Today's Eventsno events today
Do you Believe? by Pat Letendre
(Musings on cloud-based software services by a transfusion medicine techno heretic)June's blog is motivated by news that the UK's NHSBT has consolidated Human Resources using cloud-based technology:
HR cloud transfusion at NHS Blood and Transplant (28 May 2014)
The story appeared in an online journal for the UK's IT community. As such it naturally promotes the many benefits of technology. To learn more and become a true techno believer, consider viewing
The blog's title derives from a 1998 'techno' song by Cher, one of the best selling singles of all time.
If I understand correctly, until recently the NHSBT didn't have sophisticated system-wide software to operate its Human Resource (HR) system and instead relied on more primitive tools like MS Excel spreadsheets.
What follows are musings on my limited experience working with a national blood supplier using centralized services, whether operated by people or computers. I’ll use a few anecdotes to generalize about unintended consequences of centralized, computerized delivery of services like Human Resources.
I'm prepared to acknowledge that NHSBT's cloud-based HR system may be the greatest thing since sliced bread. Only NHSBT staff can assess that after a fair trial.
TECHNO JARGONFirst, for background, see techno jargon for some of the lingo associated with enterprise-wide software: cloud computing, ERP, and SAP.
Anecdotal evidence is unreliable because it's based on non-scientific, personal accounts involving a few observations. With that proviso, what follows are anecdotes based on my experiences working for a national blood supplier with centralized services and enterprise-wide software briefly in 1999-2000 when I returned to CBS as an 'assman' in the patient services laboratory (The Quality dept. addressed mail sent to the assistant lab manager as 'assman'). I had worked for CBS’s predecessor, Canadian Red Cross, years earlier and had several jobs as a consultant with CBS more recently. Although an 'assman' at CBS, I was effectively the manager of the patient services lab.
During this time, CBS Edmonton piloted Mak Progesa in the patient services lab, a large-scale software implementation, although not as huge as when Mak for donor services was implemented across Canada. To its credit CBS spent much money, time and effort on the project.
Later, Progesa was rolled out to donor centres across Canada, including developing a simulated version of Mak Progesa for staff to train on as described here (after leaving the'asssman' job, I helped develop simulations as a consultant):
e-Learning saves the day (Feb. 2004)
Since my time, CBS has become more centralized, all in the interest of efficiency, meaning eliminating staff or replacing expensive health professionals with less well educated staff (trained to perform specific functions under supervision), who can be paid less.
Errors below are due to my faulty memory of specific details but overall impressions remain clear. As food for thought, what follows is a glass half empty perspective.
CANADA v UKFor comparison, the UK has an area of 243,610 sq. km and a population of ~64 million. Canada is the world's second largest country, spanning 6 time zones, with an area of 9,984,670 sq. km (8,442,614 without Quebec) and a population of 35.1 million (~27 million without Quebec).
Staffing: CBS has ~3480 FTE, decreasing regularly, and perhaps ~4700 staff overall, judging by statistics used by CBS staff presenting at computer conferences. In contrast, NHSBT employs ~6000, which may include FTEs and part-time staff.
My CBS experience may not apply well to the UK's NHSBT, or they may. You decide.
INFORMATION TECHNOLOGYIn the 'assman' role 15 years ago, I recall that CBS IT staff were onsite and were the go-to people when computer issues arose. When called, they came that day, did the troubleshooting, and fixed the problem. Technical and other staff knew them by name, learned a bit about their families, socialized with them at staff functions.
Later, onsite staff decreased significantly and we had to call Head Office (2 hours ahead of us) with IT problems. Sterile on a personal level but usually worked to resolve system-wide issues. The local person got whatever ‘tickets’ (help requests via an issue tracking system) could be handled onsite such as printing problems.
Learning point #1
With centralized services, get used to sterile because dealing with colleagues from a distance means decreased, meaningful human interaction. You cannot see the other person’s facial expression or appreciate what else may be happening in their world.
You don’t care much about your at-a-distance colleagues on a personal level. You’ve never met, likely never will. Moreover, in the case of IT support, it’s probable that they know nothing about the realities of your world in the trenches out in what they may regard at Head Office (HO) as 'the boonies'.
