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The information revolution: An urgent need for a national training strategy—The experience of the NHS
/nfernafjonel
Journal of lnformaf~o~ ~anageme#t
(1989),
9 (173-l
77)
The Information Revolution: An Urgent Need for a National Training Strategy - The Experience of the NHS J.M. BRITTAIN
In the next decade nearly all NHS staff will be involved in one or more aspects of the information cycle. Like all other large organizations NHS is experiencing a skills shortage in information management. This paper gives the background to the NHS Training Authority’s ‘Information Management and Technology for Training and Staff Development Strategy’ and puts a case for both skills and awareness training for all personnel.
Dr Michael Brittain is Project Manager (Information Management) with the NHS Training Authority, St Bartholomews Court, 18 Christmas Street, Bristol BSl SBT, UK.
‘A series of reports on Health Services Information, produced by the NHSIDHSS Steering Group on Health Services information, and chaired by Dame Edith Khmer. The six reports were published hy NMSO between 1982 and 1985. %KITTAIN, 3.~. (1987). Information specialists: new directors for education and training. Journal of information Science, 13, PP. 321-326. RRITTAIN, J.M. (Ed.) (1986): Curriculum development in in: formation science to meet the nerds of the irzformation industries in the I YYOs. London: British Library Board.
0288401
Z/89/03
0173-05
$03.00
Introduction Information is the life blood of any organization attempting to manage complexity. The effective and efficient use of information systems, together with the use of information for management, scientific, and clinical purposes that these systems make readily available, requires a major coordinated training programme. The penalties of ignoring the need for adequate and appropriate training in&de the ineffective and inefficient operation of information systems, a neglect of information, the procurement of inappropriate information technology and its subsequent underutilization, and an inability to be able to monitor, evaluate, plan, and take informed decisions. Nearly all NHS staff in the next decade will be involved in one or more aspects of the information cycle, which includes the capture and recording of information. its storage, retrieval, analysis and use. Many personnel now working in the field of information have no professional training or background in information work. As a result of Kiirner initiatives,’ NHS staff involved in some aspects of information gathering and use have had to acquire new skills without adequate training - in many cases without any training at ail - as part of their new job requirements. Like other large organizations the NHS is experiencing a skills shortage in information management-the so-called ‘emerging market’ for a new type of information professional who has managerial as well as relevant information skills.* Because the new breed of information professionals are in short supply, the NHS will continue to experience a manp(~wer shortage in this area for many years to come, especially since NHS salaries are still uncompetitive for information staff. The need for in-service education and training is great and can alleviate some of the worst aspects of the skills and manpower shortage. The NHS has been slow to recognize that information technology will change management structures and management styles more radically than perhaps any other factor. A new generation of skilled and experienced staff is required to manage information-orientated enter-
@ 1989 Butte~o~h
& Co (Publishers) Ltd
173
Training
strategy
for the NHS
c. (1989). Managers with minds of their own. Sunday Times, 8 January, Section E, p. 1. ZUBOFF, s. (1988). The age of the smart machine. London: Heineman.
'HANDY,
174
prises: in a few years time the NHS will become such an enterprise. Outside the NHS it is agreed that the IT revolution will require organizations to focus upon innovations, ideas and information.3 A massive awareness training programme is required to alert all categories of employees to the benefits to be derived from a systematic use of information. In addition to the end-users of information systems, computing specialists and information managers also require awareness and update training. Information technology is still fast developing and IT specialists require continuing education and training in order to keep abreast of new technical developments, in addition to continuing awareness training to appreciate the appropriate applications of the new technologies to the problems facing end-users of the new information systems. Although imperfect in many ways at the present time - not least in the fact that many information systems are still not particularly userfriendly - many of the problems of human-computer interaction have been well researched: some of the new developments will work themselves through onto the commercial market in the next few years. It is important that managers and information specialists alike develop new skills for the procurement, operation and maintenance of the new generation of information systems. Concomitantly with a fast changing technology, attitudes towards computing and information systems are changing rapidly. A few years ago, the usual question asked about an organization’s computing requirements was confined to those involved directly in operating computers for data processing - usually for payroll purposes. Management was likely to be faced with questions such as: How much to allocate the computer service in the next financial year? What proportion should be spent on hardware, software and maintenance? How many computing staff and DP staff are required? What are the costs? Management decisions about investment in IT and computing now need to consider first a new set of questions. What are the business plans of the organization? How is it possible to derive the information requirements from these business plans? Given a set of information requirements, how can computerized information systems deliver the required information? And only then, is attention paid to the technical details of computing, hardware and software requirements, maintenance schedules, and their costs. There is a great need for awareness training: for managers, awareness of what the new generation of information systems can provide and the ways in which information can be used for planning, option appraisal, resource management, and many aspects of management; for investment managers, awareness training is required regarding procurement strategy, thinking first and foremost in terms of the business and corporate requirements, and only second about the budget for the computer department, and the requirements for computing specialists and IT staff. Awareness training is also needed for professional groups, including nurses and clinicians, in the existing benefits that can flow from use of information systems for clinical, scientific, and management purposes. Skills training is reauired for all those who are directlv _I involved in an 1 operational aspect of the information cycle, beginning with those responsible for data capture and input, and extending to those involved in collation, storage and retrieval, manipulation (including statistical
J.M. BRITTAIN
analysis of data), and in the various processes of communication and presentation of data. Even those who may never have direct ‘hands on’ experience of the new information systems - for example, general managers - may still require special training, followed by practice, in the various methodologies now available for the use of information for management purposes, for example, computerized decision support systems and expert advisory systems.
