Look before you leap

Words: 350
Reading Time: 1 minute 10 seconds

Imposing financial penalties if patients are readmitted as an emergency within 30 days of being discharged is the latest wheeze from new Health Secretary Andrew Lansley, part of a Government anxious to impress.

His heart might be in the right place, but his head is reported missing.

That’s the problem when we are driven to do things that we think look good, without taking the time to examine the possible consequences from all sides. In my view there is an obligation on all novices to learn a little about their new role before changing anything – at least three months.

Not doing so can so easily lead on to unintended consequences. In this case:

Planned Outcome: no patients will be discharged until they are fully ready.

Likely Outcome: hospitals will find every conceivable reason not readmit until day 31, resulting in more patients suffering and a decline in timely, responsive treatment.

Nice one, Andrew!

To be charitable to Mr. Lansley: what brainless cretin from Central Office came up with this one?

In any walk of life you will deter the actions you penalize effectively. Those working in the NHS are as self-interested as any of us. Indeed, parts of the NHS are still run more in the interests of staff than of patients – witness the issue of ‘appointment’ times without consultation.

How can it be an appointment if only one party has taken part in the decision? But I digress.

The reverse of the penalization medal is that you encourage all actions – however deleterious – that you do not punish. It’s this aspect that opens the gates to the Law of Unintended Consequences.

A few suggestions for businesses:
1) Penalties only dictate what NOT to do, rather than promoting the specific actions you want. Start with the end in mind.
2) Start earlier in the chain of causation – like shortening in-patient time to speed up admissions – before attempting to stem the outcomes.
3) Just because your mate has jumped off a cliff (this policy originates with the Obama administration) does not mean you have to follow either his lead, or that of the crowd, blindly.

Who else would decide to wait?

Words: 211 Reading time: 0 minutes 42 seconds

At Christmas 1914 soldiers from both sides climbed out of their trenches and played football in No Man’s Land. For just a brief time those engaged in killing each other realised that war was not what they wanted and that there was probably a better way.

This spontaneous act at a human level was somewhat frowned on by those in higher command and next day they all went back to a prolonged and bitter conflict.

On a personal level, with much less dire consequences, we repeat this self-destructive cycle. We realize that what we are doing is not yielding the results we want, we know there is a better way, we may even try it for a short while, but in the end we revert back to what we were doing previously, because that’s what’s expected and it doesn’t disrupt the pattern of received wisdom.

By 1918, four years later, the protagonists eventually got round a table and arrived at a settlement. The cost would have been much less four years earlier, whatever they may have agreed at that stage.

The simple lesson learnt at such cost to everyone is: if you need to change something, do it sooner rather than later; it will be so much better for all concerned.