Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Lord darzi
- neil j hughes (4 July 2008)
-
‘Darzi, Darzi, give us your answer, do .....’
- William G. Pickering. (5 July 2008)
-
Re: Lord darzi
- Peter W Ward (5 July 2008)
|
|
|||
|
neil j hughes, 3rd year medical student St Georges' University of London,Cranmer Terrace London, SW17 0RE
Send response to journal:
|
Clinical Dashboards and Open Kimonos My admission: In a previous life I was a sultan of spin. I was the designer of the Emperors new clothes and a placer of a pot of gold at the foot of the rainbow. In short I know something about dashboards. I worked in the fields of corporate venturing and management consultancy for 7 years. When I read that Lord Darzi and his boss Alan Johnson were championing the clinical dashboard I felt moved to write. Dashboards can provoke profound motivation. So Lord Darzi wants us to adopt this management information tool and display it in hospital foyers. There is no doubt that they are an attractive tool. The claim is that they take the complexity of running a large organisation and produce simplicity, the equivalent of management information sound bites. Its root analogy is the bridge of a ship where the captain can view which direction the ship is going, at what speed, how much fuel is left and have warning of any problems the engine is having. Arrays of colourful indicators – traffic lights – Red, Amber and Green - that at one glance can help you see how things are going. Search on Google and you will see that clinical dashboards are not a new idea. There are over a million results. There are companies producing the software engine that will provide the statistics. There are “consultants” who will help you decide what to show on your dashboard and even where to display it. There is no shortage of public and private organisations that have adopted them. And I have news for Lord Darzi - the NHS has already met the “dashboard”. Results 1-10 of the above Google search show that the Barts and London and the Royal College of Obstetrics and Gynaecology are practiced users. There is no doubt that managers love dashboards the question is why? And should we be worried? How is a dashboard constructed? First decide what you want to measure. What are the key data determinants that will show you that your organisation is moving in the right direction and importantly show you where problems may be brewing? So for a management team in a hospital what might these things be? Budget against spend, waiting lists, A and E breeches, procedural success rates and so on. Two immediate problems show themselves. First of all these are measurements against targets which are set at a moment in time. The psychology is important here. When setting these targets managers are one or both of two things. Extremely conservative – after all they know they are going to be judged on them. Testosterone fuelled, setting targets that show they are a thrusting team. They are not just unwilling but are unable to let anything stand in their way of achieving these targets! In the first instance is there any point in measuring the speed of the tortoise and in the second effort will be employed on failing to meet the expectations of exaggerated capability. The Natural History of the dashboard. In summary they arrive to a large fanfare, they work, they work too well, they are fudged and then withdrawn. Or put another way at first they are managed in public and then become managed in private. A Kentuckian management consultant once told me – “once you open your kimono you better have something worth showing”. So what happens? The targets are set and displayed and the energy with which they are pursued means that red turn’s amber and amber green. Of course it’s the easy stuff that gets done first. The more difficult things move at a slower rate. The managers then decide that they are going too slowly and start to introduce a text commentary to explain the dashboard. They then realise that some of the testosterone targets are unachievable. Adaptations and omissions are made. Dashboard 2.0 is released. And so it goes. Eventually the dashboard is withdrawn and like son in prison – is never mentioned again. Is there a message? Underneath the cynicism I hope I have relayed that the dashboard is a useful tool. I have one now usefully employed telling me how woefully behind I am with my finals revision. Who is it useful for though? Back to the root analogy – It’s useful for the Captain not the passengers. By making a dashboard public you assure its failure. It’s essential for the person at the helm to have a simple means of assessing how things are going. However, the complexity of what lies beneath needs a depth of understanding and the ability to change course and do what needs to be done to keep the ship moving. So a message to Lord Darzi - please sir, keep your kimono closed. Competing interests: None declared |
|||
|
|
|||
|
William G. Pickering., Doctor NE3 4AL
Send response to journal:
|
‘Darzi, Darzi, give us your answer, do .....’ Darzi’s CV defines he is an accomplished surgeon who has worked in the UK state health services for much of his working life [Ref 1]. He has progressed ever upwards in this salaried service, is therefore a compliant and a trusted fitter-in, and he has a clinical career to be proud of. Does this medley of achievements invest him with wisdom and vision beyond that of others? Does competent orthodoxy entitle or disentitle people to inform change? By contrast, there is also, we know, competent heterodoxy — within which species, for example, are military generals, occasional politicians, and even doctors. By serendipitous bureaucratic error, they pop up just in time in their respective fields to win life-saving battles utilising undreamt-of (and unconventional) method, when all had looked lost. We are not surprised to hear a medical mainstay like Darzi parrot such terms as ‘patient satisfaction’: even though we remember uneasily the ‘satisfied’ patients of certain infamous doctors. ‘Patient satisfaction’ has a politico-sonorous ring though, and sits so beautifully alongside a tick box. But some feel it rather attenuates a clinical story to the point of telling us very little or even the wrong story [Ref 2]. It should not be confused with ‘customer satisfaction’ when a product, if faulty, can be returned for a new one. Medicine is usually a little different. ‘All healthcare providers working for the NHS will be legally obliged to publish "quality accounts" on safety, patients’ experience, and clinical outcomes’. We must fervently hope no one mistakes “quality accounts” for the real thing — independent clinical accountability [Refs 3,4]. If that mentality (self-regulation) took hold elsewhere, the government might feel able to pension off tax inspectors and traffic police. A Chief Medical officer, regarding clinical errors, implored doctors to have ‘a duty of candour’ [Ref 5]. This noble (but naďve) idea was consigned to oblivion by the medical profession. Darzi, of course, has no desire to disturb the status quo in which he has been steeped for so long, and “quality accounts,” he may think, will dupe the gullible and keep the profession on-side. William G Pickering 5.7.08 wgpi@hotmail.com References: 1. www.nhshistory.net/cvdarzi.htm 2. Pickering W G. Patient satisfaction: an imperfect measurement of quality medicine. Journal of Medical Ethics. 1993; 19: 121-122. 3. Pickering W G. Systematic clinical accountability is required. BMJ, Nov 2003; 327: 1109 ; doi:10.1136/bmj.327.7423.1109 4. Pickering WG. An independent medical inspectorate. In: Gladstone D, ed. Regulating doctors. London: Institute for the Study of Civil Society, 2000: 47-63. (Civitas). 5. NHS staff should inform patients of negligent acts. News BMJ 2003;327:7 (5 July), doi:10. 1136/bmj.327.7405.7 Competing interests: None declared |
|||
|
|
|||
|
Peter W Ward, GP Gateshead NE8 1NR
Send response to journal:
|
BMJ. Commission Neil Hughes to write a proper article about this please. He's got a wonderful insight into this management speak. Competing interests: None declared |
|||