Time to Prioritise Technology

Of course, the expansion and improvement of services ought to be the top priority of our health system. It’s when the achievement of that priority is portrayed as synonymous with protecting and increasing the number of front line staff that I would shout- STOP, writes Denis Doherty.

Denis Doherty
Denis Doherty

On a recent holiday trip with Aer Lingus, I experienced how investment in technology, or lack of it, can enhance or diminish the service users’ experience. We checked in online for both journeys. At Dublin we used the self-service facility to drop our bags. It took only a few minutes, did not involve any queuing and was simple to use. It requires only a few front-line staff, to provide customer support or solve problems.

The airport at Las Palmas is large and modern but the task of transferring bags from passenger to airline there is tedious and inefficient. There was about a thirty metres long queue in front of two check- in desks allocated to our flight. Passengers for an internal flight leaving before ours were also being checked-in at these desks. As closure time for the internal flight approached, one of the check–in staff walked the line inviting passengers for that flight to go to the top of the queue. Close to the desks there were signs, obscured by the queue, intended to facilitate passengers who only needed to drop their bags from those who also needed to check in. By that stage, a common bond had formed, and we were all intent on not being herded. The check-in staff had no interest in herding either.

It would be interesting to observe what the effect would be if outpatients and those awaiting elective procedures were afforded the facility of managing their bookings on line.

Clearly, Aer Lingus does not have the volume of traffic at Las Palmas that could justify the type of technology-assisted check in facility they have provided at Dublin airport. Airlines now outsource ground-handling services at many of the destinations they serve. That results in the less progressive airlines having an undue influence on the extent to which investment is made in areas that enhance the customer experience through greater efficiency.

There are many examples of how investment in technology has contributed to improvements in our health services. The potential of technology to drive the efficiencies and quality improvements the latest version of reforms aims to achieve is enormous. The altered public system will only succeed if the lessons of past experience of resistance to change are learned.

One of the principal reasons why the cost of PPARS and the financial support system increased so much was due to the inability of employers, staff and their representatives to agree to adapt systems & procedures in order to exploit the capability of the IT system involved. Instead the IT system had to be adapted, at prohibitive cost, to perpetuate systems, procedures and practices that were outdated, cumbersome and administratively very costly.

The public healthcare system ought to be able to demonstrate that access, standards, costs and outcomes are comparable across the entire system. That will only be possible if the role of technology is understood and prioritised as a key feature rather than as an optional extra. It is now accepted that ongoing investment in our public health system is needed. Part of that investment can be achieved by changing the profile of the workforce by investing in technology in areas where it can support better administrative, managerial and professional practices. It would be interesting, for example, to observe what the effect would be if outpatients and those awaiting elective procedures were afforded the facility of managing their bookings on line, in the way airline passengers can manage their bookings on line.

Investment in specialist staff, facilities, equipment, and technology are essential not just in the initial phase but also on an ongoing basis.

The recent flights with Aer Lingus were comfortable and on schedule. The Aer Lingus fleet consists of modern aircraft equipped with the full range of modern aircraft technology. Modern aircraft, high technology as standard, and fully trained and regulated flight deck personnel produce the very high safety standards of modern air travel.

Should equally stringent standards not apply to hospitals? If they did, overcrowding would not be permitted, equipment and staffing norms would be specified and only doctors who met specified qualifications could practise as Consultants.  If introduced soon, restrictions of that nature would give rise to significant practical problems. That’s a good reason to accelerate the pace of reforms that have been accepted as necessary. Imagine what the reaction would be if instead of being able to travel with airlines of the high standards of Aer Lingus and Ryanair we were restricted to a choice of airlines that could not demonstrate comparable standards of aircraft, equipment, staff and safety records!

Fifty years ago, this year, the Fitzgerald Report was published. Sadly, it quickly became a political football that is still in play. Had it been implemented, the likelihood is that our hospital network and the individual hospitals in it would be better resourced and would still be fit for purpose. There are reasons to be hopeful that rationalisation and streamlining of hospital services may be implemented in the not too distant future. The cancer services project has shown that it is an approach that has achieved measurable benefits quickly and may be capable of being successfully replicated in many other areas.

Investment in specialist staff, facilities, equipment, and technology are essential not just in the initial phase but also on an ongoing basis. It requires a commitment to avail of updates in hardware, software and the up skilling of staff. It also requires an approach that embraces new developments in areas such as computer assisted diagnostics and the use of robotics on a par with how the airlines adopt new technologies in their industry.

We need to move beyond the mantra of ‘protecting front line staff’ by affording equal priority to investment in the latest technologies that will enable front line staff to function at the level they are capable of. A consequence will be better outcomes for patients as a result of Irish hospitals becoming better at attracting and retaining top quality health professionals.

Credit is due to the cross party Oireachtas Members who drew up the Sláintecare Report. The next test will come when all party support for the implementation of the proposals in that report will be called upon. We regularly highlight the presence of so many leading IT companies in Ireland in promoting inward investment here.  That cause and all who use our health services would be the beneficiaries if we were to position the use of modern technology at the heart of the reforms and increased investment that are promised in Ireland 2040 – National Planning Framework.