21.03.14
Rational decisions at a time of change
Source: National Health Executive Mar/Apr 2014
Professor Terry Young, Brunel University’s professor of healthcare systems, updates NHE on progress made with The Cumberland Initiative, following up on our interview with him one year ago.
Our care system is often described as being in crisis – which is interesting, given the amount of health we enjoy in our lengthening lives. However, there is an undeniable ratcheting up of the pressure under which the NHS is expected to deliver, and a continual constraining of costs, with dramatic cuts still ahead. And so the debate around change is as inevitable as it is ubiquitous.
Our society has seen other sectors make the journey from guilds of geniuses to purveyors of relentless quality at scale. We used to produce some of the most creative cars in the world. We still export some of the best-made cars in the world. However, between the ingenuity of the ‘60s and ‘70s and our present productive efficiency lay the wholesale destruction and reorganisation of our car industry. Moreover, we are now just a part-player in the automotive plans of manufacturers whose spreadsheets come in dollars, euros, rupees, yen or yuan, but rarely in sterling. Even the £100m spent on UK engineering, and critical to Ford’s new EcoBoost engine, was only a seventh of a development bill approaching $1bn (The Times, 27 Nov, 2013). The pay-off is that we drive better cars that cost us less to own.
The critical question is how a health service can transform itself into a system able efficiently to deliver the same high quality experience to the millionth patient as it did to the thousandth. Can it do so without the catastrophic reconstruction that has characterised other sectors, and remain essentially British? Could such change be an economic force for growth?
The Cumberland Initiative has some of the UK’s best thinkers from the health service, industry and academia. It was born in 2010 when a group of academics and industrial players met at Cumberland Lodge in the Great Park at Windsor, and has gathered momentum, not to mention members – especially clinicians and clinical managers – ever since.
There are two places where we believe we can contribute. First, by remodelling the processes of care using methods familiar in other service sectors: computer models, mock-ups, walk-throughs, virtual worlds and risk predictors. Such approaches represent a knowledge economy, namely the wages and rewards that go with thinking, designing, and proving out. The automotive knowledge economy is why new engines cost so much to develop – and why they work so well on the road. How many healthcare processes have enjoyed $1bn of design investment? And how would we even go about that? The Cumberland communities have some ideas.
We are committed to working together and discovering together how service streams designed by doctors, nurses and health managers could be implemented more resiliently and with greater reproducibility, to deliver higher quality outcomes at lower cost. This is, of course, a very small contribution next to the political challenges of implementing such services across the nation. But it is a start.
The second place where we would like to contribute is to support the growth of an expanded healthcare sector, based on companies bringing new products and systems to market to support the services that they are designing with their clinical colleagues. How would the country benefit if a wave of healthcare models, risk-management apps, infrastructure and personalised communication systems were developed around health and spun out into other sectors? And what sort of jobs might be created? That, too, is part of the vision.
On 9 January 2014 at Methodist Central Hall in Westminster we launched our report, ‘Emergency Simulation: How modelling is resuscitating NHS Urgent & Unscheduled Care’ (available at www.cumberland-initiative.org).
At the event, clinicians, clinical managers and academics presented examples of quality improvements and efficiency gains in British care systems through modelling and simulation. The event’s chair, Mike Farrar, the former chief executive of the NHS Confederation, endorsed such approaches and noted: “The opportunity cost of spending money ineffectively in healthcare is much more profound than it might be in other areas.”
Clearly, healthcare is not a linear design problem. We cannot start with a specification and expect to roll out a product from a production line one day. But we can set up a framework of data, information and knowledge that starts to mould the behaviours of those receiving and delivering care. As former health minister Lord Warner commented at the same launch: “What the Cumberland Initiative is doing, is putting in place at the local level data and analysis which will confront people with the realities of their daily life and give them some tools to act rationally.”
Visit: http://www.cumberland-initiative.org/