Over the last year or so, I’ve written a lot about how health care
information will become increasingly available to consumers and health care
business, and how this access will drive new decision-support
capabilities that will profoundly change how health care works,
eliminating many of the problems that have placed health care in
crisis. So imagine my delight when a colleague forwarded this quote.
Sir Muir Gray is Chief Knowledge Office of Britain’s National Health Service. His wonderfully clear explanation of how health care knowledge will become guidance – that is, decision-support – makes a compelling case for the transformative power of Health 2.0.Check it out.
The future is something we make, not something we discover. And the
future is easy to make because as William Gibson has said, the future
is here, it’s just not evenly distributed.
The second revolution took place in the latter part of the 20th
Century. It was driven by science, making plastics, airplanes,
televisions and innovation in chemical and mechanical technology in
health care.
We’re in the middle of the third Healthcare revolution. The first was
based on common sense, an empirical revolution; the health of nations
was transformed by making observations and deductions from data and
improving conditions based on those deductions. So now, for example, we
take clean clear water for granted.
We have made amazing progress, but we have though not solved the following “magnificent 8″ problems:
· Errors and mistakes, – Poor quality healthcare, – Waste, – Unknowing variations in policy & practice, – Poor patient experience, – Overenthusiastic adoption of interventions of low value, – Failure to get new evidence into practice, – Failure to manage uncertainty.
More science and more money is not going to help these. I have reservations about putting more money into health services, because my experience is that this just makes people more obsessed with money.
The third revolution is different – everyone’s involved and it’s everywhere, it’s adaptable, it’s pervasive, it’s inclusive and convergent.
I’m very much inspired by Manuel Castell’s work: The Rise of the Network Society. The third industrial (and therefore, healthcare) revolution is driven by citizens, IT and knowledge. Professionals are by and large two decades off the zeitgeist and this is not restricted to healthcare, it’s seen across all professions.
Knowledge is the enemy of disease, the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade. I’m talking about three types of knowledge here Statistics, Evidence and Mistakes – we need to be able to deliver these as simply and abundantly as we deliver clean water.
We need to take pure research and systematically review it to produce guidance that goes into the “water supply” and then comes out of the tap. What we’re introducing in NHS bodies is a Chief Knowledge Officer – because you need energy to make knowledge appear everywhere.
So how might this come together? In the past we’ve given knowledge to clinicians who’ve then passed it on to patients, now our principles are that we give knowledge to patients and give them the opportunity to discuss it with clinicians. What is the best structure for financing and organising healthcare in 21C? – it doesn’t matter – you just have to decide how much to spend, how to allocate it and maximise use of resources. We should be thinking systems rather than structures, recognising the network that runs alongside every bureacracy is responsible for innovation.
And this will help us move from thinking about hospitals, trusts etc to thinking about our core business – the treatment of disease.
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This reads like a collection of opaque, hyperbolic statements. I will comment on two:
“We need to take pure research and systematically review it to produce guidance that goes into the “water supply” and then comes out of the tap. What we’re introducing in NHS bodies is a Chief Knowledge Officer – because you need energy to make knowledge appear everywhere.”
For most people in healthcare, it is an absolute truism that healthcare decisions should be made on best available evidence. The problems are: how can this evidence be distilled into applicable guidelines, without under- and overstatements? How can we make sure that the guidelines are followed in a sensitive manner? How can we make sure that patients are motivated to follow guidelines (e.g. not to ask for antibiotics for viral infections)?
“What is the best structure for financing and organising healthcare in 21C? – it doesn’t matter – you just have to decide how much to spend, how to allocate it and maximise use of resources. We should be thinking systems rather than structures, recognising the network that runs alongside every bureacracy is responsible for innovation.”
Seems to be an noncomittal, tautologic answer … like: “What is the best way to end worldwide poverty? Uhm … decide how much to spend, how to allocate it and maximise use of resources … and don’t forget to think in systems rather than structures!”
I could be wrong, but I do not see much substance here. Happy to stand corrected and learn more.
for the past 2 decades most industries have thought about the velocity of business. At the primary care level, we’re still advancing by improving the “veolcity” of the provision of patient care.
I’m conflicted hearing this kind of talk from the NHS though. It’s all the right observations but the evidence, as I see, it is that they have a major implementation problem in their lean programs (lean vs LAME?). My theory is that that they’ve failed to engage the core staff providing care and are trying a top down approach.
How do you organize care in the 21C? You need to engage and motivate providers. You need to give the information to make it better/faster. If they are not given the motivation, information, tools or control the process is doomed to fail.
http://www.waittimes.blogspot.com
Online patient groups are a terrific example of this. The body of knowlege on many of these sites is immense. The collective wisdom of the group, while of course no substitute for the expert physician (but is in addition to the expert physician), allows for great discourse on effectiveness, doctor referrals, treatment of side effects and more. And, this is an evolution just now in its infancy.
“Knowledge is the enemy of disease, the application of what we know will have a bigger impact than any drug or technology likely to be introduced in the next decade. I’m talking about three types of knowledge here Statistics, Evidence and Mistakes – we need to be able to deliver these as simply and abundantly as we deliver clean water.”
Translating statistics, evidence and mistakes in simple terms so lay people can understand is challenging. I want to know how this knowledge supply will be delivered? In America, journalists historically have played a major role in that delivery. Well, they’re being thrown to the wayside. Who/what is replacing them? I realize the response here may be Health 2.0 companies, but what standards exist to make sure they’re providing honest, reliable representations of this health knowledge?