GUEST BLOG: Ian Powell – Effectiveology

There are few sectors that are as prone to either the overuse of meaningless jargon or the superficial misuse of otherwise credible words than health systems, particularly in more developed economies such as Aotearoa New Zealand.

This overuse and misuse, however, is not the language of health professionals. Instead it is the language of business consultants, human resource managers, and those resident in leadership bubbles.

A chat with Britain’s most prominent health blogger, Roy Lilley

Towards the end of my over 30 years as Executive Director of the Association of Salaried Medical Specialists, while supping a rather average coffee in the Kings Fund café in London, I discussed with the United Kingdom’s most prominent and forthright health blogger (Roy Lilley) what I might do after my forthcoming resignation.

When provocatively direct blends with productiveness

If I were to loosely paraphrase his advice it would be ‘blog my boy, blog’. So I did and what a stimulating therapeutic experience it has proven to be.

Roy Lilley is an extraordinary character. Provocatively direct, he never pulls his punches. But few people know how the National Health Service in the UK works than him.

He is as productive as he is provocative. This includes a widely distributed and read regular e-newsletter nhsManagers,net. It comes out daily, Monday to Friday. Further background on Lilley can be found on this link: Roy Lilley.

He also likes to give leading figures pointed nicknames, particularly Secretaries of State for Health. One (Jeremy Hunt) he called ‘Tinkerman’; Andrew Lansley, the inept architect of disastrous health legislation of 2012, was called ‘La La’.

The current incumbent, the high volume and soundbite-driven Wes Streeting, is called ‘SillyBoy’. Indications to date suggest that this is a rather kind description.

‘Simplicity is the ultimate sophistication’

There is no way in the world that I could ever emulate Lilley’s distinctive literary style. But I remain one of his regular several 100 thousand daily readers.

In the context of overuse of jargon and misuse of credible words, I was particularly struck by Lilley’s 23 September e-newsletter. His drawing upon Leonardi da Vinci’s pearl of wisdom that ‘simplicity is the ultimate sophistication’ was astute.

Aristotle and others provide more help

With a little bit of help from George Orwell, Aristotle and Thomas Aquinas, he invented his own new word, effectivelogy. Here is the critical part of this piece:

I think there’s a word missing from the English language.

I’m not sure how we’ve managed to struggle along without it. In fact, I might argue… we haven’t.

The word is ‘effectiveology’…

… the study of what works.

We have other words like evaluation and appraisal…

Effectiveology invites a concoction of common sense and simple observation.

Over the years various carpetbaggers have turned up at the department of health and pretended they know better, how to run the NHS than the professionals actually doing it.

… we can do rankings and league tables and there is always the question of judgement but ‘effectiveology’…

… well, we’re all effectiveologists because we all know, ‘just know’ if something is effective.

We all know that water companies are not effective. We all know that policies aimed at ‘stopping the boats’ aren’t going to be effective until you you sort out what it is that makes people want to leave where they come from.

Effectiveology invites a concoction of common sense and simple observation.

Over the years various carpetbaggers have turned up at the department of health and pretended they know better, how to run the NHS than the professionals actually doing it.

All the rest arrived, ‘knowing everything better than anyone else’. Upheavals and £millions later, the NHS is worse now than it has ever been.

The latest, best idea is, doing a bit of overtime is somehow going to fix the NHS. 

It gets worse, last Wednesday SillyBoy announced he plans to reject ‘status quo’ proposals…

‘… [and] warned officials he wants “bold, radical” reforms.’  

Effectiveologists will have seen all this before. This as ‘the tyranny of reform’… from the George Orwell school of management; 

‘… one does not establish a dictatorship in order to safeguard a revolution; one makes the revolution in order to establish the dictatorship…’

From; ‘1984’, Part 3, Chapter 3.

I think most of us would agree, the NHS is in a mess and three months in, the new administration, seems clueless.  

Streeting has some duffers working in a back-room trying to come up with something that is ‘bold and radical’…

… which effectiveologists will know usually means months, if not years of distraction, upheaval, argy-bargy and eye-watering sums of money forked-out to repeat the sins of the past.

Is there an effective way of looking at the NHS’ predicament and coming up with a simple fix?

Yes… it’s called the Aristotle school of management!  

He laid the foundations for ‘structure, inquiry and argument’ by asking key-questions. Later Thomas Aquinas divided questions into categories and they have evolved into the 5 W’s.

Who, why, what, when and where. For the NHS it means…

• Who is sick 
• Why are they sick
• What can we do to fix them up
• When can we do it
• Where can we do it

It’s all we need.

Who, older people and children are the heavy users of the NHS… 60% of all of us, pitch up with lifestyle related problems. About half of cancers are discovered in A&E. 

Why, because older people are unable to take care of themselves and there aren’t enough people to help them. Some families struggle to bring-up their kids without support. The rest of us eat, drink and do all the wrong things and don’t do the right things and we don’t scan enough people, early enough.

What, to do? Invest in social care, reintroduce Sure Start. Take-on the people making junk-food by taxing the junk and not taxing the rest. Focus on early diagnostics.

When, can we do it? Whenever we want to. Now would be good. 

Where, we have thousands of GP premisses, 1,257 hospitals of various sorts, 500 community hospitals and 6322 Neighbourhood Health Centres. We just need to maintain and repair what we’ve got, make sure they have modern kit and in particular, look after the people working in them to make it all productive.

In about 150 words, this looks to me, like a plan that would pass the effectiveology test.

Too simple? 

… simplicity, is the ultimate sophistication.

Applying effectiveology to New Zealand’s health system

If the simplicity of the sophistication of effectiveology was applied to Aotearoa’s health system then it would no longer be in the current terrible state of worsening crisis that it has been for several years.

This is because (among other things):

• successive governments would not have continued to neglect the effects of widespread health professional workforce shortages;
• health professionals would not be paying for the health system with their health through fatigue and burnout;
• decision-making over health services would be relocated closer to where most healthcare is provided;
• health professionals would be recognised as the main drivers of innovation and continuous quality improvement;
• legislation and policies would be put in place to overcome external social determinants of health which are the biggest drivers of healthcare demand and cost;
• all New Zealanders would have timely access to comprehensive quality diagnosis and treatment;
• the tobacco industry would not shape the direction of nicotine control (smoking and vaping) policies and strategies;
• venality-based ‘magic bullets’ such as Public Private Partnerships would not form part of the health narrative;
• hospital builds and rebuilds would be based in the first instance on what makes good clinical sense for both existing and anticipated health demand; and
• there was no Commissioner in charge of the health system.

Just saying!

My final message is that if you don’t like what I write then blame Roy Lilley. However, if you like what I write, then thank him. Just saying again!

 

Ian Powell was Executive Director of the Association of Salaried Medical Specialists, the professional union representing senior doctors and dentists in New Zealand, for over 30 years, until December 2019. He is now a health systems, labour market, and political commentator living in the small river estuary community of Otaihanga (the place by the tide). First published at Otaihanga Second Opinion