Training and elearning

How health-informatics practitioners in England’s NHS view their personal and professional development

Pam Hughes, Policy and Customer Manager at the Information Centre for Health and Social Care and ASSIST National Council Secretary, reports on her recently completed study.

Use of computers and information systems in healthcare over the last 30 years has developed significantly, and in 2001 at a Medinfo world congress the domain was expressed as “concerned with the systematic processing of data, information and knowledge in medicine and healthcare”.(1) Healthcare informatics supports the delivery of healthcare, and its scope includes the knowledge, skills and tools that enable data, information and information systems to be used, managed, and shared in healthcare. Health informatics is an emerging profession, whose practitioners, also called healthcare informaticians, were defined by the Department of Health in its October 2002 human resources strategy Making information count(2) as:

• healthcare records staff;
• knowledge-management staff/ librarians;
• information-management/ analysis staff;
• information, communication and technology (ICT) staff;
• senior managers of these areas; and
• clinical-informatics staff.

Drivers of professional development

There are drivers for encouraging healthcare informaticians to undertake professional development to improve their performance, and some of the more relevant ones are discussed. Professional organisations There are several types of organisation involved in supporting health informatics practitioners. There are professional associations or organisations; organisations empowered to award an individual a ‘chartered’ status, which may also be known as learned societies; and there is one regulatory body. Many of these engage in activities to support the drive towards creating a recognised health informatics profession.

Pay modernisation

In 2005, the NHS implemented a pay modernisation system for all employees (except doctors) called Agenda for change.(3) This has three strands, which look at: pay reward for job role — job evaluation; the knowledge and skills an individual requires to perform in a role; and terms and conditions of employment. The second strand is supported by a skills framework known as the NHS knowledge and skills framework and the development review process (NHS KSF).(4) One of the purposes of the NHS KSF is to “support the effective learning and development of individuals and teams — with all staff being supported to learn throughout their careers and being given the resources to do so”.

Drivers outside the NHS

Government and the ICT profession are collaboratively and actively pursuing a ‘professionalism’ agenda in 2007/8. Led by the Cabinet Office, the Government IT Profession programme,(5) covering all public-sector ICT staff, aims to define ICT professional competence by the creation of new or revised competence frameworks and to increase ICT capability and capacity as a result of using these frameworks and tools.

This context provided a starting point for the study. Individual practitioners working for and with NHS organisations appear to want to support the drive to become a recognised profession and recognise the implications of this.

The study

This aimed to uncover the views and approaches to personal and professional development among healthcare informaticians in more detail and to explore the factors that influence their personal, career and development choices in order to understand them better. With this knowledge, recommendations can then be made to inform the delivery of the necessary professional development interventions that are currently predominantly led by professional associations, education providers and NHS organisations.

Method and approach

A literature review yielded little of significance. Most of the studies that were found concluded with advice about what the educational programmes or interventions content should be, but did not establish how health-informatics practitioners might view either the content or the proposals for delivery. A few relevant qualitative studies were found, however, and appraised.

Qualitative methods — survey and interviews — were used. The focus was to look at behaviours and actions resulting from knowledge (or lack of knowledge) of participants in the study cohort. Bias and the researcher role were important considerations within the design of the study, and the application to COREC (now the Research Ethics Service) showed how these would be managed. Approval was granted in July 2006.

The survey was designed and piloted in June and July 2006 and went ‘live’ on the Internet on 7 August 2006. It was available online until 15 January 2007. A total of 56 responses were received; 41 from the website and 15 by post or email.

Four of those from the website were duplicate submissions; 52 responses in total were analysed. Of 37 returns from the website, 12 respondents did not wish to be contacted for interview. Of the 25 remaining web surveys received, interviews were scheduled with 10 respondents. By 15 January 2007, seven interviews had been conducted, either by telephone or face-to-face. Three interviews were scheduled and rescheduled, but did not take place.

