Analysis of The National Program for IT in the NHS - Report Example

Analysis of The National program for IT in the NHS Prepared by Submitted to Word count 1. Introduction Any program of the size of National Health Service depends on efficient handling of large quantities of information. The handling should be safe and successful. A ten-year program on the name of national program for information technology in NHS is made for its efficient handling of activities. This gives NHS activities and programs to use IT. This is proposed and implemented to enhance the quality of services offered by NHS. The centre of the program is the protection of care records and their effective access and usage. By using IT services different NHS people in various places can have patients’ clinical record. This makes the patient to receive clinical care all over the country. A unit is established in the NHS to procure and deliver the IT systems in 2002. After that the unit has become an agency of the department. It was named as NHS connecting for health. The system can be termed as centralized because, previously units of NHS used to procure IT services individually. Now whole NHS department is having a unit that renders IT systems and services for NHS. The unit is established to provide IT systems and services for NHS. The program is delivered through contracts negotiated by NHS connecting health with IT services and suppliers. The unit is entitled with the tasks like integrating the existing IT systems and configuring them to meet local circumstances and training the staff to use the IT systems. The staff has to change their ways of working to make the best of solutions provided by IT systems. Though local service providers are responsible for organizing the work, the majority of the work is needed to be done local NHS organizations coordinating with strategic health authorities, NHS trusts and other providers. 1 2. Appraisal of Systems During the appraisal of the systems, the 5 member strong team visited the agency staff at the offices. This is for 4 day site visit. This has begun on 18 april 2005. The confidential, structured 20 minute interviews with sample cross section of staff on a number of projects were conducted. The review of the organizational and project documents has been done. The processes appraised are about project planning, configuration management, project control, practitioner, doctor, service provider and patient definitions, decision making, architectural design process, Risk management process, integration process. The information gathered during the appraisal process has been carefully analyzed. The team gave respective weightage for their findings in different departments of NHS. This generated findings covering both processes and strengths of the opportunities in the system. This is through formal and unanimous consensus process. There are no minority opinions as there is no opposition for the consensus. The findings based on the multiple sources like evidence: both verbal and written. The findings emerged were briefed to the agency before the team left the organization. The NHS then had the opportunity to comment on the findings of the team. This brought forward the further information. This provided the earlier feed back that helped in avoiding the misunderstanding. This helps in validating the team’s findings. This appraisal concluded a 4 day analysis period and the production of the analysis on the findings in the form of a report. 3. Mixing Methods for organizational intervention Understanding of the domain of the offering of IT services is underpinned by critical social theory. This social theory controls the natural progression’s logical future direction. The NHS needs mixed mode modeling theory of communicative action. The mixing the methods within the NHS has gathered pace represented by two domains of mixed mode modeling and multi methodology. The developments of the systems and services in NHS can be characterized by the practice and mixing methods. The organizational intervention and the theoretical and pragmatic difficulties of such an approach need not be underplayed. To set mixed modeling the perceived problems issues need to be concerned. This includes background and history of the organization. Though there are no problems perceived by the mixed mode modeling, it may demonstrate problems when background and history of NHS is concerned. The empirical and theoretical issues need to be concerned. The problem arises when only human relations school is concerned. The needs of the service providers and patients are more than the human relations in the case of NHS. So when one offers mixed modeling in the context of NHS, the needs of the patients and the services offered by the NHS and local health service providers should be taken into consideration. If the needs of the patients are not taken into consideration, the privileged human view points and activities dominate the usage of the technology. These human view points need to be combined with the needs of the patients so that the service providers can cater to the needs of them. The convenient initiative can be found from the models developed by Jackson and the syste4m of systems methodologies. This SOSM can be used as the basis of the application of methodologies through the determination of the problem contexts. This can be argued that the problem contexts can be categorized according to the extent of exhibition.2 4. Viable system Models The viable system models have general applicability. When considering the department or area like NHS, the VSM can be considered as most viable system environment. This is because it will focus on organization of NHS. Instead of prescribing a structure, it will adjust according to environment of the NHS and its local service providers. The system will exhibit vertical and horizontal interdependence. This implies that adopting these systems, the NHS can expand and grow. The