Introduction

Learning within clinical medicine often spreads rapidly across the globe. Once an innovation—for example, thrombolysis for patients with heart attacks—is accepted, it is likely to be picked up rapidly in most countries. This is because cardiologists travel to world meetings, know each other well, read the same international journals, and are encouraged to innovate by global pharmaceutical companies. In stark contrast, innovations in how care is organised and delivered have rarely spread. We examine why countries have not been good at learning from each other and some of the areas where learning between the United Kingdom and United States could be beneficial.

Barriers to learning

One obvious barrier is that healthcare systems are culturally, politically, economically, and socially bound in a way that cardiological interventions are not. This has led some people to believe that international learning is impossible. Another barrier is mutual ignorance. Health systems have become so complex that few people have a deep understanding of more than one system. Who in Britain, for example, could explain with complete confidence the workings of the NHS in England, Scotland, Wales, and Northern Ireland? This inhibits learning not only internationally but also within one nation state.

A more disturbing block to learning is a feeling that to learn from others is a sign of weakness—even failure. We saw some of this perhaps in the hostile reaction to the BMJ paper that suggested that Kaiser Permante might get significantly better outputs than the NHS for roughly similar inputs.1 There were legitimate reasons for criticising the study,2 3 but a much healthier reaction to the paper would have been to look more deeply at Kaiser and …