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Muir Gray

Muir Gray: How to design and plan population based systems

8 Oct, 12 | by BMJ

Muir GrayI will present the approach we use in designing and planning population based systems of care in ten short blogs.



Here are the ten steps:

  • Define the scope of the system.
  • Define the population to be served.
  • Reach agreement on the aim and objectives of the service.
  • For each objective find one or more criteria.
  • For each of the criteria identify levels of performance that can be used as quality standards.
  • Identify all the resources used in the system, thus creating a system budget.
  • Define all the partners so that they need to be engaged in a clinical network.
  • Produce a system specification.
  • Prepare a plan to build the system.

Muir Gray is visiting professor of knowledge management, Nuffield Department of Surgery, University of Oxford.

Muir Gray: Meeting the Trish Greenhalgh challenge

26 Sep, 12 | by BMJ

Muir GrayIn the debate about the NHS reforms that occupied so much Twitter space before the Health and Social Care Bill was passed, Trish Greenhalgh quite properly challenged me to use the five whys approach that Taiichi Ohno used within Toyota and that I had been advocating be used for other issues, to drill down to the root of a problem, and to support my contention that reform was necessary. [1] more…

Muir Gray: Ten essential questions that only systems can answer

6 Mar, 12 | by BMJ Group

Muir GrayI have met clinicians and patients in many parts of England in the last five years and here is a list of the type of questions that cannot be answered.

1.    Is the service for people with seizures and epilepsy in Manchester better than the service in Liverpool?

2.    Who is responsible for the headache service for people in Warrington?

3.    How many liver disease services are there in England and how many should there be?

4.    Which service for frail elderly people in London provides the best value? more…

Muir Gray: Bye bye A&E, hello SFS

9 Feb, 12 | by BMJ Group

Muir GrayReality is created by the language we use. Language creates reality rather than describing it; that is the consistent message from Ludwig Wittgenstein, Benjamin Lee Whorf, and John R Searle. If we want to change reality one way is to change the language used, and for this reason we ban, or try to ban, the use of the terms primary, secondary, acute, and community in the workshops we run, like the workshop with great participants from West Berkshire that was held on the 2 February. more…

Muir Gray: How doctors working in systems could rescue healthcare

24 Jan, 12 | by BMJ Group

Muir Gray

“We have nothing as bad as America’s worst, and nothing as good as America’s best,” wise words said to me by someone many years ago, and this principle has stood the test of time. There are certainly many dreadful things in American healthcare, but there are also wonderful services and excellent innovation with a rigorous evaluation for each of them. In my collection of ten classic articles on better value healthcare, eight come from the United States. This is a paradox. Although they have no finite budget and do not have full population coverage, the thinking and the innovation within healthcare organisations such as Kaiser, or universities such as Harvard or Dartmouth, is streets ahead of the debate in the United Kingdom. But let’s not feel too bad as we have nothing as bad as the worst, for example, the Republican views on healthcare, and the millions who are uninsured. more…

Muir Gray: The need for systems

11 Jan, 12 | by BMJ Group

Muir Gray“All of a sudden a big mealie pudden came flying through the air.” This is the opening line of a Glaswegian song, which only gets worse, about an assault by a mealie pudden, a sort of second class black pudding with the blood removed. 

On the 24 November at 11 o’clock, I experienced severe central chest pain and after what I believed to be the usual assumption of indigestion, asked my wife to drive me to a cardiac centre, fortunately only four miles away, where I had a single stent inserted in the left anterior descending very quickly.  more…

Muir Gray: Competition between systems for pride 2.0

7 Sep, 11 | by BMJ Group

Muir Gray I was born in the Borough of Partick and a couple of weeks ago watched Partick Thistle, or “Partick Thistle Nil” as they are affectionately called, for the first time for fifty years. Little had changed, with the exception of the availability of a “skinny” mutton pie on the half time menu. The competition, versus Hamilton Accies, was intense. The players committed, and the supporters were loyal. more…

Muir Gray: Competition between systems for pride is effective and essential

19 Aug, 11 | by BMJ Group

Muir GrayIs care for people with rheumatoid disease better in Liverpool or Manchester?
Is care for frail elderly people better in Somerset or Devon?
Which big city has the best service for people with bipolar disorder? more…

Muir Gray:”The most effective screening programme ever”

27 Jun, 11 | by BMJ Group

Muir Gray“The most effective screening programme ever,” this was Richard Doll’s gentle jest when I was director of national screening programmes. Aware of my efforts to ensure that screening did much more good than harm, using every improvement technique I could learn from IHI, Toyota, and wherever, he would point out that the auscultation of the heart of young recruits in the first world war led to large numbers of them being deemed to be unfit for the front because of a sign we now know to be without pathological significance – a systolic murmur. more…

Muir Gray: Ann McPherson – trilingual clinician

13 Jun, 11 | by BMJ Group

Muir Gray

The obituary by Charles Warlow of Ann McPherson showed that she was not only a bilingual but a trilingual clinician, and we have to ensure that her example will stimulate others to follow her leadership and use their experience as patients or carers to change health services for the better. more…

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