Editorial

Editorial

Article Type: Editorial From: International Journal of Health Care Quality Assurance, Volume 29, Issue 6.

Are we gardeners or mechanics?

Gardening is good for the soul, but it also tells us a thing or two about healthcare. In this issue, we have a number of papers that point to the need for the patience of a gardener and the skills of a mechanic.

Sahoo et al. outline what was for me, a new concept; that of the healthscape. Although a manufactured term, it neatly encapsulates the hard and soft features of the healthcare landscape. The authors provide a very nice history of the concept before going on to apply that concept to the provision of private healthcare in India. But, as with all applications of a theoretical model, there is learning to be shared across the health sector, regardless of payment models. On the other side of the world, but again dealing with the working environment, Ford et al. examine the rollout of electronic patient records and the effect on patient safety culture. Like all new technologies, the EHR was, and is heralded as the tool that would make all of our lives better, but as the authors point out, there has been a lack of empirical evidence to support these claims. In their investigations, the rollout (or meaningful use, another new term for me) is not always associated positively with the perception of improvement in patient safety culture; whilst the figures had, in fact, improved. In addition, they suggest that it is the use of the tool and the culture combination that is important. When reading manuscripts like this, I am filled with the desire to make mandatory the enrolment of senior healthcare managers and clinicians in practical training courses in horticulture.

Guimaraes et al. go further, and find that the rollout of electronic tools to assist in the delivery of healthcare can be impeded by conflicts that arise in such rollouts; mismanagement of such conflicts can lead to poor use of these expensive tools. They discuss the tensions between using experienced technologically – adept nurses and technologically – naïve nurses in maximising electronic system usage.

Anyone following the bitter and divisive employment negotiations (or lack thereof) in the NHS in England might want to arm themselves with the findings of Ozyapici and Tanis, who compare resource consumption accounting with the more commonly described traditional costing system. Healthcare costing always elicits emotive responses, and the concept of idle time can make healthcare economists very troubled at times.

Variation in practice is nothing new to us in healthcare. Indeed, as an editor, were there no variation in the provision in healthcare, one wonders if there would be a need for a journal like this? So maybe, despite my railing against variation, perhaps Keith and I have a vested interest to declare? But I still like my airplanes to be serviced in a standardised fashion and I like my books to be laid out using the same font throughout. If I were to be sick enough to require total parenteral nutrition, I would like it to be delivered in a standardised fashion as well. When we are sick, we transfer the responsibility for our nutrition to others and the sicker we are, the more we are dependent on others to ensure we are getting what is one of the basic elements of survival in a controlled and standardised fashion. Katoue et al. in a refreshingly simple but thorough study identify variations in ordering and labelling of parenteral nutrition products across hospitals in Kuwait.

On the other hand, using standardised appointment times can lead to some waste in valuable consultation time in primary care. Doing a "time and motion" study in primary care led to some very interesting findings, when simulation modelling was applied. Yu Li Huang tells us that provider preferences must be built in to overarching system architecture to all for maximum effectiveness. In their study, the lack of such customisation time can massively increase patient waiting time.

To ensure effective customisation, we have to consider the gender lens – cancer care can be challenging at the best of times but in such a specialised area, we must always review how we do things. Olsson paints a picture that should encourage us to be mindful of the care we deliver in the context of gender as well as every other aspect of service delivery.

And finally, Kumar and Mishra have contributed a paper that looks at the effective devolution of healthcare budgets to rural communities in India. In a paper that I found very interesting to read, the authors outline a system that was clearly devised to bring control of healthcare spending to the hands of those who would benefit from it most. However, in practice, this devolution is subject to power games no different to those that take place in board rooms, governmental departments or clinical management teams anywhere in the world. Maybe we need a dispassionate computerised system to tell us all what to do? But who decides how that computer should be programmed? I do not know and perhaps it is a job I might not apply for!

This issue has, I hope something for everyone to reflect upon. That is the joy of editing a journal like this. The varied and sometimes eclectic mix of submissions should encourage all healthcare staff to consider submitting their experiences and projects to a journal so that we can share the story. I am repeatedly astonished when people who work in healthcare say to me that their work and experiences would not make the grade for publication in a journal such as this. This journal depends on our readers sharing their experiences. So go on, start writing, start sharing and start submitting your manuscripts. It is to the benefit of all of us in the healthscape!

Ian Callanan