Friday 18 December 2009

Boyle's Law for public services

The writing is now on the wall for the combination of centralisation, process bureaucracy and inappropriate IT systems which have been such a disempowering feature of our public services for the past decade. Research published in the American Journal of Medicine shows that IT investment in health services doesn’t cut costs:

In fact, the hospitals which had invested most quickly in IT solutions had found that their administration costs had risen the most. Those on the ‘Most Wired’ list had not managed to cut their costs at all.

This is important stuff because it confirms that one of the most disastrous aspects of New Labour centralisation has been the massive IT projects in public services. They didn’t just cost a huge amount. They also set processes in concrete, so that they became inflexible.

That is the real disaster about the government’s misuse of IT: it has taken the exhausting bureaucracy and it has made it even more inflexible than before. It can’t now be reformed without dumping entire IT systems.

Go along to A&E at King’s College Hospital and you will find that nobody can help you until they have gone through more than 20 pages of questions on their IT system. This kind of inflexibility – more about satisfying the craving of the centre for data than it is about helping patients – is repeated throughout our public services, and goes some way to explain why they are as expensive as they are.

But there is an even more important aspect than this. The way IT has been use in public services has overwhelmingly been to remove the human element in healthcare, to make one doctor interchangeable with any other, just as they have tried to remove variable human beings from a range of other public service systems.

This is part of the agenda of the American healthcare industry, a slow shift to the position where real treatment decisions are based on a quick conversation about symptoms between the doctor and the insurance company, in order to slot patients into their huge database of NICE-style cost-effective practice. It is an agenda which has been driven, not by doctors but by health consultants, and it is parallel to the same kind of agenda that is creeping into education.

None of this is to suggest that IT is useless. Quite the reverse. It has obviously changed the way we all work and can vastly increase the efficiency of what we do, but not if we try and take people out of crucial relationships with professionals. Nor if we believe somehow that critical human relationships can be reduced to data.

The problem is that these systems are far more ambitious than simply easing people’s work with IT. They are moving into areas where they frustrate the process whereby change happens most effectively, which is in face to face relationships. In those circumstances, IT investment undermines people’s ability to use their intuition, trust and creativity. Huge IT investment is bound, therefore, to lead to less successful organisations, more mistakes, less imagination and more crass simplification. Hence the latest findings.

This is, in fact, my own version of Boyle’s Law: The more money that is spent on IT, the more it costs everybody else.

There are obviously exceptions to this law. I am not being a Luddite here, or not seriously. Where IT gets to be a problem is where technological solutions are used to suppress the brilliant possibilities of human beings. Then the shrinking ability of the organisation to learn, to achieve its objectives effectively and imaginatively, means that we all have to pay more – whether it is in buying the products or in our taxes because the health systems heal less effectively, or our schools educate less effectively. If people get ignored, it costs us.

That is the disastrous hidden narrative of Gordon Brown’s public service reform, but it needs a political party to articulate it clearly.

Reference: David Himmelstein, Adam Wright and Steffie Woolhandler (2009), ‘Hospital Computing and the Costs and Quality of Care: A National Study’, American Journal of Medicine, 24 Nov.

1 comment:

John Craig-Sharples said...

I very much agree with what you say about the removal of the human element in healthcare. In a lecture in July last year, Lord Winston spoke about how doctors are losing the ability to assess patients in person, becoming too reliant on technology and not remembering to talk to the patient.

Less seriously I wonder about the way in which many libraries have now moved to automated systems for returning and taking out books. It may save money but I'm sure I'm not the only person who misses the human contact of talking to the library staff.