Background to the IMT (Information Technology) Training Strategy
Management
and
In consultation
with the Information Management Group of the NHS Management Board, the NHSTA (NHS Training Authority) committed resources to the development and subsequent implementation of a plan for systematic training in information management and IT within the NHS. With advice from a wide cross section of the Service, together with input from educationalists, professional bodies, and others concerned with information management and information technology (both within the NHS and outside), the NHSTA produced an ‘Information Management and Technology (IMT) Training Strategy’. The Service was consulted about the draft Strategy: all Health Authorities and Family Practitioner Committees in England and Wales were asked to comment. Feedback was assessed, and the IMT Training Strategy revised accordingly. The Strategy was launched into the Service in June 1989. The Strategy identifies: 1. Key target groups (e.g., information providers, information users, information managers, and IT and computing specialists) who need training. 2. Priority training and educational needs of each target group. 3. Methods of producing and delivering training. 4. The management of IMT training at RHA, DHA and FPC levels. 5. The recommended responsibilities of RHAs, DHAs, FPCs, NHSTA and other bodies. The Strategy contains an Action Plan detailing more than 40 recommendations about the ways RHAs, DHAs, FPCs and the NHSTA can implement a programme of IMT training and staff development. The NHSTA has already embarked upon implementation projects, aimed at helping and assisting Regions, Districts, and FPCs to implement their own IMT training programmes. A national database of training materials and training courses, eventually available to all Health Authorities, is being developed; work is underway upon the specification of the training needs of various professional groups; a major new initiative is being undertaken on the development of a portable training system for decision making for managers; and the training of nurses in operational settings is being undertaken. Health Authorities and FPCs need to develop their own IMT training programmes. A first priority is the nomination of a senior member of staff in each Authority as an IMT Training Coordinator. A manual of good practice for IMT Training coordinators will be produced by the NHSTA and made available to all Health Authorities. Each IMT Training Coordinator will take responsibility for the actions required to inaugurate and develop a local IMT training programme.
175
Training
strategy for the NHS
Factors to consider in IMT training programmes 1. Awareness training is required in order to alert potential users of information systems to the benefits and advantages of using computer-based information services, and to extend the horizons of those already involved in the information cycle. Awareness training for managers is essential. 2. Awareness training, however, is not enough in itself. In order to effectiveiy use information systems and apply the information that is derived from them to practical clinical, scientific, and managerial problems, a number of specific skills and competences are required. These can only be obtained by a training programme which includes practice. 3. Inform~~tion systems continue to advance and develop at a rapid pace, and hence there is an urgent need for continuing in-service training and retraining. 4. The NHS has not been in the forefront in the apphcation of computer technology to management information systems. Therefore new training programmes in IMT start from a relatively low base of skills and competences. 5. The number of staff in the NHS who need both awareness training and skills training and practice in IMT is large. Therefore, training methods and materials that do not involve taking staff away from their work for long periods of time are essential. 6. One of the most effective training methods in IMT is learning by doing, as part of normal day-to-day job activities. 7. A relatively modest set of skills and competences in IMT will ensure the uptake and effective use of the new generation of information systems. Relatively few skills and competences are required in order to have a major impact upon information management and information use. Therefore, the immediate requirement is for the training of the thousands of NHS staff who require this minimum of skills and competences. Once a continuing educational and training programme has been put in place, the specialist skills and competences required by each professional group can evolve and be acquired as a~~~lropriate, at a local level.