You may say, 'Who cares about sterile if sterile works'. The management of large organizations like CBS, which continues to centralize functions to save money, cares more about efficiencies than the emotional well being of its staff, although they always take care to emphasize the latter. The cliché 'actions speak louder than words' fits.
SUPPLY CHAINPerhaps because the centralized supply chain was relatively new when I was 'assman', annoying glitches existed. In patient services ordering reagents from HO sometimes was incredibly frustrating. An early experience:
Some reagent requests had been ignored for a long time and no number of e-mails had resolved the issue. It was almost as if local staff had resigned themselves to never getting anywhere with the ‘controllers’ at HO. Stonewalling would be rare if the controller was down the hall in the same building and staff saw each other daily.
Ultimately, I asked who the applicable HO manager was and contacted the manager directly with why weeks had passed and still a particular reagent was not shipped. Magically, the problem resolved immediately.
I'm told the system works better now, although challenges remain.
Learning point #2: When the centralized system doesn't work, at the first or second indication, go right to the top. If 'bureaucrats' at HO view you as one of many faceless, pestering colleagues, you're easy to ignore. Getting the attention of the responsible 'boss' gives you some leverage, because who knows where you'll raise 'poop' next up the chain of command.
Learning point #3: So, it’s not just sterile communication that results from centralized staff who control access to services and products. Being remote allows them to more easily ignore you and to see you as a nuisance who disturbs their cozy HO bubble.
Worst case is that HO controllers may even come to regard those in the hinterland as similar to peons, those of lower rank who must be tolerated by HO masters. This possibility may seem ridiculous but being at HO in a large organization does tend to breed smugness for those who are part of the in-crowd, regularly schmoozing with the executive class.
Learning point #4: Also, think about how you relate to on-site colleagues. If you know them and their current life situation (sick child, spouse out of work, aging parent with dementia), are you more likely to cut them some slack? If managers say 'hi' to you as opposed to ignoring you in the hallway or at meetings, are you more likely to try to perform to their expectations? Do you find it harder to take a hard line with staff F2F vs via e-mail or a memo?
Learning point #5: Regardless, having a HO of staff with significant control fosters a We-They mentality experienced by all. That’s never good for productivity and staff morale. Because large organizations invariably have an HO, wise executive management takes care to ensure that staff in the regions have significant control since lack of control over events breeds anxiety and, ultimately, resentment.
HUMAN RESOURCESIn my time at CBS, HR staff was onsite, which worked well. Now that HR staff is more segmented nationally across the country, challenges exist.
Giving employees direct access to online HR tools can be a plus, at least for routine inquiries easily handled by accessing computerized data and FAQs.
Managers having direct access to HR, and other processes such as accounting, via ERP software is a mixed bag, partly due to a learning curve with software. Picture scientific and clinical staff before a computer trying to learn how to do tasks that before seemed simple or were done by HR specialists.
As a new 'assman' I never received training on SAP or any of its applications, so most tasks were trial and error, onerous even for someone who was an early adopter of computers and Internet technology. Asking other managers was equally frustrating because often they knew almost as little as I. Not exactly efficient, more a huge waste of organizational time.
As well, sometimes computer software requirements drive processes. Software dictates and staff and logic must bend, similar to the tail wagging the dog.
Learning point #6
Some aspects of computerizing HR functions work well (e.g., for simple questions), others don't. Makes sense, because HR stands for HUMAN Resources. Taking the human out, having staff deal with software in a cloud, is a clue things may go wrong. Doh!
Centralized HR using a cloud ERP is often efficient. Effective on a human level, not so much. Would you rather navigate through an online FAQ or telephone support system - For A, press 1; for B, press 2; for Z, press 26? Or ask a question of a breathing human being you see F2F?
Maybe you don’t care so long as you get an answer fast. Who needs to deal F2F with humans anyway? And it all goes well, until it doesn’t.
Blogs aside, I’m not anti-technology or anti-evidence. I owe my post-health professional and post-educator career to computers and the Internet. As an instructor and CE provider I taught courses on critical analysis of medical literature. Moreover, I dig that the healthcare money pot is finite and priorities must be set, much like triage in emergency departments.
