Health: less “R”, more “D”

Much modeling is done in NHS to understand issues, but few developed solutions on offer.

I just left the Press launch for the Cumberland Initiative – an effort to bring clinicians, academics and business people together to use modeling to tackle NHS issues – especially the crisis in A&E [emergency or unscheduled care]. A great aim, but modeling has already clarified many issues for many years; ambulance scheduling, resourcing for dementia treatment, stroke-response … and emergency admissions. So it looks like we have lots of understanding, but no solutions.

To solve challenges, 3 things all have to happen:

  • Research “R” – to figure out what is happening, why and trial possible solutions
  • Development “D” – to develop, test, refine and codify practical solutions that will tell people trying to manage complex issues what to do under varying conditions
  • Roll-out – to spread the solution to all cases where it is needed

On the biggest issues it faces, the NHS seems to go endlessly round the “R” loop, with well-meaning and hard-working people trying repeatedly to use modeling to solve the same problem. This is far less prevalent for the clinical solutions themselves [a cardiologist at the meeting explained how angioplasty to treat blocked arteries was proven and rolled out 100% in just a few years].

To be fair, it is not easy – because those big issues encompass the whole system and go beyond it. Much of the pressure on hospitals, for example, arises from gross under-provision of community support, especially for many of the elderly, who both contribute the largest fraction of A&E pressure and suffer the most because A&E is the wrong place for them to be! My friends at Simudyne have developed a multi-stakeholder health-sector game, based on a model by Jack Homer, Bobby Milstein and others to give leaders and stakeholers a sense of just how complex this can get!

This challenge is not unique to the NHS or to healthcare, but in many business cases it is already solved. It is the procedural heart of the Toyota Way, for example, and R+D+rollout is evident in a wide variety of sectors and at every level, from operational to strategic [from the MacDonalds franchise manual to Cisco’s alliance/acquisition model]. But in the business sector too the principle is badly under-deployed, with managers figuring out similar solutions time and again to the same problems without either codifying them or rolling them out.

So a question for the Secretary of Health Jeremy Hunt is why Government policy and NHS management structures make it virtually impossible for widespread solutions to common problems to be developed and deployed, and why the NHS spends vast amounts on “operational research” and nothing significant on solution development and implementation. No other organisation consisting of large numbers of similar operating units leaves unit managers to figure things out for themselves from first principles, rather than developing and rolling out proven, repeatable solutions.

So long as this amateur strategic management persists, Mr Hunt and his successors will continue to waste billions of public money, and cause the deaths of large numbers of people.

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