Conclusions The NITS is already paying the penalties for the absence of a systematic programme of IMT training. For the last decade this has shown itself in the inappropriate procurement and operation of computer hardware and software, and in the massive duplication and uncoordinated development of personal computing which involves thousands of standalone systems which do not interact with each other. These are the most tangible penalties. The technology for using information for managerial purposes is racing ahead quickly; the NHS has a minimum data set as a result of KGrner; the urgency now is to make sure that the information available is put to some purpose. The problems of using information for management purposes are much less palpable than the problems involved in capturing, storing and making information available. The use of information requires a heightened awareness of both management func176
J.M. BRITTAIN
tions and the impact of IT upon information provision and management decision making. Managers at all levels need to be aware of the boundaries that are being pushed backwards; in addition - unlike their predecessors they need a number of specific ski& and competences in using the new technology to good advantage. Otherwise, the introduction of information systems, and the use of their outputs, will be patchy and uneven; staff will be ineffectively deployed and although a number will muddle along, the gap between the potential and actual achievements will continue to widen. The NHS will fall further behind both the private and other public sector bodies in the use of the new inform~~tion technologies for cost-effective management purposes. The new information technologies are coming to maturity at a time when there is a completely changed view about the advantages and attractions of systematic and planned in-service education and training. Generations of managers - indeed, also clinicians and other professional groups - have been able in the past to get by with little or no involvement with information systems. This has led many into the false belief that the call for a better trained workforce in the field of IMT is scaremongering amongst a dedicated band of IT and computer fanatics. Undoubtedly, many of the most talented and capable will be able to manage for the foreseeable future without making use of the new information systems. However, all categories of staff are increasingly being asked to manage and deal with complexity. There will soon come a time when the majority of employees find their jobs are too complex to manage comfortably without the benefits of IT. It is preferable that staff come to this realization sooner rather than later, and that they are prepared for an increasing level of complexity by a relatively modest programme of continuing education and training in the IMT techniques and procedures that are most likely to help them in the next decade.
177
Journal of lnformaf~o~ ~anageme#t
(1989),
9 (173-l
77)
The Information Revolution: An Urgent Need for a National Training Strategy - The Experience of the NHS J.M. BRITTAIN
In the next decade nearly all NHS staff will be involved in one or more aspects of the information cycle. Like all other large organizations NHS is experiencing a skills shortage in information management. This paper gives the background to the NHS Training Authority’s ‘Information Management and Technology for Training and Staff Development Strategy’ and puts a case for both skills and awareness training for all personnel.
Dr Michael Brittain is Project Manager (Information Management) with the NHS Training Authority, St Bartholomews Court, 18 Christmas Street, Bristol BSl SBT, UK.
‘A series of reports on Health Services Information, produced by the NHSIDHSS Steering Group on Health Services information, and chaired by Dame Edith Khmer. The six reports were published hy NMSO between 1982 and 1985. %KITTAIN, 3.~. (1987). Information specialists: new directors for education and training. Journal of information Science, 13, PP. 321-326. RRITTAIN, J.M. (Ed.) (1986): Curriculum development in in: formation science to meet the nerds of the irzformation industries in the I YYOs. London: British Library Board.
0288401
Z/89/03
0173-05
$03.00
Introduction Information is the life blood of any organization attempting to manage complexity. The effective and efficient use of information systems, together with the use of information for management, scientific, and clinical purposes that these systems make readily available, requires a major coordinated training programme. The penalties of ignoring the need for adequate and appropriate training in&de the ineffective and inefficient operation of information systems, a neglect of information, the procurement of inappropriate information technology and its subsequent underutilization, and an inability to be able to monitor, evaluate, plan, and take informed decisions. Nearly all NHS staff in the next decade will be involved in one or more aspects of the information cycle, which includes the capture and recording of information. its storage, retrieval, analysis and use. Many personnel now working in the field of information have no professional training or background in information work. As a result of Kiirner initiatives,’ NHS staff involved in some aspects of information gathering and use have had to acquire new skills without adequate training - in many cases without any training at ail - as part of their new job requirements. Like other large organizations the NHS is experiencing a skills shortage in information management-the so-called ‘emerging market’ for a new type of information professional who has managerial as well as relevant information skills.* Because the new breed of information professionals are in short supply, the NHS will continue to experience a manp(~wer shortage in this area for many years to come, especially since NHS salaries are still uncompetitive for information staff. The need for in-service education and training is great and can alleviate some of the worst aspects of the skills and manpower shortage. The NHS has been slow to recognize that information technology will change management structures and management styles more radically than perhaps any other factor. A new generation of skilled and experienced staff is required to manage information-orientated enter-
@ 1989 Butte~o~h
& Co (Publishers) Ltd
173
Training
strategy
for the NHS
c. (1989). Managers with minds of their own. Sunday Times, 8 January, Section E, p. 1. ZUBOFF, s. (1988). The age of the smart machine. London: Heineman.
