Introduction and background
Since its launch 60 years ago, the NHS has grown to become the world’s largest publicly funded health service. Nationwide, the NHS employs more than 1.3m people, including some 90,000 hospital doctors, 35,000 general practitioners (GPs), 400,000 nurses and 16,000 ambulance staff.
In 2007/8 it was publicly funded to the tune of £90 billion and dealt with on average 1 million patients every 36 hours. The NHS Faculty of Health Informatics is a UK wide community of practice formed in 2005 and comprises 505 members, the majority of whom come from Information Management, ICT and Clinical backgrounds within the NHS and who are passionate about using new systems and technologies for the benefit of patients.
One of the Faculty’s greatest assets has been the ability to offer a collegiate environment and act as a ‘think tank’ to discuss and make recommendations on how to best use new technologies in the NHS for the benefit of patients. Responding to requests from their members, the Faculty held a master class in May 2008 on ‘The Power and Perils of Social Networking in the NHS’ designed to elevate awareness of the challenges and opportunities afforded by web 2.0 technologies. The faculty usually produces a centrally written report of the event and the main issues and recommendations arising from it. However in keeping with the theme of the master class, the Faculty decided to produce this report and evaluate the event’s success using a using a wiki that allowed delegates to post and edit content via the web.
Developing the wiki
The use of the wiki in this way was entering unknown territory. All delegates that had attended the master class were issued with an e-mail inviting them to contribute to the final event report and discussion paper. Respondents were then granted access to view and edit content on the wiki site. In addition, the delegates were encouraged to extend the invitation to others, known to have an interest in the subject, and this gave rise to increased participation both from within the NHS and external social care organisations.
As Rowan Purdy, the wiki editor, explained:
“We opted to use an external platform called ‘Wet Paint’ (see www.wetpaint.com) to create the wiki. This was deployed as a closed site, which meant we could control access through a membership approval process, giving us greater security. The Wet Paint tools are intuitively easy to use, allowing the viewer to navigate content and edit as appropriate.”
Bruce Elliot, who coordinates the work of the NHS Faculty of Health Informatics, also drew attention to some other factors that contributed to high participation rates.
“We were very pleased with both the quality and quantity of the contributions to the wiki. The fact that we held a master class in the first place was undoubtedly an important underlying factor. Delegates had listened and contributed to discussions on a range of topics which, combined with real social interaction, helped to generate confidence and a sense of purpose vital to an exercise of this kind as well as the enthusiasm to apply learning to their own work situations.”
Colin Evans, the Technical Lead for the new eSpace on-line collaboration platform run by NHS Connecting for Health and was also a delegate at the event, identified other factors that need to be taken into consideration before using similar approaches:
“Some evidence in this emerging field shows that it is important to have clear time scales for something like this, so effectively you have a cut-off point for contributions. In their case, the wiki site was opened within a few days of the master class event and those approved to use it were given two to three weeks to make contributions. This imparted a sense of urgency and shared responsibility to complete it.
“Another helpful feature was the way in which Wet Paint allowed you to request proactive updates on the wiki site, to keep you abreast of any changes. Some might argue that they are deluged with e-mail as it is, but the relatively short, time-bound nature of the project helped to negate these concerns.”
Creating the report
Rowan Purdy, the editor of the wiki site and co-author of the final report, ‘The power and the perils of using social networking tools in the NHS’ (http://www.espace.connectingforhealth.nhs.uk/articles/do-powers-social-networking-tools-outweigh-perils-n?c=320) was very forthright in his reflections on the process:
“Although there was a considerable amount of content to review and edit, the process was relatively straightforward. The wiki had been primed with initial content and structure, based upon the discussions at the master class. This structure was then exposed to the approved users, some of whom contested it and proposed amendments. As a consequence, a new structure and content emerged from the collective editorial process of the users. My role was then to capture a faithful representation of the wiki and to re-package it into an accessible, informative and digestible document.
“One of the concerns about using wiki-based editing is the perceived risk of users destabilising the editorial process by posting highly argumentative or malicious views, capable of causing offense or creating an impasse in achieving agreement on particular aspects of the content. In ‘wikipedia’ (www.wikipedia.org)
for example, some pages have to be ‘locked out’ because of irreconcilable, contradictory viewpoints leading to a tense stand-off between contributors. I am pleased to say this did not happen in the case.”
Potential future direction
Reflecting on the process as a whole, Di Bullman who is a member of the NHS Faculty of Health Informatics with a background in workforce development, could see opportunities to extend the practice of wiki-generated feedback within other organisations.
“The departure from the traditional methods of capturing post-event feedback and ideas solely via standard forms seemed to unlock a level of enthusiasm and engagement rarely seen before. In addition to the production of an excellent report, it is likely that contributors to the wiki have since set up their own communities of practice, thereby creating extended social capital as a direct result of their shared experiences. From an HR perspective, this holds out the prospect of improving knowledge sharing and achieving workable solutions to real business issues.
“A number of things need to be kept under review, such as data ownership and protection and these will have policy implications as the scale of adoption of wiki-based practices increases. Another consideration is how best to integrate these practices within the organisation, in such a way that they actively improved service quality and efficiency sustainably. It would be unwise to think that the enthusiasm displayed by the participants in the wiki-generated report would necessarily be indicative of organisation-wide uptake. Hence, the expertise within HR to guide culture-change programmes has to be an important part of any plans going forward.”
For more information, contact Bruce Elliott MCIPD at: bruceelliott@nhs.net