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?

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

The Big Bang for Girls

It has always been a male thing…adolescent boys hunkered down in their dim, fetid bedroom fantasising about computer generated heroes…no interpersonal skills and no hope of a girlfriend. Why is it always boys? When does it start? Why do they always seem to “get” IT?



At the risk of upsetting our female readers, I suppose most men like gadgets and geeks just take this to the extreme becoming the early adopters in society. To turn this around then, they are smart, aware and engaged with technology.  This is a stereotype that girls just don’t seem to enjoy, either as potential IT users themselves or by having geeks as friends.

In the mid-2000s, Geek Chic became fashionable and there was a slight surge in girls wanting to look nerdy.  TV programmes like “The Big Bang Theory” though, have done nothing to encourage girls into technology as they portray girls in the industry as plain, desperate and un-dateable.

But girls are missing a trick here, as research by eSkillsUK, the sector skills council, shows that 1 in 20 of the total UK workforce is employed in IT…jobs in the sector are growing nearly 5 times faster than the UK average…over half a million new entrants are needed to fill the jobs over the next 5 years.

Over a number of years eSkillsUK have made inroads into understanding the psyche of young girls, finding that 11-14 years old is where their interest in IT gets closed down.  Whether this is down to the school syllabus, the subject matter or purely down to the scarcity of other girls in IT to relate to, is up for debate, but eSkillsUK have tackled the problem on all fronts.

The first indications that female students are beginning to show an interest in Information Technology were probably missed by most of us, but figures released this week by the Joint Council for Qualifications show that more girls in total took the ICT GCSE qualification this year: 38,608 in 2013, compared to 32,994 in 2012.

Girls have also excelled from an achievement perspective: 30.9% of female candidates achieved an A* or A grade, compared with 23% of males. But less of the male ego bashing, the ICT entrants as a  whole did well, since only 21.3% of all GCSEs receive an A* or A.

ICT GCSE entries have risen by 25% in 2013, with 87,788 candidates sitting the exam this year, compared with 70,420 in 2012. This is the first time since 2005 that the number of candidates has increased.

While there is a long way to go, if you believe as I do that the IT talent in UK plc is worth developing because its output is likely to drag us out of recession, give a girl geek a pat on the back.