'HANDY,
174
prises: in a few years time the NHS will become such an enterprise. Outside the NHS it is agreed that the IT revolution will require organizations to focus upon innovations, ideas and information.3 A massive awareness training programme is required to alert all categories of employees to the benefits to be derived from a systematic use of information. In addition to the end-users of information systems, computing specialists and information managers also require awareness and update training. Information technology is still fast developing and IT specialists require continuing education and training in order to keep abreast of new technical developments, in addition to continuing awareness training to appreciate the appropriate applications of the new technologies to the problems facing end-users of the new information systems. Although imperfect in many ways at the present time - not least in the fact that many information systems are still not particularly userfriendly - many of the problems of human-computer interaction have been well researched: some of the new developments will work themselves through onto the commercial market in the next few years. It is important that managers and information specialists alike develop new skills for the procurement, operation and maintenance of the new generation of information systems. Concomitantly with a fast changing technology, attitudes towards computing and information systems are changing rapidly. A few years ago, the usual question asked about an organization’s computing requirements was confined to those involved directly in operating computers for data processing - usually for payroll purposes. Management was likely to be faced with questions such as: How much to allocate the computer service in the next financial year? What proportion should be spent on hardware, software and maintenance? How many computing staff and DP staff are required? What are the costs? Management decisions about investment in IT and computing now need to consider first a new set of questions. What are the business plans of the organization? How is it possible to derive the information requirements from these business plans? Given a set of information requirements, how can computerized information systems deliver the required information? And only then, is attention paid to the technical details of computing, hardware and software requirements, maintenance schedules, and their costs. There is a great need for awareness training: for managers, awareness of what the new generation of information systems can provide and the ways in which information can be used for planning, option appraisal, resource management, and many aspects of management; for investment managers, awareness training is required regarding procurement strategy, thinking first and foremost in terms of the business and corporate requirements, and only second about the budget for the computer department, and the requirements for computing specialists and IT staff. Awareness training is also needed for professional groups, including nurses and clinicians, in the existing benefits that can flow from use of information systems for clinical, scientific, and management purposes. Skills training is reauired for all those who are directlv _I involved in an 1 operational aspect of the information cycle, beginning with those responsible for data capture and input, and extending to those involved in collation, storage and retrieval, manipulation (including statistical
J.M. BRITTAIN
analysis of data), and in the various processes of communication and presentation of data. Even those who may never have direct ‘hands on’ experience of the new information systems - for example, general managers - may still require special training, followed by practice, in the various methodologies now available for the use of information for management purposes, for example, computerized decision support systems and expert advisory systems.
Background to the IMT (Information Technology) Training Strategy
Management
and
In consultation
with the Information Management Group of the NHS Management Board, the NHSTA (NHS Training Authority) committed resources to the development and subsequent implementation of a plan for systematic training in information management and IT within the NHS. With advice from a wide cross section of the Service, together with input from educationalists, professional bodies, and others concerned with information management and information technology (both within the NHS and outside), the NHSTA produced an ‘Information Management and Technology (IMT) Training Strategy’. The Service was consulted about the draft Strategy: all Health Authorities and Family Practitioner Committees in England and Wales were asked to comment. Feedback was assessed, and the IMT Training Strategy revised accordingly. The Strategy was launched into the Service in June 1989. The Strategy identifies: 1. Key target groups (e.g., information providers, information users, information managers, and IT and computing specialists) who need training. 2. Priority training and educational needs of each target group. 3. Methods of producing and delivering training. 4. The management of IMT training at RHA, DHA and FPC levels. 5. The recommended responsibilities of RHAs, DHAs, FPCs, NHSTA and other bodies. The Strategy contains an Action Plan detailing more than 40 recommendations about the ways RHAs, DHAs, FPCs and the NHSTA can implement a programme of IMT training and staff development. The NHSTA has already embarked upon implementation projects, aimed at helping and assisting Regions, Districts, and FPCs to implement their own IMT training programmes. A national database of training materials and training courses, eventually available to all Health Authorities, is being developed; work is underway upon the specification of the training needs of various professional groups; a major new initiative is being undertaken on the development of a portable training system for decision making for managers; and the training of nurses in operational settings is being undertaken. Health Authorities and FPCs need to develop their own IMT training programmes. A first priority is the nomination of a senior member of staff in each Authority as an IMT Training Coordinator. A manual of good practice for IMT Training coordinators will be produced by the NHSTA and made available to all Health Authorities. Each IMT Training Coordinator will take responsibility for the actions required to inaugurate and develop a local IMT training programme.