Use of soft systems methodology

Soft systems methodology (SSM) — the work of Peter Checkland — is a structured way of analysing systems and human interactions with them.(6) The steps in this methodology follow a logical route from investigation of the problem through to how the data can inform improvements, see figure 1.

The study cohort was asked about barriers preventing them from undertaking personal and professional development. SSM suggests looking at relationships between ‘bodies’ involved in the problem being researched, and I used ‘relationships’ and ‘barriers’ as a means of linking healthinformatics practitioners with organisations providing education interventions. The final steps inform solutions and recommendations. The ‘rich picture’ is a schematic of the current position found within the research data — see figure 2. Steps three though to five of SSM show how to move from the current position through analysis of data provided and by use of a conceptual model.

Conceptual models are used to compare and contrast what an ideal situation would be, and inform solutions that move the study subjects from their current position to an improved one.

Results

Potential solutions

There were six potential solutions found from this compare-and-contrast exercise. These are:

1. to consolidate the activities of the professional organisations. By combining resources and membership, the impact of the activities may be greater and confusion amongst members will be reduced;
2. to promote greater awareness of the role of the informatics function in healthcare delivery, which will lead to greater demand for valued expert specialists — who require top-quality education, training and development (based on national standards) to maintain their contribution to the delivery of healthcare services;
3. to remove the need, perhaps temporarily, for professional regulation, which does not appear to be valued by employers. Also, regulation appears to be not fully understood by practitioners, and it is not a priority activity whilst it is still not compulsory;
4. conversely, to promote the need and to accelerate professional regulation, introducing accountability and barriers to entry to the profession. This should be a gradual process to move from the current position to one where all practitioners are validly registered with a recognised professional body;
5. certainly the analysis in this present study indicates that a recognised career pathway with standard development routes and programmes is required. Nearly every participant in the study made a comment to support this statement; and
6. funding is a recognised barrier to further education in many professional areas. If there was a way to provide a substantial sum of money for education and training centrally that would be valued by employers, this would create a ‘gold standard’ health-informatics practitioner. This might then help to encourage those who are keen to learn but are blocked by a financial barrier and might also incentivise those who are currently not motivated to develop.

Everyone participating in the study reported needing a little more help than they have now, so to continue as now — with disparate activity, hoping the brightest health-informatics practitioners will rise to the top — is not a solution.

Summary of recommendations

1. Define personal development and professional development, and the value/importance of each;
2. help health-informatics leaders to understand what professional accountability means and how professional development underpins competence and behaviours. Use this as a driver for (voluntary or compulsory) regulation;
3. consolidate the activities of the professional organisations into a ‘federated service’ to capitalise on the value of all parties and maximise results from the resources available (volunteers and money); and
4. provide recognised career pathways with standard development routes and programmes.

Conclusion

The most important finding from this study is that a combination of a recognised educational pathway or ladder that health-informatics practitioners can follow through their career together with supportive and credible leaders will not only make a great deal of difference to the quality of health informatics staff in terms of their work-based outputs but also to their morale and their approach to their professional development.

Pam Hughes, Policy and Customer Manager, The Information Centre for health and social care and ASSIST National Council Secretary.

References

1. Patel V, Rogers R, Haux R, eds. Conference proceedings of the 10th world congress on medical informatics: studies in health technology and informatics, volume 84. Amsterdam: IOS Press, 2001.

2. Department of Health. Making information count: a human resources strategy for health informatics professionals. London: Department of Health, October 2002.

3.Department of Health. Agenda for change. www.dh.gov.uk/policyandguidance/humanresourcesandtraining/
modernsingpay/agendaforchange/fs/en  [accessed 17.04.07].

4. Department of Health. The NHS knowledge and skills framework (NHS KSF) and the development review process. London: Department of Health, October 2004.

5. Chief Information Officer. Government IT profession. www.cio.gov.uk/itprofession/  [accessed 17.04.07].

6. Checkland P. Systems thinking, systems practice. Chichester: John Wiley, 1981.