I think I’m probably a ‘knowledge worker’. I didn’t know anything about being a knowledge worker until I got a new brilliant boss who has the brain the size of a small planet. Once she got to know me and how I did my work she told me I was a knowledge worker and one who capitalised on networks, building relationships and connecting people. The work on knowledge workers and the role in how we organise work is quite interesting but it isn’t the focus of this blog – if you want to read a little bit more then there is a link here to work by Rheinhardt et al (2011).
One of the downsides of being a knowledge worker, along with the need to be up on your game at all times, is it can be quite lonely – you sit at the edge of most groups; your role is to move around and bring and take knowledge. It’s true that I am often not a central member of a team; I move in and out and hopefully add value along the way.
Working as a nurse in informatics means that my role is often to act as a translator between IT folk and nurses; I have to have enough knowledge to be able to explain the perspective of the other group and work hard to bring the groups together, as I know that if people from technical backgrounds work more closely with the clinical and patient communities then the success of any project is more likely or it is more probable that a better solution will be found. It’s also a bit like a facilitator of co-production! If you want to know more about this I recommend this video. The need to see it from both sides is essential and the knowledge worker uses knowledge to facilitate learning and understanding from both perspectives.
Unfortunately in informatics it leads to seeing both the best and the worst of people. Over the last few weeks I have become frustrated by how people blame others about lack of progress. I have worked with some brilliant IT people; clever, caring and dedicated to working to make health services better, their drive to do the right thing sometimes shocks me, even now after 10 years of working with them. Clinical staff are not the only ones who care. Of course nurses are like this too, most nurses strive to do the best that they can and improve and I have witnessed this many times in the last 30 years.
Why is it then that I still hear one group blaming the other for a problem?
- ‘The IT staff don’t understand us and what we do!’
- ‘IT just give us the kit and walk away – they never listen’
- ‘The nurses are not interested in IT really because they will never engage’
- ‘Nurses never come to our meetings’
What I see is that all these things are true. But there is a risk that if we continue to blame we fail to recognise that the single most important thing that we need to do is learn to work productively together; for nurses that means making the IT folk your friends and listening to their ideas and plans and for the IT folk, it’s respecting nurses and helping them to understand the potential of IT. Why not go out with a district nurse if you want to understand or get down onto those wards?
The boundaries that seem to exist are not real but I am getting exhausted climbing over the wall between nurses and IT!
So my piece of knowledge that I’m trying to share is that if we are going to innovate using technology the relationship between clinical staff and technical staff needs to change to one of partnership, mutual respect and trust. It’s the only way we can do this.
PS Shhhh: Dear nurses – I always find that cake is helpful when you want to have a difficult conversation with IT 🙂 I make a mean Victoria Sponge 🙂 
anniecoops 
Annie,
I think part of the issue is the silo mentality of many organisations – everyday experience of both parties is not routinely shared or communicated only if there has been a critical event or failure (then blame gets involved). That everyday conversation about practice would help both parties to understand each other and the limits that both parties work under. Are there regular meeting with IT and ward staff to review what’s going well and what isn’t? Is there a role for a designated iT specialist nurse on each ward – someone who can keep staff up to date about the latest developments or could a member of IT staff be deputed to visit wards and become more familiar with both the working of the ward and their face become familiar to ward staff?
More and more I hearken back to my academic days and the concept of Communities of Practice as a base model to examine and ‘play’ with organisational structures. Boundary spanners are a given in such models – and all within that community of practice can be boundary spanners in one way or another. However this means that ‘traditional (read institutional barriers) have to be first recognised and then changed. Silos don’t let boundary spanners to work effectively but other structures do.
Cop’s aren’t about websites (I was recently told that someone’s organisation was a COP because it had a website!) but about the people inside the organization sharing practice – ie communicating (ward meetings, observing practice, even just talking over coffee about the working day) . It is simply a matter of open, effective and timely communication with both parties able to listen, and translate it back into practice.
Thanks for that Mandy – I agree but also only to a point. It is equally the responsibility of individuals to seek to understand and take responsibility. Leaders should be finding ways to resolve problems and not just blame others. Yes, its about silos but its also about people and respect.
Like you Anne I work in clinical informatics leadership and my small clinical change team have been successful in delivering clinical change using technology. I attribute this to working closely with IT and being more agile in our approach to develop systems based upon clinical need. Projects that are too prince focused are often to inflexible and by the time they deliver NHS services or structures have changed so they are out of date and no longer fit for purpose.
Hi
Great post!
The ‘working as a translator between clinical staff and IT folk’ resonates; this role seems to be essential to the progress of a project. My experience has been that this ‘translator’ role is not assigned to a particular person, it emerges as someone happens to have this understanding and more importantly is prepared to use it to help both parties understand. Without this ‘will’ then the progression of the project is hampered and the ‘blame’ stuff starts to creep in.
Rose, I tend to agree with your point about the formal structure of particular ‘project management’ structures; there does need to be flexibility and agility afforded when developing systems to support clinical practice. It can be the difference between the project output being ok and being great. It links into the ‘translation’ and the seeking to understand – it might not be right at first and it should be ok to refine and develop – not being deemed as having to suffice as the impact on the timescales of the project is more important.
Re the Victoria – do you weigh the eggs?
No weighing involved 🙂 they are from my own hens too 🙂
Annie,
I think the crucial fact here is organisational structure – IT ‘take their orders’ from elsewhere other than the clinical front team. The clinical front team probably see IT as ‘another dept’ . The historic nature of hospital organisation breed those walls. The only place that I have seen where IT & clinical needs meshed was back when I was working in SCBU back in the day. The technician actually had *her* – if I recall correctly – workshop next door to the ‘going home’ nursery. She was involved in maintaining the computers / screens / data banks and was accepted as part of the team. The closeness made for excellent team work.
As I have said many times before – nursing depends on information (in whatever form it comes in) surely it makes sense to decentralise the IT dept so that the information specialists can see and be seen as part of the overall clinical team – even if they are not clinicians themselves.
Great Blog Anne. Oh how I wish everyone would see the value of others in the contribution to achieving a goal. I recently observed a senior management team at a workshop on Team Work. They had all had 360 feedback and one of them was surprised when her manager had said she had little impact on pt care! surprising you would think, but she actually said ‘why would I, I am not on the front line’!!! very curious that she didn’t recognise that her whole reason for being in the role was for the delivery in excellent pt care and her contribution was critical to the overall service !!
My motto, ‘no such thing as a free main’ – if there is a problem don’t blame others – deal with it.
have a great day.
Fab blog Anne (again!) I feel your pain. An eternal frustration of mine. Across all divides and boundaries. My question is always, “So what can you/we do about it?” Blame is ultimately an abdication of our own personal responsibility. It is when we look to ourselves as a starting point we achieve positive change.
Morning Irene. Thank you for commenting again 🙂
I agree and I think you will like the work of Bridges – there is a link in the blog em to more of his work. X
All you need is #Love. | theDistractionChair
Great blog – the key to successful implementation of an electronic record keeping system in a Children and Young Peoples service was the appointment of a clinical lead and engagement with the IT Department from the helpdesk to the Head of service. As the deployment progressed so did the involvement of these key partners. Collaboration not blame is the key.
Great example Angela! Thank you