Innovation or Novelty?

It’s a tough call commissioning new care processes.

Do you do the same as usual but faster? Do you do something different, by definition an untried process .

Doing something different is often described as an innovation, but is it really innovative?

A new contract to an existing supplier which is accomplished by the supplier in its current form is not innovation. It may have the novelty of newness, the frissant of freshness, but if the provider is just doing more of what it is set up to do, then there is no innovation. More of the same does not change the landscape and although novelty is amusing for  a while it soon fades and the system returns to normal.

Setting out to commission something which requires existing suppliers to change their processes and structures or which can only be fulfilled by a new provider is innovation. Beware that all existing pressures in our complex adaptive health system will attempt to force the new initiative into a shape that neuters the effect of innovation, so the emergent commissioning decision will need to be protected and steered to produce an innovation solution.

Why bother about innovation?

It is the nature of healthcare systems to be complex and adaptive. These systems want to revert to their current attractor state and the only way to move the system is a significant disruption. If you’re not ready to break it- and we’re not quite there yet with healthcare, the next best thing, possibly the best thing, is to innovate.

Go ahead, give it a try, but not as a novelty item.

Why start with Why?

Been enjoying a book called "Start with Why?"
In essence the author suggests that customers buy in to services not because of what they do but why they do it.
Although the book majors on Apple, I have been able to think of lots of other companies whose value set and raison d'etre are more attractive than the products they sell. BodyShop, Rohan and the NHS all have value sets that mean their products are treated differently by customers. There is a cachet in having the product because it says something about the user/wearer/ patient. Bodyshop products bestow an environmental and ethical label on their users. But what is it that the NHS label bestows on patients? If asked "Why did you use the NHS?" what answer would you give?
Because it was there?
Because I had no choice?
Because I needed it?

I don't think many of us would say "because I value the core principles of an equitable health service, free at the point of care", which kind of makes me think that there is something missing from the way that we market NHS Services. Not just their marketing but also their usage. Perhaps we should remind patients of the Why afterall.

Costing an arm and a leg

I recently had a conversation with the family of a gentleman in his eighties. Sadly he had undergone surgery, contracted MRSA and suffered significant complications.

The family were concerned that recent swallowing difficlties had required the use of liquid based medicine, his multiple pathologies included various cardiac treatments that were only apparently available as "specials".

In the course of the conversation it transpired that the family were already well aware of the costs of such "specials" and even more surprisingly aware of the perverse incentive that some pharmacists use the most expensive route to obtain the drugs and maximise the profit.

When the son said "bit of a conflict of interest there Doc" I started to tactfully enquire as to their background- were they Lawyers, Teachers or God forbid- Medics?

Oddly no- she worked in IT, he worked in the Council. They were both aware of the cost pressures we all face and willing to consider any option which meant their Dad received good care.

After a while we reached an arrangement involving alternate treatments, delivery mechanisms and some PRN  subcutaneous drugs.

There was no rancour, anger or demanding of "their rights". In effect they were acting as custodians of the NHS purse in much the same way as many GPs do.

Perhaps there is something in sharing care footprints with patients afterall.

Shift your paradigm please, I'm trying to get home.

What would happen if we discharged people from primary care to hospital and readmitted them back to primary care?
Just take a moment to consider what that simple shift in thinking would mean.
Yes the discharging practitioner would need to prepare the patient for their brief exit from the wrap around support of primary care, but also it would not be possible for patients to slip out of primary care and in to the hospital without it being sanctioned by a primary care physician.
Similarly on readmission to primary care the appropriate information would need to flow but the decision about readmission to primary care would again be controlled by the primary care physician.
I know some of us will argue that that's how it already is- but ask yourself honestly- do primary care physicians get consulted or have knowledge a priori of admission?
What would happen if we worked like this? I suspect reassurance that Mabel is always like that, and "yes, I'll see her in the morning" might, in many cases, prevent Mabel entering the hospital walls.

In a similar way when it came to the return of Mabel to primary care, her re-admission as it were, the checks on availability of a primary care bed, the required systems, and of course the information, would ensure that Mabel was not admitted to primary care unnecessarily and that since her readmission would be the default, the Hospital would need to find daily justification to keep the patient.

Perhaps Primary care physicians would like to consider doing the ward rounds in the hospital in order to decide who must stay behind in secondary care and who can leave to be readmitted into primary care.

If we all adopted this simple mind shift I'm sure less people would end up in hospital, they would spend less time in hospital and ultimately remain longer where they wish to be- at home in primary care

Go with the Flow

It's interesting looking at how other professionals work to see if there's something we can adopt in medicine. This last month or so I've been interested in Flow. It all started with the golf, a young player nails the first round, leads the board but next time around he's hopeless- the yips have struck.

Equally in snooker, darts, chess, whatever there are moments when the players are so "in the moment" that for them the game is over in seconds, their performance is faultless, the result dramatic.

This state of "Flow" is something we should be able to promote in medicine. At the very least we should be able to redesign our environments to promote the chances of us being able to deliver an optimal experience.

Here are  a few suggestions to be going on with:

• Prevent interruptions when focus is needed- do not disturb rules.
• Promote an environment which facilitates relaxation
• DO ONE TASK AT A TIME
• Turn off e-mail notification, mobile phones etc.
• Plan the session to reduce breaks in flow- prepare papers, tools etc.

I'm sure there are dozens of other ways we can go with the flow, I'll keep looking and let you know.