DOWN TO THE WIRE

Fear is one of the biggest obstacles to introducing change - in particular, people's fear of losing their jobs.

The sad truth is that this fear can become a reality if the process of change is not managed properly. Too often managers shy away from dealing with the impact of change on people's working lives. The result can be miserable staff and squandered opportunities to improve quality and efficiency. Of course, none of this need happen and, as always, the key is in the planning.

The introduction of computer systems into hospitals provides a good example of the issues to be faced and the way these fears can be overcome.

Many trusts are procuring major computer systems to meet the NHS's aggressive information technology modernisation targets. Typically they aim to replace a creaking mainframe and stand-alone and/or paper-based systems with a single integrated modern system to be used by thousands of clinical and clerical staff. If they select a system that works, the resulting organisational change will be massive and inevitable.

The benefits of new systems can broadly be divided into two categories: cash-releasing and quality.

Interestingly, the impact of poor planning on the two types of benefit is quite different.

Wards provide a good example of how quality benefits can be achieved.

In many hospitals nurses and ward clerks spend significant amounts of time answering phone enquiries about patients' whereabouts, ordering services and chasing test results.

These days most computer systems will track patient activity so that calls and documents can be sent to the right place. They will also allow orders to be placed in a fraction of the time required now, and give staff access to results as soon as they are ready.

The system will save significant amounts of time for clinical staff, but there is no quest ion of reducing their numbers. The time saved will reduce the stress on nurses and give them more time to care for patients. In addition, timely availability of clinical data will bring other quality benefits such as reduced length of stay and better- informed clinicians. The point is that these quality benefits will occur with or without planning.

Cash-releasing benefits are a different matter. Unless there is a planned reorganisation of services accompanying the system's implementation, the benefits may well not be realised. Worse still, failure to plan can lead to serious personnel problems.

Consider the clinic clerk who has a specific job such as booking outpatient clinics. The new system will allow many appointments to be booked directly by GPs or by other staff in the trust without the need for a phone call to the clerk. The result is that the clerk's workload will reduce in front of their eyes, as more and more people use the new facilities.

Unlike their clinical colleagues, a clerk's job is usually fixed. There may be no obvious productive tasks with which to fill the released time, and it will soon become clear to the individual that their job is at risk.

In such cases, staff who are dedicated to the NHS can find themselves in the impossible position of being asked to put their own or a colleague's job at risk by helping to implement a new system successfully.

Every job loss is personal and it is human nature to fight to keep those jobs. People soon unite behind the cause, and I have seen the situation spiral out of control, to the point of industrial action or a refusal to use a system. But all of this can be avoided through proper planning.

The first thing to realise is that the people on the ground will see the real benefits of a new system at a very early stage. I have often heard the phrase 'that is me out of a job, then' during supplier demonstrations. Existing computer systems are so awful that the savings possible through the introduction of new technology are completely obvious and impossible to hide. This means that you need to start your staff planning at the same time as your procurement if you are going to avoid problems. By the time the system is implemented, it is already too late.

Second, although there will be massive savings of time, most of these savings will be translated directly into improved services and patient care.

This means that although many jobs will change or no longer need doing, other jobs such as training, data quality and improved service-related posts will be created. It is essential that staff in obvious at-risk posts are identified as early as possible and given a clear understanding of what they will be doing in the future. Vague pronouncements about job security are not good enough.

Finally, there are likely to be some net job savings required to help bridge the dreaded 'affordability gap' (the difference between the cost of the new system and the ongoing costs of the systems being replaced).For the average medium-sized trust, gaps are running at about 10 to 20 whole-time equivalents over the lifetime of the contract. This saving will be documented in your business case and will rightly become public very early on. But it can be managed.

By the time the new system is procured, implemented and settled in, you are likely to get up to two years to prepare for these savings. During that time there will always be normal staff turnover, and their replacement should be planned in conjunction with any cash-releasing staff savings required. With foresight, permanent posts can in some cases be left vacant or filled with fixed-term contracts.

Usually, compulsory redundancies can be avoided entirely. If this is going to be the case, make sure that everyone knows. Also, introduce some examples as soon as possible so that people can see the words translated to action.

Remember that a decent system will reduce workloads, whether this is planned for or not. However, early planning and good communication will smooth the transition and remove very real and stressful problems for the people affected.

Markus Bolton is chief executive of a healthcare computer systems supplier.