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The right kind of contagion

 

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Friday, 8 October 2010

The right kind of contagion

Everybody talks about the importance of good practice – not just because of the immediate benefits it creates for patients and the efficiency of the NHS, but because it is infectious. Once somebody has developed a new strain, the rest of us can catch it and spread it. Pretty soon it’s endemic

That’s the theory, but if it worked we wouldn’t need a QIPP programme or NHS Networks or the many organisations that devote their time to bottling good practice and peddling it for gain or glory.

The problem is not simply the old chestnut of verification – how do we know it’s good practice? It’s a valid question, of course, but if it takes forever to answer, then we need to move on.

The other excuse is that what works in one place won’t always travel. Choose two similar environments, check your evidence, try it on a small scale. If it works, do it again. How hard can it be?

The problem is a bit of both of the above, compounded by the problem of “spread”. The germs of good ideas are not as contagious as they should be – or our immune systems are too well developed. Either way, taking good ideas and repeating them is harder than it sounds.

It would help if we had more evidence but case studies are surprisingly thin on the ground. You might think that the NHS would be littered with examples of innovations that have saved money, time and effort, reduced waste, cut out delay, frustration or anxiety for patients, made people better faster or stopped them getting ill in the first place. But such examples are thin on the ground.

The cynical view is that this is because a lot of good practice is anecdotal, lacks reliable evidence, and comes with exaggerated benefits and cunningly concealed drawbacks. Part of it stems from a defeatist notion that whatever good happens in one part of the NHS has negative consequences for another part – a perverse law of relativity which allows the bad molecules to be moved around the system but never eradicated.

The hunger for evidence remains strong – in a recent survey of PCT and practice-based commissioners, case studies came top of the list of requirements for information. Similarly, a meeting of the Healthcare Professionals Commissioning Network earlier this week agreed on the urgent need to harvest more and better case studies. The idea is not to just to collect good practice like stamps, but to develop and distribute it in an approach modelled on the 21st century music industry. The first thing you do is copy, then you improve on it and then you pass it on.

Theories are interesting but case studies are authentic. The thrill is in discovering that something can be done for real, not that it looks good on paper. Case studies are all about illustrating the possible, preventing needless reinvention and making successes repeatable in less time and with less effort than the original. Behind the headline news – cost savings, reduced referrals, more effective treatments – there is often a wealth of useful information about how it was done, the process developed to support it, the avoidable mistakes and the other lessons of hindsight.

Much of this detail is pretty dull and perhaps the difficulty of getting it down in a digestible form explains why good practice is shared less often and less effectively than it should be. If you find yourself trying to do what has already been done successfully somewhere else, the dull detail is priceless.

We don’t need to wait for GP commissioning to see good practice in action. NHS Networks has started collecting some examples of local success stories from the current system. These will be made available on disc and online later this month. Until then, we are posting excerpts from the video interviews on the NHS Networks Channel on Youtube.