Samir Dawlatly: Advancing healthcare—less self-improvement, more system development

Healthcare systems are notoriously bad at embracing innovative change. The reasons for this are many, complex, and ultimately frustrating for those trying to bring about change—even those who don’t stand to benefit financially from innovation. This resistance, and other factors, may stifle change that could potentially improve the lives of our patients.

One stumbling block that makes healthcare professionals wary of change is the mantra of “First, do no harm,” and the understandable aversion to risk when the health of patients is at stake. No healthcare professional wants to expose their patients to the next healthcare scandal—the next Vioxx, vaginal mesh, or other dodgy implant. But is this just one of many excuses we use to shun innovation? Another is the assertion that we feel so stretched and overworked that we haven’t got the time to consider how we could do things better.

It is also argued that healthcare does not, on average, contribute that much to the health of our patients, and overall health can be up to 90% dependent on social factors. Instead of investing in what seems to be the diminishing returns of healthcare and health technology, perhaps as a society we should be investing instead in reducing inequality in the social determinants of health? These are valid points, but should not obviate the need or desire to continually improve healthcare.

It has been pointed out to me that meaningful change often happens in small steps, one foot at a time. So instead of blaming systemic factors that delay healthcare innovation, such as funding, ethical approval processes, subject recruitment, and the selective reporting of findings, should I instead ask myself whether I have developed a mindset that inhibits meaningful change? After all I am trying my best to make a difference for the patients I look after, but I don’t always believe I can do that much for them, as I can’t always influence the determinants of their health. Despite trying my best, this may not mean I am actually doing my best.

I already feel like I am constantly having to improve (as well as prove) how I work as a doctor, through appraisals and by collecting structured feedback from patients and colleagues regularly. It strikes me as being very introspective and that self-improvement doesn’t necessarily lead to significant advances in patient care. Perhaps I should take the focus off myself and ask my patients, “What can we do here at the surgery to improve your experience?” Using this as a starting point could help identify, albeit imperfectly, areas of care that can be changed, little by little. The focus could then shift from self-improvement to system development.

Beginning the process of change with this one question has the potential to provide fulfilment (as doctors would feel that they are making a difference) and would also improve care for patients.

Samir Dawlatly is a GP partner at Jiggins Lane Medical Centre in Birmingham. The views expressed here are his own and don’t necessarily represent those of any organisation he works for. Twitter @SDawlatly

Competing interests: I am a GP partner at Jiggins Lane Medical Centre, a partner of Our Health Partnership. I am an occasional member of the RCGP online working group on overdiagnosis.The views expressed here are my own and don’t necessarily represent those of any organisation I work for.