Not long ago a local NHS manager told me they were pursuing the Dave Brailsford model of lots of tiny little improvements – he the cycling supremo who let us bring home so much gold from the Olympics. I thought it a one off comment, but a blog of Roy Lilley’s this week called it an NHS fad. Like him, I’ve no doubt it’s a misguided one.
Cycling is a beautiful thing, highly sophisticated and at the Olympic level, a more streamlined cut of sideburn can make the difference between podium places. But the NHS is not a competitive sport, it’s an operational business and if everyone had a rough imitation of the current best model, we’d all be miles better off.
The problem with thinking about marginal gains when the system is broken is that you miss the biggest opportunities. Attention, that very limited resource, is in the wrong place.
“Improvement is not enough. We need transformation.” W Edwards Deming said it thirty years ago.
“If I had asked people what they wanted, they would have said a faster horse.” Henry Ford said it, a century ago.
If he had listened, we’d have carbon fibre wagon wheels by now.
Gee up, Dobbin.
PS. You’ll have noticed all the noise about STPs. They have transformation in the title, of course. But they are really about money, and I’m afraid that’s no way to achieve transformation. Cost cuttting, yes, restructuring, yes, noise, aplenty. What we need is different thinking, starting with patient demand.
PPS. “Marginal gains secured by new care models…” was the title of a King’s Fund blog this week. Marginal gains? Remember, the new care models were the flagship policy of the Five Year Forward View. Two years in, untold £millions spent, and they are bigging up “marginal gains”??? Please don’t get out of bed. If it was working they would have something more to shout about