What football teaches us about researching complex health interventionsBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8316 (Published 16 December 2012) Cite this as: BMJ 2012;345:e8316
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Who are more tribal, those working in healthcare or football fans? And who are more preoccupied with status (position in the league table)?
Competing interests: No competing interests
With the becoming of Web concept the world has abruptly changed. Now it’s very difficult to say what you can do without Internet. After the last century seventies we are living a new era characterized by the introduction of new technologies and the promotion of new concepts. The fashion words in the contemporary world are official or social accreditation, competence, quality, standard, certification, quality control …With the becoming of new electronic powerful tools now it’s not very difficult to quantitatively measure those parameters.
For making football better as spectacle it’s urgent and indispensable to change. For that the International Football Association Board are studying how to positively change with the proposal of ameliorating that wonderful spectacle.
The footballistic competence is the quality that has a sportsman of being perfect and able to perform a well playing football. It is the skill and ability demonstrated by him at the playing field for successful implementation of that game’s rulers during a match or a tournament supported by FIFA organization. It should be measured comparatively in relation to other footballers involved. This parameter changes from player to player and it emphasizes in the development of the footballer’s potential as a product of his basic formation and personal experience. From a footballistic point of view, competence is what the player is, as professional of that sport. This parameter gives an excellent idea about the ability that he has for satisfactorily performing that sport and for that, competence is an effective way for assessing his real effectiveness. It must be calculated or determined through a process in which we can watch how his performance on the playground is. Until now there aren’t official standardized criteria or viewpoints to objectively determine the quality with which a player performs on the playground. Footballers, representatives, journalists and those who run the world market of this sport, always use subjective parameters for assessing the individual and collective football team performance. Between these specialists there are serious controversies regarding this issue and most of the time, they do not coincide in their respective points of views. In order to evaluate a player, many experts consider, as the most important parameter, to watch by TV the most relevant or determining plays made by the sportsman during a game; others feel more important to watch his personal appearance, his look, or to the force with which the player attacks the opponent to recover the ball, or the way as he moves in the playing field, or how he comes near the opponent in order to prevent that the last one can receive the ball, or the quality or category of his team, or the obtained by his team results in the last tournament, or the city where he was born, or by his footballistic history or by... Not only there are big controversies among experts, but also a lot of superficiality in their estimates to analyze each parameter. The lack of clear criteria hinders the work of coaches, players’ agents, journalists, fans and in general, all members of the international family of football, to recognize and really to know who the best players are in the field. Most likely this problem is also generated because those subjective concepts are produced by expert pundits, who almost always, on insufficient knowledge, make judgments based on their personal information or comments taken from specialized journals or as happens most of the time, from watching video clips, some positive data generated at attack by the player in a match or during a tournament. The procedure for assessing individual and collective performance of a team should be a process that must consist of several stages. The first of these is to determine which objective and reliable parameters or indexes should be watched in order to assess the team professional quality for taking care and following them at practice, on the playground, in order to use them as markers or labels of productivity on the field, for all players. It is necessary to carefully write and order the information produced by the players’ work, and then organize, analyze, draw conclusions and if it is possible to make inferences and deductions.
From 1998 at the Surcolombiana University we have standardized and successfully evaluated, with excellent results, a very objective, easy, logical, and understandable method for measuring and determining the individual and collective performance of a team, accordingly the activity of their players on the playground during an official game or a tournament backed by FIFA organization. Ten years ago we have scored (annotated) the first football match, watching it by TV. Nowadays we continue having, every weekend, the same pleasant experience. We only register in blank sheets, which contain forms specially done for that proposal, play by play the work made by team footballers at the playground and then we value their performance using an Epi-Info program, also designed and done by us. We have called it EVALFUT. It is a good instrument for objectively assessing the individual and collective footballistic competences of a team, during a game or a tournament, accordingly their player performances on the playground.
The people daily work at health sector is algorithmic and there are official guides for all medical procedures with patients. Additionally we are living the video era. There are video cameras at any place of all cities around the world. They are being used by controlling people’s activity in order to optimize and make daily processes most functional, effective, and perfect. In all health organizations we have the ideal conditions for making the same procedure done for us in football. Although all daily procedures in health systems are complex we can make a lot of things using the new big possibilities offered by the new technological world.