But I also see the downside of the rise of centralization and computer technology like cloud-based ERP, especially as they decrease human interaction. Less F2F interaction has subtle but real consequences, most of which are negative.
Looking back on life or a career, most people recall a series of 30 second F2F interactions with fellow humans that shaped our perspectives for good or bad. Maya Angelou’s wisdom on this issue is so true:
'I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.'
Organizations that promote efficiencies such as centralized services over human wellbeing believe they are doing good, coping with financial realities, but may not realize or care about the insidious downsides to staff attitudes and morale of diminishing F2F communication.
Centralization and using information technology to bring about efficiencies (cutting costly staff) largely transfers specialized functions to technical and scientific staff, who are already overwhelmed with doing more with less. Or as the management gurus pompously say, working smarter, not harder.
Let's be clear. Eliminating specialized staff and using software over an Intranet, cloud-based or not, transfers functions to existing staff whose expertise lies elsewhere. The tasks are an add-on to work they already do and come with a learning curve. Sometimes effective training occurs, sometimes not.
Often, the organization's senior management achieves efficiencies on the backs of scientific and other staff and has the audacity to brag about it.
It happened in healthcare in my province of Alberta, where top management were government bureaucrats and politicians. It happened at CBS and other healthcare organizations where staff have become cost centres to be eliminated in the interest of efficiency.
Humans have become expendable as organizations strive to contain costs, indeed decrease costs. And those left in the trenches must suck it up and do more with less, including assuming the tasks earlier done by departed colleagues in other departments.
BRAGGING RIGHTSIT innovations by blood suppliers are always touted as the latest and greatest. Staff of national blood suppliers like CBS regularly attend software conventions and promote software solutions they’ve bought and implemented as wonderful:
The software may be crap but it's our crap. (Who likes to admit they bought a lemon?)
The organization achieves efficiencies, i.e., enables staff to be axed. They promote effectiveness, and the software may be effective from their perspective, but the real star of the show is cost saving.
See for example:
Canadian Blood Services integrates CRM in Appointment Management Solution
Presentation at America's SAP Users Group (ASUG), 2012
by Annette Blackwell, Senior Project Manager at CBS and Kevin MacDonald, SAP CRM Business Analyst III at CBS
Translation: CRM = Customer relationship management. CBS created a centralized call centre to manage donor appointments and blood type targets. Presenters list many ROI advantages, including, ‘Staff reductions’.
Canadian Blood Services boosts AP Transparency & Control inside SAP
Presentation at America's SAP Users Group (ASUG), 2012
by Linda Dyck, Corporate Accounting & Travel Manager, CBS, and Blake Evans, Director of SAP Technologies, ReadSoft
Translation: AP= Accounts payable. Many advantages listed, including ‘Reduction in the number of AP Administrators’.
Presenters’ Conclusions (I’ve highlighted the ‘Aren’t we great’ stuff.)
For CBS increasing productivity means finding even more effective ways to maintain our uncompromising standards.
Cost-efficiency is not about getting by with less; it’s a matter of maximizing the value of limited health-care dollars and gaining the ability to achieve even more.
As trusted stewards of Canada’s blood system, we have a responsibility to be a nimble and productive organization, and to help our employees work more effectively.
Admittedly, I’m a bit of a techno heretic. Despite making a living off technology, I value people over machines and, yes, people over efficiencies. People - health care professionals - with jobs, who pay taxes to help society's unfortunate, who contribute to their communities, who enjoy the camaraderie of colleagues. Not efficiencies that transfer money from local people (health staff) to software companies or automated instrument makers. Losing battle? Perhaps. But they're still worth fighting.
As always, comments are most welcome. If you're an NHSBT employee and you love the new cloud-based Human Resources system, I'd love to hear from you.
If you dislike 'techno' music, you may sympathize with those who dislike techie innovations like cloud-based IT because it’s dehumanizing. If you love synthesizers and other techno sound tricks, you'll love this 1998 song. Funnily enough, I like the song but maybe it’s just that I like Cher.
- Asturias (Andre Segovia)
ServiceNow: IT Heroes Transform Enterprise Services NHS Blood and Transplant (see 3 items in right side menu)
30 Apr 2017