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EDITOR'S CHOICE: Richard Smith Need good results? Fiddle them BMJ 2003; 326: 0-e [Full text]

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Fiddling while Rome Burns?

Annabelle L Mark   (17 May 2003)

Need good results? Find satisfaction in good practice

Canavese Caterina, Emanuela Maddalena, Giovannino Ciccone ,and Piero Stratta   (12 June 2003)

Fiddling while Rome Burns? 17 May 2003
Annabelle L Mark, Professor of Healthcare Organisation Middlesex University Business School Send response to journal: Re: Fiddling while Rome Burns?	What you describe as a maxim of management is rather a maxim of poor management, which even the health service has woken up to in responding in this way. It is heartening how ever to see that the medical profession is waking up to some of the downsides of the type of systems thinking at the heart of this, which in trying to make everything explicit leads to this kind of result. Perhaps by allowing a little more of the paradox to break through which is at the heart of much of both medical and managerial reality and matching that to patient experience rather than organisational numbers we might find ourselves nearer the truth. Competing interests:   None declared
Need good results? Find satisfaction in good practice 12 June 2003
Canavese Caterina, Nephrologist Molinette Hospital, Torino, Italy, Emanuela Maddalena, Giovannino Ciccone ,and Piero Stratta Send response to journal: Re: Need good results? Find satisfaction in good practice	The Editor's choice from Richard Smith ( 17 May, BMJ)1 depicts in a terribly fascinating way a method for obtaining good results, that is, make them up. The editor wrote: " It's not surprising that people play the system when the results have consequences". But what consequences ? Funding, extra resources, economic incentives. No more? Do well a single week in order to obtain convenient distribution of sticks and carrots, independently from the other weeks and our feeling about our work? Please, let me be naïf, let me remember other reasons for doing well not for a week, but always. We have taken an oath, we have, every day, the possibility of improving our knowledge and helping people, and we can find simple, profound satisfaction in our doing well every day. How can we live without realizing some dreams? Please, let we make the ideal real. We can find satisfaction in good practice, as the best satisfaction may be do as we would like other do for us in similar situations. Too naïf? Possibly. Anyway, perhaps better than just to wait for some more money. We began by preaching, so why not end with a sermon? Good results may derive from good practice and may produce good satisfaction. Satisfaction derived from knowledge and feeling of doing well may help us to live, and, as incentive, may work better than other carrots. Rewarding for quality: satisfaction, a new incentive, emerges to improve healthcare and promote best practice. Caterina Canavese1 , Emanuela Maddalena1, Giovannino Ciccone2 and Piero Stratta1 Departments of Internal Medicine, Section Nephrology1 and Unit Cancer2 and Epidemiology of the University of Torino, Molinette Hospital, Torino, Italy 1) Smith R Need good results? Fiddle them BMJ 2003:326 Competing interests:   None declared