Intended for healthcare professionals

Letters What went wrong at Addenbrooke’s?

Problems at Addenbrooke’s caused by failure to implement electronic patient record system effectively

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5721 (Published 27 October 2015) Cite this as: BMJ 2015;351:h5721
  1. Stephen Black, data scientist1
  1. 1Biggleswade, UK
  1. steve.i.black{at}gmail.com

Most commentators agree that NHS hospitals face mounting pressures. But these don’t explain the sudden emergence of problems at Addenbrooke’s Hospital. And Keith McNeil’s interpretation of management grip as Stalinist control suggests that he doesn’t understand it either.1

McNeil’s philosophy of empowering clinical teams, with the support of IT, to raise quality and efficiency is surely correct because sustained improvement comes from bottom up changes.

McNeil’s failure was not adequately translating his vision of an eHospital into an effective implementation of the new Epic electronic patient record, and not recognising quickly that the implementation had a disturbing number of serious problems. We know this was obvious on the ground very quickly. Emergency department performance fell off a cliff the week the system went live. Many of the medical staff across the hospital were worried that the system wasn’t working properly and that nobody in a senior position wanted to admit it.2 To achieve his vision McNeil needed a good grip on operational reality; this was clearly not present in the implementation plan or after the system was rolled out.

Visionary plans don’t work unless they are backed up by a detailed understanding of the operational reality for all the staff on each ward and in each department. It was a failure to achieve this “grip”—not failure to implement a Stalinist bureaucracy—that brought down McNeil.

Notes

Cite this as: BMJ 2015;351:h5721

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