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NHS crisis and cognitive dissonance

So the Red Cross tells us there’s a humanitarian crisis in our NHS hospitals and ambulance services.  What reactions does that trigger in your mind?

This is the same Red Cross which is helping those left alive flee the ruins of Aleppo, and in context I don’t know about you but I have a problem with that language.  I don’t mean to shrug “Crisis, what crisis?” but the point is that it is so easy to make headlines by building on public perceptions and so hard to challenge them.

Many players within the NHS ecosystem and media thrive on continual crisis but strangely it doesn’t help us to measure, analyse, reflect and redesign.  We are addicted to firefighting.

Now I want to raise the subject of cognitive dissonance.  If you haven’t yet read Matthew Syed’s “Black Box Thinking” then I urge you to do so:  well written, engaging and with a powerful message.  (the subtitle about marginal gains doesn’t do it justice.  It’s much more about learning from failure).

I’ll declare an emotional “COI” here in that aviation comes out much more favourably than healthcare, and some decades ago I was a tiny cog in the industry at Rolls-Royce aero engines.  The difference centres around attitudes to failure:  forensic analysis, learning and rapid dissemination in aviation, versus cover up in health.  Doctors have admitted to me that that’s a huge fear of failure in medicine, but the problem as Syed so eloquently puts it is that failure happens continually and repeatedly.  Aviation by contrast is very open, and very safe.

I’ve talked for some time about the primal fears which keep GPs from change, impenetrable to evidence.  But perhaps I’m wrong, it’s more the gap between beliefs about current practice and what we imagine we might have to do – cognitive dissonance.

Does reframing the problem make it any easier to solve?  Your thoughts gratefully received.

Harry Longman


PS Counter that crisis thinking with this US doctor’s experience of the NHS as a patient.  We must count our blessings vs USA never mind Syria.

3 responses to “NHS crisis and cognitive dissonance”

  1. Andy Lee says:

    I agree this is something health service providers could improve on. In my experience though GPs have mostly been more receptive to learning than secondary care services. Also, in my experience, that latter pattern is due to the response of both clinicians and managers. I don’t mean GP services can’t improve but I have continuously experienced resistance and avoidance of learning from failure by secondary care for nearly 30 years. Almost every response to any situation is defensive and a justification for why nothing can or needs to change.

  2. Tony Jones says:

    The following is my take on one of the main problems in the NHS, professional risk

    Residential home staff call an ambulance to a resident who has had a fall. They do this not so much because of genuine concerns about injury but because of fears of adult protection being raised by social services who have themselves been criticised for shortcomings over child protection and have stepped up pressures in all areas of safeguarding.
    Paramedics attend; they almost always convey the patient because of perceptions that their managers will never condemn this line of decision making whereas any decision not to convey will inevitably increase the risk of professional discipline or even losing their livelihood in the event of deterioration of the patient.
    The patient arrives in A&E and is found to have no treatable pathology but she is unsteady on her feet and slightly confused and the level of risk is deemed too great to allow discharge and so she is admitted.
    The patient becomes progressively more confused and loses what mobility she had, so after a lengthy stay, prolonged because of complex discharge procedures and lack of nursing home beds, is discharged to a more expensive care facility to the one she left several weeks earlier.
    The patient eventually arrives in a nursing home where she is registered with a new GP; she continues to deteriorate but her new GP is not confident enough to make the decision that she is entering the terminal phase of her life. He fears the potential complaint of relatives and is also under pressure from the home who are under investigation by CQC and are keen to prevent any death from occurring on their premises so soon after admission. As a consequence she is readmitted, continues her decline & dies.
    The consequence of all of the above risk averse behaviour is that our hospitals are overcrowded which increases the risk to other in-patients. A lack of beds means that the Trust cannot get waiting listed patients in for necessary surgery and is thus under financial threat.
    So risk and perceptions of risk have actually put the whole local health system under threat.
    (my caricature of risk)

  3. Simon Dodds says:

    I heartily agree … the medical profession (as a whole) has a fear of failure and, sadly, that impairs learning and makes future failure more likely, not less i.e. chronic. It also explains why we are not very good at measuring outcomes. Perhaps the root cause is that we do not know what to do to fix the problems we find when we ask … so that is a good place to invest some time … because most of the root causes are within our circle of control. Our helplessness is learned.

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