This investigation identifies 138 contradictions, the summary and conclusion sections are thick with contradictions - so what do we mean by contradiction? I will start with one which we are all very familiar with…
“A huge amount of time is lost to handover delays where ambulances
arrive at emergency departments but there is no space for their patients.” Page 88
The word “but” is a conjunctive and the contradiction pivots around the word, it clearly identifies a place to innovate.
Rob Horton, CEO of Akumen, in a previous role as Ambulance Strategic Commander concurs. Further investigation into these contradictions will reveal deeper insights.
“Much of my role whilst I was on duty was negotiating with Trusts who may have had 10-15 ambulances waiting outside, whilst others didn’t have any ambulances waiting at all. It was frustrating to experience such variation.”
So, 'contradictions' are important to recognize. The top three holders of global patents all use TRIZ (Theory of Inventive Problem Solving) methodology as a key part of their innovation process. Looking for and resolving contradictions is at the core of this method and their culture; this is no coincidence.
Here are Akumen’s favourite contradictions in Darzi’s report, of course relevant to our work.
It is hard to capture the essence of people’s emotions. But there seems to be a deeply held belief that NHS institutions are not inclusive in the sense that many staff do not feel that their work is part of a common endeavour.
o Measuring emotions and behaviour is what we do best and have been doing so for 10 years.
Response to safety incidents is dominated by personal reactions; fear of blame by colleagues and others is a significant disincentive to investigation and learning; a culture of openness is essential to patient safety, but often lacking.
o That’s why we developed “PsySafe,” actionable metrics that measure psychological safety which identifies, and benchmarks closed and open cultures by department, site, division, or hospital.
The number of formal complaints raised about NHS services has changed over time as awareness of the complaints process has risen. But it is still striking that
complaints have nearly doubled in a little over a decade…
o That’s why we have developed the capability to triangulate the narrative in patient and staff comments, complaints and compliments. Mapping them to the CQC’ framework (or a framework of choice, NHS Wales have a different structure) and creating a single actionable metric.
Mental health accounts for more than 20 per cent of the disease burden but less than 10 per cent of NHS expenditure
o That is why we have developed our mental health capability designed to triage risk & reduce therapy times based on analysing patients lived experience of their mental health. 120 million GP appointments uncover mental health issues.
With its deep and broad datasets, and the global AI hub that has emerged in the UK, the NHS could be at the forefront of this revolution with NHS patients the first to see the benefits. But to capture those opportunities, there will need to be a fundamental tilt towards technology.
It is doubtful that there is an NHS leader in the country who would not recognise that research and innovation are important. It has simply not been a high enough priority in a world where waiting lists are long, and finances are tight. But in the medium term, it is innovation that can make the NHS more sustainable.
As Darzi says, "In the NHS, what gets measured, gets funded" (pg. 81). Let's hope the new government focuses on medium-term innovation rather than short-term fixes and knee-jerk reactions that have led to the current situation. The medium term will arrive sooner than we think!
Very insightful analogy