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EquiPOISE – Blog

All the difference in the world: the simple hard v the complicated easy

By on Mar 18, 2015 in EquiPOISE - Blog | 0 comments

With May’s General Election drawing close, in a guest contribution,  Valerie Iles offers her GRACE manifesto for the NHS. “When we can all: Engage effectively with others, Grasp the complexity of the situation and see how to contribute rather than compound, Respond wholeheartedly and constructively in-the-moment because we feel emotionally ‘full’ instead of empty, Care about what matters to our patients and colleagues, and Experience a deep sense of personal Agency (this is what I care about and this is how I’m bringing it about), then we will all flourish and so will the NHS. Properly supported, challenged and enabled, people fly, they come into work wanting to be there and looking for ways of doing things better.” Val is a visiting professor at both Buckinghamshire New University (where she is a member of the Bucks Consulting Group) and at the London School of Hygiene and Tropical Medicine.  She is also a Fellow of the Royal College of General Practitioners (RCGP).    More...

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Price and Service Signals: Challenge and Opportunity

By on Sep 22, 2014 in EquiPOISE - Blog | 0 comments

22 September 2014 Chat to a GP practice manager about missed appointments, patient complaints and crowded waiting rooms.   Pop into an A&E somewhere near you on most nights: just sit and watch.   Listen to nurses’ tales of patient reactions in the wards and along the corridors. There are two common threads:  rising service expectations and the complete absence of any cost-benchmark. Expectations first.  Ours is an advanced western economy.  It is, today, dominated by services.  They constitute as much as 80% of GDP, according to some estimates.  Service orientation is, by extension, tangible everywhere.  From holidays to restaurants, and chic boutiques to (yes) smiling, service-trained lawyers.   The benchmark of acceptability is relative and rising.   It is a tide  which leads us all to expect ever higher standards in most scenarios.   So, the patient in the surgery or ward arrives with pre-set consumer-society expectations of how s/he will be treated.  Like it or no, that’s the way it is. Except in most contexts, the service layer and brand align typically with a price signal.   McDonalds vs. The Ritz, Aldi vs. Waitrose,  Kia vs. Mercedes – in all cases our expectations software is engaged and runs.   And most consumer marketing assumes that this model (solidly founded on extensive social psychology literature) will function. But at the surgery or A&E?  A little gentle research among your non-medical friends will rapidly expose great uncertainty about true costs.  (I.e. salaries plus fixed overheads plus variable treatment costs plus contribution).   In my experience even best guesses are often only 10-20%. Now imagine. A patient exiting A&E patched up at 4AM.  Or leaving hospital after major surgery and a few nights’ stay. At reception s/he receives a comprehensive invoice – over-stamped ‘Paid by H M Government’. Price-signalling theory would predict a serious and beneficial reaction in the way people demand, consume and respond to our healthcare services. Politically impossible of course.  But worth a reflection?...

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Scotland’s ‘No’: Now Back to Budget Business

By on Sep 22, 2014 in EquiPOISE - Blog | 0 comments

22 September 2014 Whatever your view of Scotland’s ‘No’, you’d probably agree that  politicians of all stripes manipulated the NHS shamefully.  Like a magic totem, at times during the closing phases of the referendum campaign it seemed the only topic.   If, though and regrettably, few concrete facts or issues were in play. But now it’s back to business.  Money business. North of the border, NHS Scotland and the Edinburgh Government together face some very serious decisions.  If leaks are credible, they confront a looming gap of £450 million.   Meantime, heading south, the growing English ‘black hole’ is estimated to be multi-billions deep.   But no one wants to go there this side of the 2015 General Election. So, based on the recent referendum, it is fair to predict a whirligig of buck-passing and mutual recrimination. Instead here’s a couple of novel thoughts for our political class: First, when you’re in deep holes already, stop digging. Second, put the facts and options in play clearly, constructively and objectively.   Treat people like adults.  Let them decide.   Surely what’s good enough for the Union as a whole is good enough for the NHS? Flying pigs anyone?...

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The Limits of Consultation: Steady Ahead

By on Aug 27, 2014 in EquiPOISE - Blog | 0 comments

The NHS recently published its Five Year Forward View– catchily ‘5YFV’.   Wags of course noted that ‘chance would be a fine thing”.  Two governments, five health secretaries and ten transformative plans hence, the finest cut-glass crystal ball will have fragmented in despair. Five years?  Anyone’s guess. The report did, though, contain some refreshing thinking.  With no sense of irony, it notes that: “the NHS and social care system is not short of reports or evidence”.  And it adds: “we will not run yet another lengthy and costly engagement exercise, asking people what they want from health and health care”.  Amen. In the simple language championed by this blog, there is a time for talking and a time for doing.  Or more precisely, a time for thinking and a time for acting.  Consultation is a fine principle.  And it offers a wonderful device for delay and deferral.  But it has its limits. We may not have chosen this vehicle, this road or this destination.  Yet we are where we are.  So, please, let there be no more re-drawing of our maps, no more hesitancy about our choices and no more roadside tinkering. Let’s do it. And let us be left alone to do...

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I’m Lingua-nauseous Doctor! The Problem with Words

By on Aug 27, 2014 in EquiPOISE - Blog | 1 comment

I’m Lingua-nauseous Doctor! The Problem with Words With words we build meaning.  We express emotion.  We clarify logic and much more. In turn, grammatical forms are the mortar with which we construct the syntax to form our overall intention.  By orchestrating syntax carefully, we hone precision. So the very act of careful writing insists upon exactitude.  According to Jeff Bezos, ceo of Amazon, “there is no way to write a six-page narratively structured memo and not have clear thinking”.  Bezos further demands that his senior executive team spend 30 minutes in silence before an executive meeting to absorb each memo carefully. But most of us live in a fog of words.  It is easy to drift amid more words rather than fewer.  We experience daily a veritable ‘pea-souper’ of conflicting, confusing and often opaque jargon.   In the world of health, the many mansions of clinical science must co-exist with the onward march of professional managerialism and political correctness. Easier by far to write: “as a strategic imperative, our next-phase organisational development will require the seamless integration of neuropsychology and neurology departments to better serve emerging patient needs and re-define the most appropriate pathway…” Our word-processor writes this stuff on auto-pilot.  Local kremlinologists will decipher it. Than? Than simply: “we will save money and increase efficiency by merging the two departments”. Hard, yes.  But think about the waves of wasted words and wasted time.  Think about clarity.  Think about motivation. A cure for our collective lingua-nausea,...

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