inspector in the West Midlands, said: "We have concluded our investigation into the death of four patients at Stafford Hospital and have decided there is sufficient evidence and it is in the public interest to bring criminal proceedings in this case. "There are four separate charges, each alleging a breach under Section 3(1) of the Health and Safety at Work Act."
Change management that specifically relates to healthcare involves important concepts, for instance the learning organisation, management theory and practice, public policy, NHS policy, organisational innovation, communications and professional practice. I have observed hospital culture and practice changing over the past twenty years mainly due to pressures from funding, regulations, and higher expectations from patients. Boundaries are being constantly redefined in response to pressures from government, patients and technology.
As Malin (2000) observes, NHS Partnerships, Foundation Trusts and commercial participation are now considered appropriate goals for professionalism. Consequently, personal and professional values are changing professional boundaries in healthcare practice. For instance, in some NHS healthcare professions the boundaries are particularly hard to maintain:
The nature of professional practice, as it relates to scope, competence, level of discretion and power, has been linked to organisational culture within the NHS. A notable example of the need for boundary redefinition arises from current links between professionalism and market/enterprise culture. (Malin, 2000, p. 7) Also, it seems that there is a change in the nature of NHS professionalism with regard to healthcare technology. This change is being driven by the demands for more up-to-date technology from medical professionals, including the doctors, nurses and patients. It is important to recognise the need for user training to ensure that any new technology is used safely. Unfortunately, this was not the case at Mid Staffordshire NHS Foundation Trust, and the Care Quality Commission are finding more examples across the NHS of mis-management and Trusts not providing appropriate learning platforms for technology, and also not understanding their regulatory responsibilities. Additionally, there is commercial competition between NHS Trusts and private healthcare providers, impacting on culture and attitudes towards management of learning, and policies that guide the learning needs of the organisation.
As indicated in a recent report by the Competition Commission, the NHS healthcare market is opening up to the private sector and challenging current occupational, functional and professional segmentation, NHS monopoly and division (Competition Commission, 2013).
Patients are now accessing technology dependant services delivered by various professional practitioners due to the deregulation of professions and monopolies of competence, allowing nurses to do work and use technology that was previously assigned to doctors, and carers allowed to do the work and use technology that was previously assigned to nurses, and so on. There are evident benefits and risks associated with the use of technology, whether that is hardware or software. It is imperative that healthcare providers make use of technology in a professional way. This requires management policy to guide the application of technology and associated learning, whether that be through formal academic means, or through 'on the job' training.
The fall of these barriers between occupations and practices within healthcare organisations means that members of different occupational groups are now required to work in multifunctional teams using multifunctional technology and are able to prescribe devices and drugs that they may not have done previously because they were not considered appropriately qualified.
For instance in the UK, in addition to doctors and dentists, a number of supplementary prescribers and appropriately qualified nurses, optometrists and pharmacists can also write prescriptions for patients (Department of Health, 2013, p. 188). This has resulted in the rise of the 'organisational professional', with a shift from productive behaviour to a different emphasis on the total behaviour, attitudes and self-understanding of individual employees.
Challenges are posed by this enterprise culture but, as shown in the example above about prescribing, there is a definite stride towards blurring or removing boundaries and improving the flexibility of the healthcare workforce, both private and public. Learning how to prescribe, manage or use healthcare technology is something undertaken and developed by individuals, but healthcare technology management policy can promote or inhibit the learning process by guiding the conduct of practitioners.
Hospital culture and policy, within which stakeholders work, shapes their engagement with technology and the learning process. There are questions as to whether and how NHS Hospitals are able to tap into new technology, given spending cuts, and even where new technology can be acquired, how the learning achieved by its stakeholders given shortages in staffing of both doctors and nurses.
Continued professional development (CPD) is promoted as being part of the NHS culture, but evidence suggests a lack of professional development and that the learning needs to have more emphasis laid upon it. Hospitals that position learning as a core characteristic have been termed 'learning organisations' (Senge, 2006) and this concept itself sits within the wider field of organisational development (Linstead, et al., 2009). Zuber-Skerritt (1996) discusses the 'learning organisation' and building a culture that enables innovation and change (Zuber-Skerritt, 1996, p. 91). She says that building a 'learning organisation' is a relatively new concept, mentioning Senge's book, The Fifth Discipline (2006), as 'a breakthrough'.
Technology is at the heart of everything we do in healthcare. It is now time to ensure that healthcare technology management is guided by an appropriate policy that meets the needs of the organisation, the user and the patient. If we can succeed in improving access to technology and learning how to use that technology, then we can make the NHS safer and more productive.
Competition Commission, 2013. Private Healthcare Market Investigation, London: Competition Commission.
Department of Health, 2013. Review of the balance of competencies between the United Kingdom and the European Union, London: Department of Health.
Francis, R., 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry Volume 1: Analysis of Evidence and lessons learnt, London: The Stationery Office.
Francis, R., 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry Volume 2: Analysis of Evidence and Lessons Learnt, London: The Stationery Office.
Francis, R., 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Volume 3: present and future, London: The Stationery Office.
Linstead, S., Fulop, L. & Lilley, S., 2009. Management & Organisation. 2nd Edition ed. New York: Palgrave Macmillan.
Malin, N., 2000. Professionalism, Boundaries and the workplace. London: Routledge.
Senge, P. M., 2006. The Fifth Discipline. London: Random House Business Books.
Zuber-Skerritt, O., 1996. New Directions in Action Research. London: Falmer Press.
Dr John Sandham CEng FIHEEM MIET