Please hold, caller…

Communicating With Telephones Using Old Technology


NHS 111 is in the news again for all the wrong reasons.

Under-staffed, under-skilled, under-experienced, under-performing…all the old recognisable issues.

The report in the Daily Mail says that Ministers are demanding assurances there are enough staff for the service after reports that only one nurse was left to cover an area of 2.3 million people. The Royal College of Nursing warned that a “tragedy” could occur. According to the Sunday papers, tragedies are already occurring.

It is understandable that NHS managers want to protect the performance of the ambulance emergency services. We are all familiar with the business case for providing an alternative service for “urgent” cases, as opposed to the 999 service for “emergency” cases:

-reduce the emergency services time spent on non-emergency calls;

-reduce the response times for emergency calls; and

-make this critical emergency service more affordable.

But is it the concept of how the alternative is provided that is fundamentally flawed?

Would anyone chose a disembodied voice on the end of a telephone to advise at a critical moment in their existence, when at that moment the caller may well be stressed and fearful?

Perceived wisdom may say there is no truth in it, but there is a body of work* that indicates that any communication is made up of:
Body language 55%
Voice 38%
Words 7%

Based on this premise, the NHS 111 service can only ever communicate 45% of the whole, to callers whose anxiety levels are likely to affect their ability to make well-thought out decisions.

Add to this the “remoteness” of the operator (who are they?), which may well contribute to trust issues (are they unaccountable?) and the delays experienced (do they really care?) and you have a complete turmoil of emotions that is not helped by the telephone as a communications medium.

I don’t have any bright ideas for how else the service could be provided, but I’d be pleased to hear any suggestion you might have…

*Mehrabian, Albert, and Ferris, Susan R. “Inference of Attitudes from
 Nonverbal Communication in Two Channels,” Journal of Consulting Psychology,
 Vol. 31, No. 3, June 1967, pp. 248-258
 Mehrabian, A. (1971). Silent messages, Wadsworth, California: Belmont
 Mehrabian, A. (1972). Nonverbal communication. Aldine-Atherton, Illinois: Chicago

Excuses, excuses…

© Lori Martin | Dreamstime Stock Photos
© Lori Martin | Dreamstime Stock Photos

I’ve been having a “bit of a moment” over the last few months where the superficiality of leadership in business in general and government specifically has caused me lots of tutting and fuffing.

It’s finally dawned on me what’s bothering me and wondered if my conclusions made sense to anyone else?

I realised a while ago that one business driver in the health sector was the sheer complexity of information around the provision of health care now. The volume of data available to inform decisions is so vast and disparate that we cannot expect an individual to consider it all when reaching decisions about care journeys and pathways. When things go wrong it is always easy for others to point to yet another set of data which “should” have been considered.

Hence the growing traction of “expert systems”, that are attempting to assist front line staff in their decision making, and “management systems”, that are attempting to assist front line staff in…well, just keeping track.

But what sort of systems are available to our business and government leaders to help them to consider all that is under their jurisdiction and to keep track of it? Nothing…they are reliant on their staff to provide them with an objective view of what’s happening and they need to be asking the right people, the right questions…even down to what they are actually spending.

Now, in my experience neither of these things happen with any rigour, if they can be avoided, as it’s all takes too much commitment to basic information gathering and analysis, when there are fun things like self-promotion to be done.

The result of this failure to gather information is that whole businesses and departments can be so badly off track before those who are leading them have any idea that things might not be as they seem.

The reaction of the leadership and their staff is to spin the real reasons that the situation is so far out of control…shock, horror…thereby maintaining the status quo and protecting both set of jobs.

We’ve seen it in government departments and the private sector…in banking it seems to be part of a standardised cycle with fines every year. It is a useful technique to master if you are a business leader who wants to avoid being saddled with responsibility…

…the alternative, which seems to have fallen out of fashion is “the buck stops here”.

Pharming the Health Sector

I’m always wary when I see the words “NHS” “drug companies” and “partnership” in the same sentence. Call me an old cynic, but conflict of interest springs to mind. We are purposeful beings and there is a purpose to everything we do no matter how remote or obscure it might seem to others. Just as there are always two sides to every argument, one man’s meat is another man’s poison, etc.…there are always two sides to the coin:

Safety education for medical staff v converting more sales;
Promoting correct drug usage v converting more sales;
Encouraging economic medicine management v converting more sales.

