And the award goes to…

‘Congratulations Dr Kersh, you and your team have won the award for best Quality Improvement Plan 2020!’

We hear things like this from time to time.

Awards in healthcare are funny.

Essentially, if you don’t apply, you have no chance of winning. If you apply, your chance of winning is dependent on the competition. None of this necessarily reflects the actual effectiveness of what you have done.

Much of this can be condensed to two questions: Effectiveness – how meaningful is the improvement? And, Sustainability – how long have you been improving for?

With the former, if the improvement is meaningless to patient care and the award supports patient care, you haven’t really improved, equally, if the improvement is only ongoing so long as you are beating the drum, it is not sustainable and unlikely to spread.

Last week, I had a moment with the Costa people.

I was standing in the dining room at Bassetlaw Hospital – two of the coffee people were servicing one of the machines while I waited for my latte.

Costa person one opened the machine and all the sugar sachets fell on the floor.

Costa person two said, ‘They always fall out, there isn’t a lip on the door.’

Costa person one, ‘We’d better tell the continuous improvement team about that.’

And, there was I momentarily mesmerised by the interaction.

This was followed by an email I was privy to reading at the end of the week, sent by one of my colleagues in relation to a call to participate in Quality Improvement (QI).

‘I can’t believe the management can find the money to waste on such bs. All I want are my notes in clinic!’

You see the issue?

One system – the Costa, has somehow embedded, or at least introduced QI into their culture, the other, certain elements of the NHS (most often senior doctors it seems), don’t see the wood for the trees.

The response to the email was the Winnie-the-Pooh quote from Christopher Robin bumping Edward Bear down the stairs.

I thought this quite clever. But, not necessarily a sustainable way of changing behaviours or attitudes.

You see the problem?

This is all compounded by awards –

‘Do what we are doing as we won the award for best xxxx,’ ‘Our way is the best,’ this becomes what Bruce Lee worried about in relation to his martial art Jeet Kune Do – a Classical Mess (for this reason, he initially didn’t want to give it a name – The Way that is No Way).

Once a name is ascribed to a system or process and once awards are notched-up the organism starts to calcify, growth ends and any initial value becomes diluted.

Bruce Lee in the 1960’s applied QI to his method for self-defence – he famously said, ‘It is not daily increase but daily decrease – hack away the unessential!’

Perhaps this is a lesson we could adopt within the NHS.

Please share or let me know what you think!