processes of self organization in the complex systems need to be employed to work according to the health service providing circumstances. The classification under the functionalist paradigm may emerge as the weakness of the VSM. The systems considered from the view points of the interpretive or emancipator paradigm, the limitations and weakness can be observed by the local service providers of NHS. If the view is interpretive, the VSM is a partial representation of the organization. This even misses the needful character required for the health services offered by NHS. The human resources can be considered as the components that can attribute the situation and therefore see in the organizations. This is regardless of the purposes they want to wish and make of organizations they want to create. The minimized purposeful role of individuals in the organizations will make the criticism for the viable systems. This is due to the lack of centralization and control over the system and services offered by NHS. If this role of individuals is not controlled, there is a chance of failure. The SOSM can control the failures by limiting the roles of individuals. This may result in overemphasizing of organizational design. This may even neglect the possible different values and view points and perceptions. The need of control of the roles of the individuals in the system arises from the above mentioned context. This is minimized by over emphasizing the organizational design, and neglecting the possible different values. This happened despite presence of view points and perceptions that existed among the individuals. The overemphasizing of the organizational design should not create autocratic nature that undermines the roles of individuals. This may result in irresponsibility and may harmful in rendering health services. Jackson argues that it is not inevitable to be autocratic by emphasizing on organizational design. According to his view there is a possibility of building the safeguards.3 5. Critical Systems Thinking 5.1 Integration of hard and soft methods: Critical thinking systems were developed from 1980s after the works of Jackson, Mingers and Ulrich. These are considered as the attempts to give new view of integration of different soft and hard methods by critical analysis. The critical analysis is about the advantages and disadvantages and relevant applications of multiple approaches. Though critical systems thinking is not individual methodology, it is considered as methodological pluralism. This is also termed as multi methodology. This allows deciding on suitability of methodological choices for NHS health purposes. This is done by critical awareness of strengths and weaknesses of the methods chosen for appropriate care giving methods. These care giving methods need information and that is furnished by critical thinking systems. A wide range of problem solving issues than a single method is taken into consideration. The example of critical system thinking can be operationalised into methodological tutorial. This is according to total systems intervention (1991), and system of systems methodologies (1984). The TSI can also be called as meta methodology. This is for guiding the practice of systems intervention within a system of examining the patients treated by other health service providers or medical practitioners. 5.2 The phases in adopting the system: This suggests 3 phases of SD. They are creativity, choice and implementation. These involve viewing organization by means of metaphors as a practitioner or a patient or a treatment. The choice involves the methodology for collecting information about patients individually and collectively. The implementation is will bring about a change in NHS about its offering of services. This was initially chosed to be a framework for UHII development research. This is been validated against the other approaches and the use of critical thinking theory. This needs specification in the operations of the NHS’s local service providers. The application need to create guidelines for policies and strategies for implementation of systems. The assumptions about relevancy and suitability of TSI for the cases of patients were prevented and the recorded facts can be taken into consideration. The SOSM and TSI have been criticized in determining the criteria of choice for the methods to apply in SD. The choice to be made about the SD modeling can be an answer to the problem. The criticism about the addressing the different levels of theory, the in depth philosophic paradigm levels, theoretical metaphors, practical, and the way the message was passed to other service providers in the network has to be considered and the problems need to be addressed. The dynamics of the system dynamics by Jackson and Flood was assessed as ill informed. This is due to the lack of reference to incorporate representation of values and goals within the models and possibilities of deep qualitative system analysis. When we consider the work done by Veeke, the conclusion about his analysis, fundamental for creation of logistic conceptual system modeling, answers the requirements of Lane. This in turn can be treated as an operationalised and extended approach to complex system of modeling. Concluding to make the use of Veeke’s the Jackson and Flood’s approaches are used to find universal guidelines in mixed methodologies discussion. 