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Risk work in NHS 111:: the everyday work of managing risk in telephone assessment using a computer decision support system

Risk work in NHS 111:: the everyday work of managing risk in telephone assessment using a computer decision support system
Risk work in NHS 111:: the everyday work of managing risk in telephone assessment using a computer decision support system
The substitution of clinical with non-clinical staff to triage and manage calls in the NHS urgent care services is one of the number of measures designed to meet growing health services demand. The deployment of a Computer Decision Support System ‘NHS Pathways’to support this work has created a new type of health worker and a new form of risk work. In this article, we examine how call handlers manage, experience and respond to risk in their everyday practice of telephone assessment. We draw on data from an ethnographic study of 5 NHS 111 sites involving 356 h of observation plus 6 focus groups with 47 health services staff in 2011–2012. We found that there was a‘risk problem’involving balancing the competing demands of asses- sing patients safely against rationing limited health resources. The new service used technology to support risk management but this technology also created risk work for call handlers, clinicians and patients. We found that call handlers engaged in risk work that involved interpretation, judgement and flexibility in using NHS Pathways. Call handlers also deferred some risk work to both clinicians and patients/callers. Risk work now involves‘making the technology work’and much of this work has been delegated to non-clinical call handlers. These new healthcare workers are interpreters of risk. Risk work creates a sense of responsibility (and sometimes anxiety) for these non- clinical call handlers.
1369-8575
189-208
Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Prichard, Jane
64ba5e39-0b0f-4529-877f-aa6ecc7e7e2e
Pope, Catherine
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Brook, Simon
d25a5f8f-e8cf-43fc-8e91-e231645ac3a5
Rowsell, Alison
058f3917-b556-4eef-a393-4c025a3c4ccb
Turnbull, Joanne
cd1f8462-d698-4a90-af82-46c39536694b
Prichard, Jane
64ba5e39-0b0f-4529-877f-aa6ecc7e7e2e
Pope, Catherine
21ae1290-0838-4245-adcf-6f901a0d4607
Brook, Simon
d25a5f8f-e8cf-43fc-8e91-e231645ac3a5
Rowsell, Alison
058f3917-b556-4eef-a393-4c025a3c4ccb

Turnbull, Joanne, Prichard, Jane, Pope, Catherine, Brook, Simon and Rowsell, Alison (2017) Risk work in NHS 111:: the everyday work of managing risk in telephone assessment using a computer decision support system. Health, Risk & Society, 19 (3-4), 189-208. (doi:10.1080/13698575.2017.1324946).

Record type: Article

Abstract

The substitution of clinical with non-clinical staff to triage and manage calls in the NHS urgent care services is one of the number of measures designed to meet growing health services demand. The deployment of a Computer Decision Support System ‘NHS Pathways’to support this work has created a new type of health worker and a new form of risk work. In this article, we examine how call handlers manage, experience and respond to risk in their everyday practice of telephone assessment. We draw on data from an ethnographic study of 5 NHS 111 sites involving 356 h of observation plus 6 focus groups with 47 health services staff in 2011–2012. We found that there was a‘risk problem’involving balancing the competing demands of asses- sing patients safely against rationing limited health resources. The new service used technology to support risk management but this technology also created risk work for call handlers, clinicians and patients. We found that call handlers engaged in risk work that involved interpretation, judgement and flexibility in using NHS Pathways. Call handlers also deferred some risk work to both clinicians and patients/callers. Risk work now involves‘making the technology work’and much of this work has been delegated to non-clinical call handlers. These new healthcare workers are interpreters of risk. Risk work creates a sense of responsibility (and sometimes anxiety) for these non- clinical call handlers.

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Risk Work in NHS 111: The Everyday Work of Managing Risk in Telephone Assessment Using a Computer Decision Support System - Accepted Manuscript
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Accepted/In Press date: 26 April 2017
e-pub ahead of print date: 12 May 2017
Published date: 12 May 2017
Organisations: Leadership & Health Systems, Researcher Development

Identifiers

Local EPrints ID: 408028
URI: http://eprints.soton.ac.uk/id/eprint/408028
ISSN: 1369-8575
PURE UUID: 1b1d081f-e621-4aa4-826f-8e0471e83a22
ORCID for Joanne Turnbull: ORCID iD orcid.org/0000-0002-5006-4438
ORCID for Jane Prichard: ORCID iD orcid.org/0000-0001-7455-2244
ORCID for Catherine Pope: ORCID iD orcid.org/0000-0002-8935-6702
ORCID for Simon Brook: ORCID iD orcid.org/0000-0002-2694-7134

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Date deposited: 10 May 2017 01:03
Last modified: 16 Mar 2024 05:20

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Contributors

Author: Joanne Turnbull ORCID iD
Author: Jane Prichard ORCID iD
Author: Catherine Pope ORCID iD
Author: Simon Brook ORCID iD
Author: Alison Rowsell

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