Competition Time?

This weeks BMJ has an expoloration of competition as a means to drive up quality. It turns out that the jury is still out as to the effectiveness.

I think it is pretty clear that competition does improve quality, take motor racing for example. If there was no Ferrari, would there be a Maclaren? Would Red Bull be quicker if there was no one to race? The answer is clearly no, the fact that there is someone to compete against means that the quality indicator of lap time is improved incrementaly year on year.

Stepping back from quality the piste appears less certain. Right now a formula one car costs $7 MILLION. Now I appreciate that this costs is exactly what is required to stay ahead of the competition and that the purpose of the car is to go faster than the competition, but ask yourself this one question- if Vettel and Hamilton were racing in Ford Mondeos then would we find out who was the faster? The answer is of course yes, we would know who was quickest, the competition could be won or lost and the purpose of F1 acheived.

You see competition comes in many dimensions, with many aspects and so when we argue that competition improves things we are correct, when we argue that competion makes some things worse we are also correct.

So is competition good or bad?- the answer is yes.

Buy, Make or Partner?

One of the issues that seems to be hindering the NHS is the belief that the structures currently in place, both organisational and financial, are preventing the creation of a collaborative, patient centred system which offers the chance to deliver improved quality with improved productivity.
Granted we can argue that every organisation has a responsibility to achieve financial balance. However it is not the only requirement on NHS organisations. The real duty of every organisation is to deliver the best it can for it's customers, be they stakeholders, shareholders, paying clients or non fee paying service users.
The NHS has two blind spots, one is the payors, this Americanism translates to the commissioners, and the other is the service user, in our case the patients. Hospitals, practices, community trusts all forget that they have payors, commissioners who have an expectation of value and performance and instead focus on being the best organisation that they can. Although I don't believe we have a total blind spot for patients we often don't accord them the true status of customers, i.e having choice, power or purchase and a right to expect good service.

Is there a fix for this dichotomy, good organisation and good patient service?

The answer I believe is almost certainly, yes.

Commercial organisations can deliver financial success, efficiency and value. They also deliver customer focus and survive in harsh competitive environments. In that world view it seems obvious that competition is the answer to the NHS.

However if a commercial provider wanted to be the best it could, deliver most value it would also seek to expand it's market, it's influence. Examples such as Facebook, show a service provider who is now partnering with Spotify and other media providers to improve the range of services and value to it's users. Amazon achieved similar benefits when it bought out Audible to enable customers to choose printed, e-book and audio versions of it's products.

So it would seem that acquisition, alliance and collaboration is also the answer.

In the new NHS we now need an understanding of when to choose collaboration, competition or merger as the right blade on the NHS Swiss army knife.