175
Training
strategy for the NHS
Factors to consider in IMT training programmes 1. Awareness training is required in order to alert potential users of information systems to the benefits and advantages of using computer-based information services, and to extend the horizons of those already involved in the information cycle. Awareness training for managers is essential. 2. Awareness training, however, is not enough in itself. In order to effectiveiy use information systems and apply the information that is derived from them to practical clinical, scientific, and managerial problems, a number of specific skills and competences are required. These can only be obtained by a training programme which includes practice. 3. Inform~~tion systems continue to advance and develop at a rapid pace, and hence there is an urgent need for continuing in-service training and retraining. 4. The NHS has not been in the forefront in the apphcation of computer technology to management information systems. Therefore new training programmes in IMT start from a relatively low base of skills and competences. 5. The number of staff in the NHS who need both awareness training and skills training and practice in IMT is large. Therefore, training methods and materials that do not involve taking staff away from their work for long periods of time are essential. 6. One of the most effective training methods in IMT is learning by doing, as part of normal day-to-day job activities. 7. A relatively modest set of skills and competences in IMT will ensure the uptake and effective use of the new generation of information systems. Relatively few skills and competences are required in order to have a major impact upon information management and information use. Therefore, the immediate requirement is for the training of the thousands of NHS staff who require this minimum of skills and competences. Once a continuing educational and training programme has been put in place, the specialist skills and competences required by each professional group can evolve and be acquired as a~~~lropriate, at a local level.
Conclusions The NITS is already paying the penalties for the absence of a systematic programme of IMT training. For the last decade this has shown itself in the inappropriate procurement and operation of computer hardware and software, and in the massive duplication and uncoordinated development of personal computing which involves thousands of standalone systems which do not interact with each other. These are the most tangible penalties. The technology for using information for managerial purposes is racing ahead quickly; the NHS has a minimum data set as a result of KGrner; the urgency now is to make sure that the information available is put to some purpose. The problems of using information for management purposes are much less palpable than the problems involved in capturing, storing and making information available. The use of information requires a heightened awareness of both management func176
J.M. BRITTAIN
tions and the impact of IT upon information provision and management decision making. Managers at all levels need to be aware of the boundaries that are being pushed backwards; in addition - unlike their predecessors they need a number of specific ski& and competences in using the new technology to good advantage. Otherwise, the introduction of information systems, and the use of their outputs, will be patchy and uneven; staff will be ineffectively deployed and although a number will muddle along, the gap between the potential and actual achievements will continue to widen. The NHS will fall further behind both the private and other public sector bodies in the use of the new inform~~tion technologies for cost-effective management purposes. The new information technologies are coming to maturity at a time when there is a completely changed view about the advantages and attractions of systematic and planned in-service education and training. Generations of managers - indeed, also clinicians and other professional groups - have been able in the past to get by with little or no involvement with information systems. This has led many into the false belief that the call for a better trained workforce in the field of IMT is scaremongering amongst a dedicated band of IT and computer fanatics. Undoubtedly, many of the most talented and capable will be able to manage for the foreseeable future without making use of the new information systems. However, all categories of staff are increasingly being asked to manage and deal with complexity. There will soon come a time when the majority of employees find their jobs are too complex to manage comfortably without the benefits of IT. It is preferable that staff come to this realization sooner rather than later, and that they are prepared for an increasing level of complexity by a relatively modest programme of continuing education and training in the IMT techniques and procedures that are most likely to help them in the next decade.
177