Hard Jobs

A quote attributed to Peter Drucker, one of the great management gurus:

1. “The four hardest jobs in America (not necessarily in order) are: President of the United States, a university president, a hospital CEO, and a pastor.”
   
2. “Health care is the most difficult, chaotic, and complex industry to manage today.”
   
3. “The hospital is altogether the most complex human organization ever devised.” 

I find that hard to believe, but on mature reflection, maybe not.

Systems Thinking in healthcare

This blog just launched is well worth checking out. Based on work by Vanguard, a UK systems thinking consultancy and its CEO, John Seddon. Seddons stuff, books, papers, podcasts etc are worth checking out. There is a simplicity which hides a very deep and profound complexity in his methods. I don't think they have done much in healthcare, but read Systems Thinking in the Public Sector , and you will immediately see analogies. Value Demand and Failure Demand have become part of my vernacular. Bottom line message, our healthcare system is broken, and we need to rethink it. Positive spin, there is a huge amount of waste. Read it and decide.

A vision of the future? Bilingual healthcare workers

From the inestimable Muir Gray, (thanks Tony), one possible approach to the problems facing us. Remember Einsteins definition of insanity, doing the same thing over and over and expecting different results. I think that summarizes healthcare. The model we have is designed, or rather evolved from the post war period to deal with a different set of problems. Acute self limited, or fatal illness. Coincident with the rise in healthcare technology, probably the early 50's with the development of ICUs following polio epidemics, the healthcare-industrial complex has in part generated problems and expectations that we are no longer equipped to handle. The paradigm of how care is delivered has to change radically. There is a very interesting book published in the 80's looking at how complex societies fail. The thesis and it applies equally well to complex systems is that a system evolves to deal with a complex problem, problems become more complex, hence the system becomes more complex and eventually a point of diminishing returns is reached where the inputs (think regulation, accreditation, legislation etc) consume more resources and the system collapses.
Gray provides one possible approach to this challenge. Basically the bilingualism to which he refers is that healthcare workers must be versed in not only the ability to provide clinical care to their patients,

"They need to know how to:

• Develop systems
• Build networks of clinicians and patients
• Design pathways
• Manage knowledge
• Harness the internet’s potential
• Engage patients
• Create and manage programme budgets
• Develop the right culture"

He describes this as population medicine. It is highly recommended.