Knowledge Like Clear, Clean Water: NHS’ Sir Muir Gray on Health Care’s Progress - Brian Klepper
Over the last year or so, I’ve written a lot about how health care
information will become increasingly available to consumers and health care
business, and how this access will drive new decision-support
capabilities that will profoundly change how health care works,
eliminating many of the problems that have placed health care in
crisis. So imagine my delight when a colleague forwarded this quote.
Sir Muir Gray is
Chief Knowledge Office of Britain’s National Health Service. His
wonderfully clear explanation of how health care knowledge will become
guidance - that is, decision-support - makes a compelling case for the
transformative power of Health 2.0.
Check it out.
The future is something we make, not something we discover. And the
future is easy to make because as William Gibson has said, the future
is here, it’s just not evenly distributed.
The second revolution took place in the latter part of the 20th
Century. It was driven by science, making plastics, airplanes,
televisions and innovation in chemical and mechanical technology in
We’re in the middle of the third Healthcare revolution. The first was
based on common sense, an empirical revolution; the health of nations
was transformed by making observations and deductions from data and
improving conditions based on those deductions. So now, for example, we
take clean clear water for granted.
We have made amazing progress, but we have though not solved the following “magnificent 8″ problems:
· Errors and mistakes,
- Poor quality healthcare,
- Unknowing variations in policy & practice,
- Poor patient experience,
- Overenthusiastic adoption of interventions of low value,
- Failure to get new evidence into practice,
- Failure to manage uncertainty.
More science and more money is not going to help these. I have
reservations about putting more money into health services, because my
experience is that this just makes people more obsessed with money.
The third revolution is different - everyone’s involved and
it’s everywhere, it’s adaptable, it’s pervasive, it’s inclusive and
I’m very much inspired by Manuel Castell’s work: The Rise of the Network Society.
The third industrial (and therefore, healthcare) revolution is driven
by citizens, IT and knowledge. Professionals are by and large two
decades off the zeitgeist and this is not restricted to healthcare,
it’s seen across all professions.
Knowledge is the enemy of disease, the application of what we know
will have a bigger impact than any drug or technology likely to be
introduced in the next decade. I’m talking about three types of
knowledge here Statistics, Evidence and Mistakes - we need to be able
to deliver these as simply and abundantly as we deliver clean water.
We need to take pure research and systematically review it
to produce guidance that goes into the “water supply” and then comes
out of the tap. What we’re introducing in NHS bodies is a Chief Knowledge Officer - because you need energy to make knowledge appear everywhere.
So how might this come together? In the past we’ve given knowledge
to clinicians who’ve then passed it on to patients, now our principles
are that we give knowledge to patients and give them the opportunity to
discuss it with clinicians. What is the best structure for financing
and organising healthcare in 21C? - it doesn’t matter - you just have
to decide how much to spend, how to allocate it and maximise use of
resources. We should be thinking systems rather than structures,
recognising the network that runs alongside every bureacracy is
responsible for innovation.
And this will help us move from thinking about hospitals, trusts etc
to thinking about our core business - the treatment of disease.