Enter the CCG

You may recall from my first column in this slot that I’ve just been appointed clinical lead for informatics at Bedfordshire Clinical Commissioning Group.

Although the popular image of an informatics lead is of a doctor with his head buried in a computer, in my case it’s not turning out like that.

My work seems to be about communication and what is communicated, rather than hardware and software.

A little word about email

On the day I was appointed, the CCG’s chief operating officer asked – almost as an aside – “John, how can we get in better control of our email?” An apparently insignificant request – but one with huge consequences.

My first thought was purely technical – to label and file incoming emails using Outlook’s Rules – but this quickly gave way to a much more holistic approach, concerning the content and use of emails themselves.

It’s so easy to cause email mayhem. The simplest way of doing this is to habitually ‘Reply to all’, thus cluttering up dozens of other people’s inboxes unnecessarily.

More subtle – but very disruptive – is to send apparently simple emails (“Here’s the flier for our next meeting”) with the important information contained in an attachment.

This takes significantly longer for the recipient to open and read; and neither of you will find it easy to search for it later on using Outlook, because the information isn’t in the body text.

Another problem is routinely to include the entire email trail with every reply. Not only does this take up bandwidth, but from time to time you will find at the bottom a private set of emails containing some juicy comments that have now been broadcast to the world (“Will you reply to this idiot, or shall I?”).

And this is just the tip of the iceberg.

So, in response to my COO’s request, I wrote a short handbook, nattily entitled ‘e tiquette’, outlining the difficulties our email habits can pose, and giving a variety of simple ideas for creating emails that communicate crisply and neatly.

Its conclusion is interesting: getting in control of your email is a very altruistic activity. Success isn’t in your hands alone; instead it’s about how your high-quality email behaviour helps others.

It’s only when the majority of our colleagues adopt the same email etiquette that the tsunami of emails will finally subside for everyone.

The penny drops…

There’s an unexpected twist to this tale. How much time do you spend each day reading emails? An hour? In ‘e tiquette’ I suggested that good email discipline might save each of us 20 minutes a day. Wouldn’t that be nice? We could all chill out…

It took three weeks for the penny to drop. Wait a minute – what does that 20 minutes represent? It’s just under 5% of a working day.

If your CCG spends £10m a year on its staff wages then putting ‘e tiquette’ into practice could save £500,000 every year (or alternatively, give its existing staff 5% more time).

And that assumes a daily saving of just 20 minutes: how many staff – particularly high level managers – currently spend vastly more than an hour each day on their in box?

Suddenly, an off-the-cuff remark from my COO has turned into a CCG-wide project. Everyone will be asked to protect their colleagues’ time (and stress and sanity) by being more careful about their own email behaviour. The financial benefits alone could be immense.

High quality data

I have always felt that the NHS should adopt the very highest standards over handling information.

Practices need to know that the central CCG will never ask unnecessarily for data; that it will always treat data with respect and meticulous confidentiality; and that it will analyse data fairly and present the results honestly.

So with help from colleagues I compiled an ‘informatics manifesto’: a statement of principles about the proper use of NHS data.

I would like it to be adopted by our CCG – initially as an aspiration, later on as policy – so that if anyone finds that data is being requested or used contrary to ‘manifesto’ principles, they can cry “foul” and get the activity stopped.

The ‘manifesto’ covers a variety of subjects, including data acquisition, its analysis, and its use in relation to targets and standards.

This last area is close to my heart. I loathe the abuse of statistics. I hate it when clinicians or practices are judged using metrics that are outside their control.

This includes ‘red-rating’ a practice because too few of its new mothers breastfeed, or because parents decide not to have their children vaccinated. Why should a practice be judged on what is essentially patient choice?

I also detest the attitude that assumes that improvement is always possible; it’s so demeaning. We had an example of this recently, over A&E attendances.

Amazingly, during an entire quarter, just three patients from my own practice went to casualty when really they should have attended the surgery (pure luck, I assure you).

But, despite this near-perfect result, we were told that to get our Quality and Outcomes Framework points, the national regulations required us to describe three ways in which we aimed to improve in the future.

To say that I was incensed would be an understatement. Just how do you increase a near-perfect score? You can’t.

Fortunately, our locality managers and practice representatives were completely sympathetic, and helped us develop a set of suitably general responses that technically fulfilled the national regulations and got us our points – but what a needless palaver!

Proper use of metrics

This episode led directly to the ‘manifesto’s’ section on targets and comparisons. High on the list is a promise that the CCG will not judge individuals or organisations using metrics over which they have little or no control.

Also, that it won’t publically rank practices or clinicians in the absence of full exception coding; and that league tables will only be published when like is truly being compared with like. High quality will be acknowledged and further improvement will not be demanded.

May I fervently hope that all NHS organisations will ultimately adopt the ‘informatics manifesto’? It is ethically appropriate, statistically valid and above all, honourable.

About the author: Dr John Lockley is clinical lead for informatics at Bedfordshire Clinical Commissioning Group and a part-time GP.