Transforming the Horse and Cart

Part of the problem in healthcare is that we don’t actively seek transformational change. We focus on being better, being safer and just working darn harder to get results. Unfortunately building a better horse and cart has inherent limitations.

Sport illustrates this quite nicely, the high jump in the early days of the Olympics was a standing jump, which became a scissor jump after a run up. Of course performance increased, and thanks to occasional falls a mat was introduced to prevent injury.

Things went on for a while with slightly better results every four years but then, the straddle jump evolved and results improved dramatically. Now everybody did the straddle jump and things were slightly improving every four years, it seemed that the straddle jump was the best way of doing it, period-until Dick Fosbury came along that is.

Once again a transformation occurred which changed the game with a quantum leap.

Of course now the NHS faces a major pressure to survive, and surprise surprise we’re squeezing efficiency out of the current systems, getting that better horse and cart. Even the potentially transformative shift to Clinical Commissioning Groups looks like it will be focussed on better pathways, again that horse and cart.

So what should the transformation be? Who is the Dick Fosbury of our NHS. I don’t know, it could be you or me. The solution is not going to come to those of us who are equine focussed in mentality. The solution will come from people who are not afraid to question the status quo, and ask the question “why not?”

What's in a name?- it's a Quantum Thing

People often talk about primary care, secondary care, General Practice, community care. But really what does it all mean?

Sometimes General Practice, which is strictly speaking General Medical Practice is used interchangably with primary care and equally community care is also blurred in the boundaries. 

The reality is that Primary Care is probably better thought of as a space rather than an organisation. A space in which multiple services operate providing care appropriate to deliver within "Primary Care".

Lets face it-there are Hospital Nurses who spend their days delivering primary care, being the first port of call for a child with diabetes, or a stoma patient, or specific illness. These nurses are by default part of the primary care approach, albeit operating from a secondary care base.

Equally most General Practitioners spend considerable amounts of time delaing with complex patients who have been through the halls of secondary care institutions and now need to return to some kind of normality.

I suppose my point here is that sometimes naming the process or issue, tends to fix the observed packet of care in place. It's probably best thought of as a quantum event, until you name it it is potentially everywhere, but once named it becomes fixed in time and space as a primary or secondary event.

The trouble with quantum observation is that it also changes the observer. Until the box was opened on schroedingers cat the observer wasn't happy or sad- not knowing if the cat was alive or dead.

Once opened, defined as dead, the observer is also "fixed" in sadness, so we also change who seek to define what should be in primary care, what is and isn't possible in each domain of care.

Perhaps we should seek less to define what should be done where and concentrate on the infinite possibilities that a quantum view of healthcare might provide.