© Alexey Lisovoy | Dreamstime Stock Photos

© Alexey Lisovoy | Dreamstime Stock Photos

The recent article by Margaret McCartney in the BMJ makes reference to medicine management programmes paid for by the drug industry, and of course such a well-researched piece caught my imagination.

Apparently, a 1995 parliamentary enquiry called for “greater restraint in medicines promotion, particularly soon after launch.”…which I must admit I read as “soon after lunch”…but then as I said I’m just cynical.

So, how have we arrived at the current position? I think it has to be because NHS staff value the services they are receiving from Pharma and Pharma are prepared to provide the services for the return on investment they are making. The basic business of supply and demand, then.

And what are the services that NHS staff value? It seems to me that medical staff are being provided with information based on data, often gathered from their own patient cohorts, which happens to indicate the need for increased/changed drug usage. The key here is that the data evidences the need and it is difficult to disconnect the statistics from the clinical decision-making process which is more subjective based as it is on skill and experience. It is hard for anyone to ignore information about a possible risk without worrying that that risk might occur and they would be “to blame”.

NHS Informatics groups already know what is prescribed, why, when, how long for and to whom. What is missing is the bit before and the bit after…the inputs and the outcomes, such as what did the patient present as their symptoms and when the course of treatment was over did they recover or is it on-going? There is much talk of the “Patient Journey” but in terms of information in the NHS we are a long way off joining the dots.

So, if the NHS was able to provide end-to-end informatics on drug usage e-prescribing solution could be developed and medics wouldn’t need to accept the drugs companies conclusions. Bearing in mind the complexity of all the factors that need to be considered these days when prescribing, it’s only a matter of time before this type of system becomes essential to protect the prescribers.

Perhaps Big Pharma could make an altruistic move and use the existing funding that they have already set aside for the creation of an independent NHS “drug squad” to review prescribing and ultimately to implement an e-prescribing system that works. could have been the NHS’s ultimate repository of patient data, making a useful contribution to the institution that provides care free at the point of use. Could we re-task them?

Rest In Peace

© Lisa F. Young | Dreamstime Stock Photos

© Lisa F. Young | Dreamstime Stock Photos

When I heard that the NHS was planning to add a “Death Plan” to patients’ records, I was pleasantly surprised that the management of End of Life Care and someone’s death wishes would be taken into consideration. We often hear that the NHS has no time, or that it’s soulless, leaving vulnerable people to die on trolleys but this is clearly not what the NHS wants nor anybody else for that matter.

I’ve had a Living Will for years now, which specifies everything down to the music to be played at my funeral and family reactions are varied. “Oh, listen…they’re playing your tune” has taken on a whole new meaning.

There is so much news today about dying with dignity and people fighting for their right to do so, that it seemed to me that the whole thing is down to the individual and what they want. It’s a fine line between choice and protection.

The Daily Mail says that patients will need to “sign here if you’re ready for death”. It makes a great scare story.

There are medical professionals who say it is ‘blatantly wrong’ and that it will frighten the elderly into thinking they are being “written off”. One expert said that the guidance was “the thin end of the wedge of assisted suicide”. But if you want to die at home, what can you do other than set down your wishes and sign them?

Some GP surgeries have been cold-calling their patient list to check what they want and have been condemned for doing so. This might not have happened when patients’ had a personal relationship with their GP; when they had more time, GP’s could find out what their patients wanted without appearing blunt. But let’s get over it…those days are gone.

As usual the real problem is caused by peoples’ approach…everything can be interpreted to suit the point of view of the interpreter.

Whilst I don’t want to give anybody the right to legally end my life, I would definitely chose peace and respect over brain damage and broken ribs.

Death Plan…good idea, better way to go about it…?

Skills for the Job?

© Lisa Turay | Dreamstime Stock Photos

© Lisa Turay | Dreamstime Stock Photos


On the drive to work my traffic stream was halted by a huge truck reversing round a corner into the tiny domestic driveway. I gazed at the scene without registering it…thinking about my day and what was waiting for me at the office.

Suddenly the scene snapped into focus and realised how amazing the skill of the truck driver was, reversing while turning 90 degrees, with inches to spare on each side, at some speed so as not to disrupt the rest of us for any longer than necessary.

I realised that the thought of making the same manoeuvre would have brought me out in a cold sweat, especially as it would have had to be performed in front of a host of impatient drivers cursing me for holding up their day.

Now, let’s be clear. I’m not a bad driver. I can pretty much get into any vehicle and drive it. I can park parallel or otherwise, although my concentration slips sometimes and I have done that thing where you set off on a familiar journey and on arrival at your destination, don’t remember how you got there.

