■ Andre Spicer, professor of organisational behaviour, Cass Business School, City, University of London
REMEMBER pagers? Simple devices that were used fairly widely before the advent of mobile phones and SMS messaging. If you had a pager, you could receive simple messages, but you couldn’t reply. One of the few places you will find a pager today is in a hospital. The UK’s National Health Service has over 130,000 pagers in use. That’s about 10 per cent of the total number of pagers in the world. The NHS is not alone. A recent survey of clinicians in US hospitals found that despite the availability of many alternatives, pagers are still the most commonly used form of communications technology for doctors.
But the pager’s days in the NHS could be numbered. As part of his mission to digitise the service, UK health secretary Matt Hancock wants to ditch pagers. Getting rid of antiquated technology seems like an obvious thing to do. But is it in this case?
A professor of organisational behaviour, I can see clear reasons for getting rid of pagers and replacing them with mobile phones using SMS or a messaging app. The pager system is only supported by one network. The technology is very simple and only lets you to share the most basic messages. Staff are of course already familiar with mobile phones.
A survey of doctors in a UK district general hospital found they were already using their mobiles to communicate clinical information. A small observational study found doctors using a digital assistant responded quicker to an incident than those using a pager. Doctors saw SMS messaging as convenient, unobtrusive, reliable and efficient. Using a mobile improved the transfer of information between medical staff. The use of technology can even challenge medical hierarchies.
If it’s not broken…
Before the NHS rushes out to bin all 130,000 pagers, it is worth briefly considering whether there may be any good reasons that people are using this antiquated technology. Pagers have some big technical advantages. They have a long battery life. They use radio waves, which are better at penetrating the thick walls you find in some parts of hospitals. They also run on their own dedicated network, which is less likely to get overwhelmed during an emergency.
There are also social reasons that pagers are preferable. Because they are so simple, it makes it difficult to share information that would breach patient privacy.
When medical staff began using mobiles, they created lots of disruptions, led to less professional communication and there was less clarity about which messages were urgent and which were not. It also significantly increased the number of interruptions clinical staff faced while working. Such increases in disruptions might be bad for patients, too. After all, we know that distracted doctors are more likely to make mistakes.
As well as increasing interruptions, doctors using mobile phones spoke less to clinical staff from different specialisms. Mobile phones and messaging systems may crowd out face-to-face interaction — particular beyond one’s immediate colleagues. This can be a problem because it is often during face-to-face interactions that complex information is communicated.
Also, because mobile phones can transmit much more data (including photos and videos), the risk of inadvertently sharing information that breaches patient privacy laws is much higher.
Binning pagers might seem like an obvious move. But there are some significant unintended consequences that hospitals need to watch out for including privacy issues, less face-to-face communication and more interruptions. All this reminds us that sometimes outdated and simple forms of technology, such as the pager, can be superior for certain jobs than more complex and up-to-date technology.