Evaluate the people skills in health procedures is a key that decisively contributes to the permanent personnel training as it allows to identify the employees potential to strengthen it and their defects and difficulties to overcome. Knowing exactly how a person individually or collectively works allows us to find the best strategies to improve performance. For better results at practice assessment must be permanent and based in reality. Evaluator should record everything the employee does in intervention. Assessment should be comprehensive, i.e., it must take into account all aspects or dimensions of the employee’s development. It must be interpretative, easy for understanding the meaning of the process done by the worker. It must consider the true employee’s activity. It must be organized and cover all aspects of the process. It must involve both the employee and his team and should be formative to the worker to continuously improve. It must allow reorient educational processes in a timely manner in order to permanently improve.
It’s necessary to design and to build special blank sheets containing forms for collecting and registering useful information directed to evaluate the employee’s competences. Evaluator should use standards token from official guides backed by the WHO. He can watch videos where are shown all daily collective procedures done in any health clinic or dispensary. It’s necessary to make a program for processing all obtained information. Workers , at practice, always display their true skills. Those should be evident when they participate in routine procedures backed by the WHO. During each procedure’s step evaluator can observe and record all the knowledge and skills that emerge at the precise moment in which the employee interacts with others in the procedure. In health the evaluation must be external (hetero). Experienced and skilled observers as evaluators can determine how good the employee, individually and collectively, works at practice.
The permanent evaluation provides excellent information that can be used by health authorities, officials and employees in order to redirect the staff working activity and to consider new strategies in the working place. The assessment is also interesting because the results can be used for implementing new policies through which they improve the quality of daily work in clinics, hospital and other health dispensaries.
Competing interests: No competing interests
Professor Clark and colleagues present a very insightful take on “research into complex healthcare interventions” by comparing the current state-of-the-art to the sport of football and underscoring what the former can learn from the latter.1 Unfortunately, they start out with the idealistic proposition of having to choose between Lionel Messi and Alex Clark, “an amateur from the University of Alberta, Canada” in forming one’s team.
Granted that Silver Arrows FC would prefer Mr. Messi over Mr. Clark, the fact of the matter is the choice is not between the two men but rather between Mr. Clark and others in his price range – and if we accept that the a football player’s skills are reflected in his market value – and stature. As such hard reality qualifies the choice set that one faces.2-3
That we ask rather simplistic questions and simplify things does not necessarily mean that we are ignoring complexity inherent in health and health care but reflects the way we deal with reality.4-5 This is especially true in the area of health economics with its propensity to work on models of real life and which proceeds on assumptions that are simplistic if not fail to capture reality.6-7
To be sure, we can do better in terms of the questions we pose, the methods we employ in investigating answers as well as translate them to solutions to vexing problems. The nature of the beast that is (professional) football, should not be missed, however, if we are to truly learn from it. Given that institutions matter in both football and health care, given the choice between Lionel Messi and Wayne Rooney, who do you want to be on your team?
1 Clark AM, Briffa TG, Thirsk L, et al. What football teaches us about researching complex health interventions. BMJ 2012;345:e8316.
2 Carrera P. 2008. Investing health care resources. Health Affairs (Milwood), 27(1): 301-302.
3 Savedoff WD. What Should A Country Spend On Health Care? Health Aff. 2007;26(4):962-970.
4 Huber M, Knottnerus JA, Green L et al. How should we define health? BMJ. 2011;343:235-237.
5 Oliver A. Markets and targets in the English National Health Service: is there a role for behavioral economics? J Health Polit Policy Law. 2012; 37(4):647-64.
6 Carrera P. Tell me who your friends are: “Peers” in comparing health care systems. Value Health. 2011;14(7):A363.
7 Beutels P, Edmunds WJ, Smith RD. Partially wrong? Partial equilibrium and the economic analysis of public health emergencies of international concern. Health Econ. 2008;17(11):1317-22.
8 Burgess JF Jr., Maciejewski ML, Bryson CL, et al. Importance of health system context for evaluating utilization patterns across systems. Health Econ. 2011 Feb;20(2):239-51.
9 Carrera P, Bridges J. 2008. Health financing reforms in Germany: The relevance of all stakeholders. Harvard Health Policy Review, 9(1): 17-25.
Competing interests: No competing interests