2 million clinical decisions every day in the NHS
Why have we have failed to manage demand for healthcare?
The established, rather passive view is that demand is driven by demographic changes, technological advances and rising expectations.
The corporate response has been technical through QIPP schemes and financial instruments such as pricing and incentive schemes along with “whole system” pathways and patient flow methodologies. More recently through Population Health and its well placed desire to target resources to those most in need, but having no mechanisms to stop doing things for those least in need.
Looking at variation in care, both in supply and outcomes, is a promising tool, but it tends to lead again to redesigning pathways and systems rather than highlighting attitudes and beliefs.
In our blind spot is the fact that every day sees 2 million clinical decisions in the NHS. Each of these decisions is based upon a behaviour that reflects a clinician’s learning and organisational culture.
If we are serious about targeting our resources effectively, we need to take good hard look at clinical decision making as a behaviour and take collective responsibility for it.