5.3 Priority aspect in the systems: The critical approach in offering the health services need to be given priority. This priority is after the analysis of the system objectives. This decides the way to model or even if to model and after detailed analysis on the suitability and goals of chosen methods. The critical systems approach is based on the modern research in this direction. The main statements of critical systems social theory is useful in the services offered by NHS. The statements of critical social theory involve the critical approach of human beings to existing conditions. This constraints the environment and can be expressed by the same statement that describes the aspect of radical changes. According to Daellenbach, the above mentioned critical system approaches the emancipatory systems approaches will claim the critical systems approach location. The existing inequalities of wealth health, status, power accessibility, knowledge, gender race and sexual orientation along with views and interests have no voice in the decision making process. The approaches mentioned here are said to be used for emancipating the NHS services from the organization in order to strengthen the health status of the people. This will help in fighting poverty and can protect the health of people. The emancipator approaches have been assessed as suitable for dealing with the situations of moderate complexity. The views of the patients and the service providers, health practitioners need to be taken into consideration on the relevancy of the system adopted. The critical approach to application of single methods can be termed as a base to create mixed methods. This should be mainly the combination of soft and hard methods. This can be termed as methodological triangulation. This is not necessarily complete in terms of social change. The critical system approach can be treated as an umbrella for the framing of mixing methods. This can be a better choice for the case of NHS as the developing countries than the triangulation gave a more complete view on the organizational and educational problems. 4 6. Evaluation of Systems 6.1 System methodologies: After the above discussion the Jackson’s systems of system methodologies can be considered as best known model for structuring the thinking. The mapping of system complexity against the decision makers’ environment is necessary for useful means of categorizing systems methodologies. This provided an indication for underlying assumptions concerning the systems complexity. The patient situation and the keys are used in the SOSM to argue that an examination of problem contexts can suggest suitable methodological approaches. The examination of a patient in NHS local service provider can suggest suitable methodological approaches. This use of SOSM has been considered as a functionalist interpretation of the framework and such a use for the SOSM was invalid as problem context and system’s characteristics are in the eye of the beholder. The criticism of realism placed a strong emphasis on unearthing of the deep structures and mechanisms that make the NHS. The SSM did not provide the specific model that NHS want within the purview of SOSM. 6.2 Reproduction of the systems: The mechanism did not explain the reproduction of the system that offer health services and interaction between local service providers. There is adherence to the notion of the structure of the provision of health services; the mechanisms are not clearly specified. The argument about the soft systems movement have seen the local service providers of the NHS as social entities that seek to manage relationships. This sees the NHS as the relationship that manages entities. Even though the SSM in practice did not particularly emphasize the relationships. This is due to the recognition in the development. This reflects the rich picture of such relationship and their interaction. If this interaction is identified, there is a little further reference to the rich picture and identified structures. The traditional use of SSM within the IS field has tended to neglect the interaction between the network partners of the information systems of NHS. This in turn tended to focus on the transformative purpose behind the information systems. This is exemplified in the root definition of the system that requires the inclusion of a transformation. This suggests that the SSM need to gain a wider application if it is to concentrate on the interaction aspect as well as the traditional systemic concept of transformation. As part of this change in focus, the dependence on the system may include a definition of the interaction process rather than the transformation process. This is inline with the Flood and Jackson model. The two primary metaphors reflected within SSM are transformation and interaction. The traditional transformation of the information regarding patients has been the primary focus of SSM and action research in general. 6.3 Move towards interaction: The action researcher’s primary aim of research intervention is transformation. This resulted in concentration of action and neglected the underlying structures like power relationships and external structures. The later versions of SSM concentrated on the idea of the NHS as a human activity system. This is done with primary focus on relationship maintenance. This move towards an interaction metaphor can be seen as an attempt to address criticisms of SSM that does not reflect pre existing structural relationships. Though rich pictures have provided a mechanism, the structures identified are not used to large extent in the formal modeling process of the health services. The critical realist perspective of the concentration within SSM in SOSM is on transformation and process missed the concept of NHS. The approaches concentrated on professional issues and initiated social action. This tended to ignore important impact of structural impositions that can constraints. The inclusion of techniques like analysis of patients within the SSM seemed a sensible means to address the neglect of social structures. The approach proposed an extension of multi view 2 that included the analysis of the patients. The first rich picture be developed to reflect the complex and messy situation under investigation. Once completed the picture is used with map of the patients to identify the concerned service providers. After the identification of patients and service providers, the system might impact each of the situations. The