To Inform, We Need to Enable

Pritpal S Tamber

August 1, 2012

Why information is not enough to change practice - change also needs to be proactively 'enabled'

Last week I witnessed how information can scare the living daylights out of doctors and managers, and made me wonder whether England’s policy-makers have any clue about the real world of its National Health Service (NHS). It started at a fascinating meeting at which a tech entrepreneur was demonstrating a tool that enables localities to better understand specific biometric data in their populations. He’s enthused because, as a general practitioner, he sees the tool as a way to identify “outliers” that may need early and/or aggressive intervention. Such people may not have visited their GP in years but the tool has the potential to extrapolate historical data, in a clinically-robust manner, and suggest citizens to seek out and assist.

An effective way to use this kind of tool is across a locality because it means identifying more at-risk patients in one go. The people he was demonstrating to understand managers and clinicians that work at that level; they have a clear sense of their problems and what would interest them.

Despite the obvious clinical value of the tool, however, our audience worried that no one would ever want it.

Why? Because it not only helps you see the problems you know you have, it also identifies new problems. They were clear that the last thing anyone wanted was a tool to make their lives tougher than it is already.

I had predicted this response. People want solutions, not something that tells them their problems are bigger than they thought. The entrepreneurial GP, however, was surprised and more than a little disappointed. He’d assumed that the ability to find patients at risk would have been of interest to any clinical body. I think it’s fair to say that the tool would be “of interest” to localities but without resources – including training – the tool is only likely to deflate already-stretched teams.

I call this “inform-and-enable”, and all the political rhetoric about the revolutionary power of information seems to say little about the latter.

Later in the week I was in the “patient participation group” of my local practice. We were reviewing the text proposed for the new practice leaflet and one of the patients – a journalist – was slamming almost every word of it for being medical-speak. It was too delicious to simply observe so I joined in. “What”, I asked the other patients, “is a DRCOG?” One guessed, the others looked blank (I wasn’t sure myself). “What”, I continued, “is an HCA?” No one knew. “And who”, and this was my favourite, “was Harmoni?”

It turned out that Harmoni was the local out-of-hours service, the organisation patients should call when the practice is closed. The GPs were so used to it that they used it throughout the proposed text for the leaflet but to patients like me it’s just jargon. It also turned out that practices have to list the qualifications of their general practitioners, hence the listing of a DRCOG (Diploma of the Royal College of Obstetricians and Gynaecologists), but the journalist and I agreed that there was little point in listing the acronym if it meant nothing to the average patient. In fact, the GP it was listed against was also listed as having a specialty interest in child health, not obstetrics or gynaecology, which was even more confusing.

Getting a practice leaflet right is about understanding what patients need and want to know, and then delivering it in a format that communicates. It’s not easy. You’re effectively designing information to get people to act in the way you want. At the same time, just being able to design information, such as enabling a locality to understand biometric data across a population, does not mean you’ll get the “right” response.

There is a chasm between political rhetoric and the daily reality of how the NHS uses, or could use, information. I can’t help worrying that it’s because it’s easier to reflect on the “power of information” than it is to truly understand how new information can or should influence behaviour. For a start, frontline clinicians and managers need help to get the basics right, such as practice leaflets. It’s only when we master the basics will we ever want tools that show us that our problems are bigger than we thought.

It’s only if we enable can we truly inform.

Competing interest: I am working with the entrepreneurial GP to define how his tool can be used by primary care localities. I also offered to help my local practice overhaul their practice leaflet but only if it was aligned to the practice’s annual clinical strategy.

This post was first published on my original blog, Optimising Clinical Knowledge, and co-posted on BMJ Blogs.

Pritpal S Tamber

I’m a doctor who trained as a medical editor and publisher and now researches and consults on the link between community power and health equity. My interest in community power started when I was the Physician Editor of TEDMED and is explained in My Perspective. I also work as a freelance medical editor and publisher for organisations that want to write high-quality articles and a strategy for their publishing and promotion. Find out more on my About page.

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