High reliability in health care

Many industries can lead the health sector into better safety
procedures, but not all translate well across sectors. Car manufacturers
and supermarkets have developed just in time supply chains and have
outsourced almost all their core functions to subcontractors. This leaves
a so called "hollow corporation". This works were skills are basic and
easily hired then fired. It has failed spectacularly in the NHS.

The National Programme for IT / Connecting for Health awarded fat
contracts to slick multinational corporations. They seemed too big to fail.
The little established specialist national companies were sidelined. I met
these firms as they hired "warm bodies" (short term employees lacking
competence but fulfilling the contract by their presence) to do the work
of developing new software. They failed and CfH were surprised. In fact
they were bound to fail due to their business model. The skills to develop
a complex IT package for primary care have come from small firms who
completely understand the business and clinical processes of doctors, the
most sucessful firms having GPs who can instigate programmes directly. Big
corporations have suberb sales teams and legal departments but cannot
deliver sucess as they are hollow.

Similarly the idea that out of hours general practice can be
delivered by any medical practitioner who is parachuted from other parts
of the globe into a night shift is folly.
If one is to have safe care one needs to have locally embedded doctors who
know the BNF doses of diamorphine and local pathways.

Medical and Computer expertise in complex healthcare is not the same
as a supermarket supply chain where tins of beans can be translocated
round the globe just in time. We need the wisdom to adopt the safety
culture of the airline whilst rejecting the simplicity of the bean
counters.

Competing interests:
NHS GP