The driver of the truck was a man (I’ve never seen a woman truck driver in the flesh, although I’m sure there are many, so please don’t get on your high horse) and that fact took me back to my early staff management training when my lecturer told me that men are better at some tasks and women better at others.

His reasoning was that the male/hunter brain was able to focus on a single task without being distracted by anything else, whereas a female/social brain was programmed to cope with many inputs at any one time. He was telling me this to justify his opinion that women are better at repetitive production line tasks and should be restricted to this type of work, but hey,…it was the 80s.

So, the truck driver can reverse with total focus, while I am programmed to be distracted?

Is this true? Surprisingly, according to the BBC research finds it may be so.

Whilst I believe that there is probably a continuum for brain performance traits with “male” and “female” at either end, I don’t think that all male traits are a male preserve and similarly for females.

Have women and men evolved to perform some specific task better than others? In a business environment which tasks would they be, then?

Lifeguards for the Tech Pool

The Tech Partnership? Never heard of them? If you have any staff who you class as tech-enabled then have I got news for you…

Tech Partnership Logo

The Tech Partnership is a growing network of employers, collaborating to accelerate the growth of the digital economy, and Quicksilva is a member along with the “great and the good” of the technical sector. Quicksilva is an SME, but we identify with the agenda of the Tech Partnership, just as the giants of our industry do…and you probably will do too.

We believe that for the UK economy to grow, the digital economy has to grow to drive it along…and we can all support this aim by:

  • Inspiring young people to embark on technology careers;
  • Improving opportunities for apprentices and graduates;
  • Developing strategically important digital skills; and
  • Raising quality and standards in education and training.

So, it’s about investing in the future? Well yes, that’s a huge part of it, but there are benefits being delivered to the Tech Talent Pool from day one…and everyone in our industry needs to be a lifeguard, safeguarding the life of that valuable Pool.

The Tech Partnership is the place to go for tech training and development support for your company. Match funding for courses is available now and it is there for you to help make a difference to your team.

I will be making use of this fund myself and I wanted all our contacts both private and public sector be aware of what they are missing out on. Ask me about it next time we are in contact, or…

You could just Join us

Cradle to Grave – the New Battleground?

© Robert Bayer |

© Robert Bayer |

It all started when I was on the Tube last week and a woman in her 30s gave up her seat to an elderly man on walking sticks, he thanked her and took the proffered seat…next to the child, whose mother didn’t think it necessary to get her little girl to stand for the man.

I suppose when you think about it, the question is “Does this show a lack of respect?”

From the mother, from the child? To me it seems to be the norm these days, in a Britain that is too cool to stand up (no pun intended) for what are now see as old-fashioned values.

In Britain in the 1900s, respect was demanded by those who held the power, money and status, but it was likely to be a sham respect, not earned by the actions or manners of the one demanding it. In the 1940s it was all about “being a lady” or a “real man”, and good manners earned you respect and “genteel” was something people aspired to. Following the levelling of society’s powerful and the upper classes in the World Wars, being polite and respectful developed a bad rap to be rebelled against and was becoming viewed more as “putting on airs and graces”.

Is it any different abroad?…probably not. There seem to be many people like me, stuck in the past, who don’t get the modern vibe around the culture of self, self and more self.

Showing respect for others these days seems to be a sign of weakness, almost as if giving respect selflessly, detracts from the giver in some way, maybe even making them look naïve or a bit dim.

Once respecting others becomes an act that attracts a personal cost, where do we go from here?

How about the case this week of the 6 care workers sentenced for ill-treating residents. The son of the abused resident said of the convicted “there was no respect”. The strong generations now having their day, seem to have little if any respect for older people, who might be viewed as just living longer and longer and using up resources that could be conserved.

What about those at the end of their life…often treated with indifference in the health sector as seen in its discredited use of the Liverpool Care Pathway and more recently in a new report claiming that hospitals continue to fail patients at end of life.

To take this to its inevitable conclusion…with the assisted dying legislation paving the way for an “acceptable” solution, and with respect for others on the slide, will we slip into a future we weren’t expecting?

The future “cultural war” to be waged is likely to be young v old, as the scary prospect of a world populated by millions of old people, who need care, but aren’t valued, overwhelms a generation who were never taught to respect older people anyway.

Sixties sci-fi at its most horrific.

Bullseye…or a shot in the foot?

