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Health polemics

March 16, 2014

I ran a workshop today for several NHS groups in Leatherhead.  It was a basic introduction to complexity theory and examples of health projects using SenseMaker®.   I alway enjoy teaching professional groups who have passion, and probably learn more from the conversations than they do from my teaching!  With our increasing involvement in the development sector and health I am discovering that there is a lot of that passion but also a lot of frustration with the overall management framework and resourcing within which they work.

Some of that is resourcing and restrictions, but there is a lot of waste at the same time.  Now to be clear I mean waste here in the sense that Lean (properly understood) is about eliminating waste created by techniques such as sick stigma.  The irony there is that lean six sigma is one of the fashion items at the moment in the NHS; the desire for order is understandable but also scary.  Complexity offers the possibility of changing some of that, and more importantly allowing locally contextual solutions to evolve/emerge rather than be engineered.

I made three polemical points up front. &nbsnbsp;To be clear there is nothing wrong with a polemical statement, but it is always qualified by the need to say that it is polemical, which means it is not universal.  Polemical statements are a way of making a point that a pendulum has swung too far.  So what were they?

  1. Too much medical practice is based on statistics rather than biology, the obsession with the mean and averages at the price of individualisation.  Patients being treated as slabs of meat is one form of objectivisation, but so is being lost in a sea of averages.  This too frequently means that patient pathways cannot modified, as I know from my experience with Diabetes in which the pathway determined appears to be palliative not curative.
  2. Less of a polemic, more of an observation; when I go to a US hospital to meet a Dean they often come into the room in a white coat having been on the rounds of a ward.  In the UK they normally wear a suit or business casual.   Human judgement is influenced by experience and the problem is that in a professional environment that takes years to acquire.  Managerialism tends to produce more measurements, process and monitoring as it is an alternative to judgement.  Now I know this is a little extreme but I am making a pendulum point here.
  3. Finally and most important we seem to be replacing professionalism and professional judgement (that word again) with process.  National guidelines and measurement systems mean that my Doctor has limited freedom to allow variation.  Her computer says that if I have a certain level of cholestral then statins will increase my life span by a specific period.  The process pathway then pops pills rather than taking me down a diet and exercise regime that would cost the NHS less and which is measurable.  More about that one in tomorrow's post.

So a brief reminder, these are polemical statements; I reserver the right to be more reasonable under challenge!

I chose the the Fildes picture deliberately.  Painted in 1887 it is a somewhat idealistic picture of the relationship between Doctor and patient that does not reflect Victorian practice (a good article on it here by the way).  But it does represent a direction we need to travel, the current alternative would seem to have us all taking the Blue Pill as we would then be easier to manage.  I always try and play in red …..

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