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Chris Williams: When will we learn HOW to deliver healthcare?

1 May, 12 | by BMJ

If I had one thing in healthcare to banish to my room 101, the choice would be easy: waste, inefficiency, and delays. “That’s three things”’ I hear you shout. Yes OK, but: in the NHS they go hand in hand; they are part of the guise that Andrew Lansley used to push through his dubious reforms; and in the face of mounting national debt, efficiency, and value for money would make healthcare more sustainable. Furthermore, Nick Hancock/Paul Merton/Frank Skinner let you have three, so hear me out.

Recently my rugby-loving younger cousin had a bad break of his collarbone. Outside their 22, a quick break from a ruck, turn of pace from the young number 10, just the fullback to beat, no support, tries the hand-off, huge hit, bad fall: broken collar bone. Thankfully here in the UK our NHS can provide healthcare from the emergency through to rehabilitation, all free at the point of delivery. At first presentation to A&E the surgical books were full: “come back after the weekend.” Tuesday: “no beds.” Wednesday: “no theatre space.” Thursday: promised a bed by the over-worked, stressed bed manager, and space in theatre for the surgeon to work. Problem: no plates for the operation.

I—and most patients—have no problem with cancellation or delay of surgery for the benefit of another patient with greater clinical need. For simple logistical problems, however, no arguments hold water. This is my most recent story, but we have all heard it before from exasperated patients, family members, and friends. Blaming it on the unchangeable system is a fallacy. How long do we have to hear about incessant delays, unnecessary waste, and blind inefficiency before something is done about it?

Top down thinking may argue that the front line staff should be more empowered. Doctors running the delivery of healthcare and managing the budgets: the people who see patients everyday and know what to do for them and the public. While this has broad appeal it is a weak argument when critically analysed. Doctors may be experts in the what, where, when, and why of diseases and their remedies, but not necessarily the HOW.

Often to make advances in one field, we must draw lessons and learn from (copy) another. Humanitarians are experts in delivering healthcare, and other basic needs to people within contexts of conflict, disaster, and instability. The public perception may be that organisations such as Medicines Sans Frontiers (MSF) are made up solely of doctors and nurses. A doctor on his/her own, however, would not be able to deliver healthcare—they would need to: order supplies of drugs and equipment; source food and water for themselves and patients; ensure security and protection; fix broken equipment. The HOW is not organised by frontline doctors, but by the HOW expert: logisticians.

Beneath the national director come the directors of healthcare and logistics. Separate departments, with separate areas of expertise. The doctors provide the what, and the logisticians provide the how. So when my cousin—your friend, parent, or patient—presents at A&E, and the surgeon prescribes a healthy dose of emergency surgery, the logistician’s next question would be “when do you need it done?” At best, the patient knows when the operation will be happening—bed, theatre, plates and all—and will not have to present five times while individual problems are addressed. At worst, we have increased accountability and transparency.

So where will these logisticians come from? Well, there’s a certain military force whose jobs are becoming increasingly redundant. We have been over reaching since the days of British Empire: we now have a shiny, new aircraft carrier but cannot afford any planes to fly off it. Initiatives have seen ex-military men and women turn to trouble schools to teach and maintain order. Yet the NHS may also benefit from skilled logistics personnel, with their efficiency, order, and getting the job done ability.

Bad news spreads: patients will tell all who will listen about their ordeal in hospital, but far fewer will retell the stories of kindness and good practice. To ignore complaints is to let them spread and erode public trust in our NHS. Current problems in the delivery of healthcare in the NHS are opportunities to improve. New technologies such as mobile phones and telemedicine are proving that changing how we deliver healthcare can make vast improvements in individuals’ health and wellbeing.

Healthcare delivery is an art. Medical staff are the vital resource in the NHS: cogs in the vast machine of healthcare. Logisticians may be the much needed oil, allowing staff to do their jobs, without having to worry about all the other pieces of the puzzle that must fit into place before they can help their patients. This is not about a new level of bureaucracy or another form to fill in, this is adding the human element to facilitating the timely, efficient, and de-stressed delivery of healthcare to people in need: like my young cousin, who—better late than never—has his collar bone back in the right position.

Chris Williams is a medical student at the University of Liverpool, currently intercalating at the Liverpool School of Tropical Medicine for an MSc in Humanitarian studies.

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  • http://twitter.com/dimercaprol Dimer Caprol

    You are quite right. But do you think logistics people are all equal? My feeling is that there are good and bad ones and with public pay and pensions (for the same qualifications) being lower than in the private sector, why should the good ones choose to work for the NHS?

  • http://twitter.com/ChrisGeeW Chris Williams

    For sure there are always people that are better at their jobs than others, but I don’t think people are driven solely by pay and pensions – otherwise no one would work for many humanitarian organisations. Having a logistician in the multidisciplinary team would at least increase accountability for the perpetual flaws in the flow of healthcare delivery to patients – and maybe start learning lessons to avoid repeated, usually simple, mistakes. And why work for the NHS? Well why does anyone? It’s a fantastic institution, one of the best health systems in the world, and I will gladly work for it even though more money could be made elsewhere. With the money saved in efficiency, we could probably pay these logs a tidy wage too!

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