© Andres Rodriguez | Dreamstime Stock Photos

The recent reports of A&E waiting times are an about face worthy of Alice Through The Lookinglass…”Shock 250% rise in patients waiting more than 4 hours in A&E: Six-month total soars by 146,000 – as Labour says crisis is worst in 20 years” from the Daily Mail.

Apparently, since the Government took over the “4 hour wait target” for A&E patients introduced by Labour in 2002, waiting times are supposed to have rocketted.

Not long ago, in the days of Labour, the Press were tutting over the fact that the 4 hour wait target was causing patients to be left in ambulances rather than being brought into A&E departments for the clock to start ticking…now it’s missing the target that is the issue.

The Guardian further explains that “NHS failed to meet four-hour A&E targets for past two months” and that 93.3% of patients have been dealt with under the 4 hours instead of the required 95%…and this is with 1 million patients more being dealt with than in a similar period last year.  Ahhh…that explains it then…there are just too many people presented at A&E…

The Scotsman seems to have it right with their stirring story “A&E patients told: If it’s not an emergency, visit GP” and quite right too. Its the worried well that cause prolems not only in emergency situations at A&E but also with England’s new 111 Service where the volume of call to this urgent number have brought down the systems.

If I was in A&E with a life threatening problem and the guy next to me was being treated for a cut finger as he was nearing the 4 hour wait target I’d be pretty vocal. Surely it’s the triage professionals that should be making the decisions about who is seen first? About who is emergency and who is urgent?

They could always install direct lines to the 111 Service in the A&Es for those who are fed up of waiting.




Darwin Strikes Again…

© Dana Rothstein | Dreamstime Stock Photos

I’m sorry to bring this up again after all the uproar has died down…but there are lessons for all of us from the Paris Brown affair.  I think Police Commissioners everywhere will be feeling the strain of this one for a while yet…but for the rest of us the worst may be yet to come…

As managers, we must be left with the unease that a member of our staff might cause our company name to be linked with the disreputable, damaging reputations and ultimately costing jobs.  Of course, this is covered off in company policy…but can we ever be sure that “one of ours” isn’t going to have their moment?  Is it our head on the block, too?

As employers, the recruitment scene subtley changed when social media became a source of addtional information about prospective candidates. Thanks Yahoo, you may have spoilt it for us by explaining to people that vitriolic tweets can catch up with them… and yet there are still people out there who appear not to care what impression they give and employers can manage to avoid them.

As parents, what if our precious offspring follow Ms Brown’s lead and broadcast their immaturity to the world…the world that you and they hope will one day offer them a living. How do you get over something like this?

At Quicksilva I usually say “Recruit for behaviours as you can always teach skills” and this is becoming accepted by more and more businesses as the competition for jobs increases.  It is sad to see so many young people who do not have all the skills needed to communicate in the workplace as reported in The Guardian.

So, once they have these skills, how do we teach them about the consequences of using them?




Legs 11 (1)…thoughts on the NHS lottery

It's a lottery out there...Don’t you just despair over the constant stream of NHS bad news? It’s like a lottery out there if you’re sick…
The main cause of recent Press hysteria is the NHS 111 Service…and yet reading the various articles there is no consensus amongst journalists about what really is the problem. Of course, there is “The Computer System”, that baddie from the sci-fi genre of the 50s and 60s. If you are my age you will recall that computers are violent towards humans and are looking to take over the world.
There is no grasp that today’s services are brought to us through many systems working together (or not) and in the case of the NHS 111 Service I imagine there to be Call Centre Systems, Triage Systems, Patient Record Systems…which has failed us? Or are we blaming them all?
The BBC talks about high call volumes. Is that the Call Centre system causing the long wait? Or is it the staffing levels?
While the Daily Mail sees the Triage System as possibly the main problem…or could it be that staff with only 10 days training, who are so desperate they admit “I don’t know what to do”?
Reports of IT crashes are common in all reports and maybe that was a reference to the Patient record System…or maybe not. Or could it be that as usual a Government project of this size is suffering from flawed planning, know-nothing procurement, poor project management and inadequate testing?
All of the above I suspect, the bigger-is-best policy wreaks havoc again, it never changes and it never will until leaner, meaner, providers are given the chance to prove themselves on Government projects.
I feel a twinge of sympathy for the solution designers as, having worked for years within Government, call volumes have probably been vastly underestimated. The NHS 111 Service is designed for “urgent” calls; the NHS 999 Service for “emergency” calls. However, if you give the public an easy option, they will take it…and hey, who wants to wait two weeks to see a GP?