Hancock’s digital revolutionBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3861 (Published 10 September 2018) Cite this as: BMJ 2018;362:k3861
All rapid responses
Re: Hancock’s digital revolution attitudinal and cultural changes will win or lose Matt Hancock's digital campaign
Samina Munir, Salford Health Informatics Research Environment (Shire), University of Salford, & Dr. Ruth Boaden, Manchester School of Management, University of Manchester Institute of Science and Technology (UMIST), audited the NHSIA ERDIProject on patients accessing their own records in 2001. Their incisive report clarified what the attitudinal and cultural changes were that the patients and NHS needed to adopt to move forward. Their report was tiltled “Culture and Change at The Hadfield Medical Centre" and is still valid today.
The report was commissioned as part of the ERDIP Patient Held Records, Modernisation Enabling Project at Hadfield Medical Centre (HMC), in order to document and analyse the background to the organisation and its culture prior to its involvement in the current project. The report endeavoured to explain the practice’s activities with respect to patient involvement, patient access to their records, and health information relative to the NHS Plan. This was achieved by examining the process of organisational change, the organisational structure, and the culture and leadership of the HMC. The report drew on empirical evidence from a variety of sources related to HMC, as well as a range of theoretical models which are used to present the data.
“Dr Richard Fitton, staff and patient volunteers at the HMC have worked hard to promote and to maintain the momentum of patient participation for over seven years. The focus of change has been emergent change – an open-ended and continuous process of adaptation to changing conditions and circumstances. The main aspects of emergent change are discussed;
• Organisational culture: defined as “the particular set of values, beliefs, customs and systems that are unique to that organisation” . Culture is shown through the basic assumptions that people work in a team, and each person’s skill and knowledge is valued.; people are considered to be very important and valued whatever they can contribute.
• Planned Change: an iterative, cyclical process, involving diagnosis, action and evaluation, and further action and evaluation.
The purpose of this type of change is to improve the organisational effectiveness of the human side of the organisation.
However, this approach has gained many critics over the years, arguing that ‘planned change focuses on top-down [change is led by managers who effectively ignore the needs of the bottom levels of the organisation], autocratic and rigid rule based organisations operating in a somewhat predictable and controlled environment’.
Emphasis is on incremental and isolated changes with the assumption that one approach to change is suitable for all organisations at all times.
• Emergent Change: The emergent approach to change views change as driven from the bottom-up rather than top-down.
Change is seen as an open ended and continuous process of adaptation to changing conditions and circumstances.
The process of change is regarded as a process of learning for all. This approach accepts that many organisations are faced with changing environments and turbulent circumstances and considers these in its approach to organisational change.
3.2.2 Levels of Culture
Many different and varied models describing organisational culture are available. Of these, a model was chosen that best reflects the purpose of this report and best describes the organisational culture at the HMC. This model is that of Cummings and Huse (1989), who describe culture as 4 elements existing at different levels of awareness within any organisation. These levels are:
1. Basic assumptions, New assumptions - patients have brains, will and friends and are the only person to attend each health intervention that effects their health
2. Values, New values – The patient and their social network as a literate, activated co producer of health
3. Norms, New Norms – Patients have use of their records and can contribute to them and navigate them through their service attendances
4. Artefacts – mobile and communication technology and their own personal health data
Competing interests: No competing interests