identification of such stakeholder (patients, service providers and practitioners) effects allowed for their inclusion in the new system. This analysis can provide an opportunity for a clear pluralism reflection in the network of NHS. According to Vidgen evidence the development situations contain pluralist perspective as an invariable norm in the system projects. This rejects the simple category that is reflected within the Systems of system methodology. The close relationship between the definition of stakeholders and the critical realist conception of social structures needs the attention of the inclusion in the network priorities. This inclusion will see the patients, service providers and practitioners as any individual group. They may even be considered as organization or institution within the network of the NHS. The defining of the patients, practitioners, doctors and service providers effect the policy or policies of NHS. Their performance will decide the route followed by NHS. As a result the NHS can be termed as a web of stakeholder relationships rather than a single entity. 6.4 Interactive system: The critical realism involved in internal network of social relations can essentially constitute the structure of NHS. By adopting simplistic support to the above argument suggests that examining the interactive system of NHS is particularly important. For this purpose, the tool that can analyze the patients, doctors, service providers and practitioners is useful. The structural analysis is also important when the transformation of the system is considered. It has been argued that the powerful components of SSM is the interpretive stance. This aspect belongs to doctors and practitioners in NHS networking. They need to have interpretive thinking to the fields of the systems they possess. They should help in problem solving regarding the patients. SSM resided within the so called transitive dimension. The name systems thinking highlights the emphasis and has been one of its major strengths. Though interpretation is a strong aspect in case of SSM, it have its own weaknesses. This weakness is not observed in the NHS network as the practitioners and the doctors depend less on the system and more on their analysis for the interpretation. The weakness regarding the interpretation in the remaining areas is due to the overdependence on the system for interpretation. Though the system has interpretation tools, they have their limitations as it is not intelligence. In case of health services offered by NHS, there is less dependence observed regarding interpretation on SSM. In this context of NHS having less dependence on SSM regarding interpretation, it can grow faster within the purview of SOSM. The inclusion of analysis of patients, practitioners, stakeholders, doctors will help the fellow stakeholders to interpret accurately. The recognition of social structures provided by a combination of SSM and stakeholder analysis will provide strength and reality for the use of SSM in NHS. 5 Conclusion At level 0 the processes are observed to be incomplete and the priorities have been overlooked. After that at level 1 the processes are characterized that generated the work products. This needed the efforts of talented individuals rather than the efficiency of the system. The working practices of management are also in reality improvised when they are planned and needed. These should be in written form and adhoc also. At level 2, the process activities are conducted according to the definitions taken in level 1. The projects carefully considered at the outset and how they are going to undertake the work. These considered both technical management practices. By checking the defined processes followed, the trained specialists audit process activities are appraised. This made clear that management viewed the process issues as a priority by being seen to carry out periodic process reviews. At level 3 the organizations and individuals in the network are serious and identified the best practice. The active searching of optimum ways of developing work has been observed. These organizations establish a repository for process assets, tools, techniques, methods and processes. These make the assets of the NHS available to the patients. The process areas integrated into implementation process that are descriptions of the management tools and techniques. The life cycle descriptions have shown the process components and ordered the tailoring guidelines. These are best to choose and utilize the components. These elements are compulsory. The information used and provided by assets is also collected and analyzed. The outcome was that the collection and dissemination are satisfactory. After establishing the standard set of processes, the assets and individuals in the network, also collected process database.6 References: 1. Comptroller and auditor general, 2006, The National program for IT in the NHS, House of Commons, ,electronic, page 7 10, 15, 2. Steve Clarke, 2001, MIXING METHODS FOR ORGANISATIONAL INTERVENTION: BACKGROUND AND CURRENT STATUS, sociotechnical.org, ,electronic, 28-4-07, http://www.sociotechnical.org/archive/Clarke.pdf 3. Panagiotis D. Panagiotakopoulos, 2005, A SYSTEMS AND CYBERNETICS APPROACH TO CORPORATE SUSTAINABILITY IN CONSTRUCTION, Heriot-Watt University, ,electronic, 28-4-07, http://www.sistech.co.uk/media/PhD%20Master-small.pdf 4. Maura Eva Merson, 2004, Manage data-manage hazards: Methods for development of an urban hazard information infrastructure in Windhoek, International institute for Geo information, ,electronic, 28-4-07, http://www.itc.nl/library/Papers_2004/msc/gim/merson.pdf 5. Philip J Dobson, 2004, SOSM revisited-the importance of social structures, Edith Cowan University, ,electronic, 29-4-07, http://www-business.ecu.edu.au/schools/mis/media/pdf/0015.pdf 6. QinetiQ/D&TS, 2005, NHS Connecting for Health Process Capability Appraisal, National Audit Office Read More