As we approach the next International Consortium for Health Outcomes Measurement (ICHOM) conference in November (http://www.ichom.org/news/conferences/), we thought it was time to recollect one of the most touching outcomes talks from last year, “From Bedside to Boardroom: the Pursuit of Transparency” by Beth Daley Ullem. In the talk, through telling her personal story, Beth describes the true importance of outcomes.
Talking as a guest on BBC Radio4’s today programme this morning (15th August 2014) was Dr Martin McShane, NHS England Director of the care for Long Term Conditions. Recently there has been lots of discussion on the importance of reducing the stigma associated with mental illness. It can be claimed that stigma is not only present in everyday life, but also in the healthcare system itself.
On Wednesday 16th July, OBH in partnership with TableCrowd invited a number of Health Tech start-ups for a first ever health tech dinner for founders, CEOs, and other health tech enthusiasts. The dinner was indeed unique: we wanted to liberate ourselves from common but at the same time restricting seminar/talk format and move towards something akin to French salons – have dinner, wine, a bit of exclusivity and a lot of in engaging, yet spontaneous conversations.
“Start-up”, what a great phrase; a punchy two-syllables that conjures pictures of young people in a garage (or equally insufficient workspace), flooded with work yet awash with enthusiasm, people who have ‘stuck-it-to-the-man’, ‘done-it-their-way’, ‘shaken-things-up’. People on the forefront of their fields, people with the initiative and pluck to take a risk, people sculpting the very future we will live in. Gosh, what must it be like to work for a start-up?
It’s exactly like that. At least for me, working at OBH, it fits the stereotype. Albeit we’re perhaps doing better than a garage-conversion, given we have top-floor offices overlooking Cavendish Square London, but when everyone is there at the same time, things are definitely ‘cosy’, perhaps sometimes ‘snug’, in fact we may only be a extra few square feet short of ‘intimate’. Just this week, given the unenviable task of transcribing reams of A1 posters at my bantam-workspace, I climbed out onto a large flat section of our roof on a fortuitously sunny and gust-less afternoon; my colleagues later described this as ‘…innovative’ with a preceding pause and cautionary intonation that left me in no doubt that they actually thought I was a moron and my actions were not innovative but plain uncouth. That being said – I like that we work close together. In fact I wouldn’t want any more room then we already have. Ideas are shared quickly, the ‘hierarchy’ is practically supine and there is strong sense of fraternity (in fact I’d go so far as to say there are also quiet undertones of liberté and egalité).
As for flooded with work – we are deluged with it. It would probably take me the good part of an hour to decipher to the ‘to-do-list’ scrawl running across the whiteboards on all walls but one; ‘to-do-list’ sounds a little banal and perhaps it does our boards a disservice; it’s more of a non-sequitur stream of information that we need in order to get done whatever it is we are currently doing (I once saw “get Harry business cards” on there but it was promptly erased and replaced by something that probably contained the words ‘synergy’ ‘disruptive-innovation’ and ‘big data’ – I don’t blame them, beyond possibly my mother and identity thieves, nobody wants a card with my name, place of work and contact details on). The volume and turnover of work means there is never any shortage of projects going on at anyone time, the work is always varied and new interesting things are continually coming to the forefront.
Are we awash with enthusiasm? We have bucket-loads – wheelbarrows of enthusiasm – seriously. That’s the best thing about start-ups isn’t it? By the very nature of their size, recency of conception and premise of doing things in an, as yet, un-tried-and-untested way they attract people who are not only creative and hard-working, but who are dyed-in-the-wool committed to the cause – whatever that new ‘cause’ may be. For us that cause is people’s health. Specifically, how can we improve peoples’ health by looking at the outcomes that matter to them and organising care around those outcomes. The people I work with care about peoples’ health and believe that through our combined efforts we can make people healthier and happier. How could anyone not be excited by that?
What’s the point of having an on/off button on your phone? Encouraging Jobs’ new thinking unleashed a myriad of different and often better designs for powering up devices. So, what was it that allowed all these different ways of achieving the same result to flourish? More specifically, the question we should be asking is: how can we design the care system to help, rather than hinder, what patients are trying to achieve? As a junior doctor and GP, I was as frustrated as patients at all the seemingly pointless processes we both ‘had’ to jump through, even if we both knew they were detrimental to the overall objective. One day a patient confronted me with her long-winded route to getting help. But that is how the system is set up. And it is bonkers. We need to focus on outcomes. You might say that it’s hard to define and measure outcomes. It’s a good question, but there are solutions. In the meantime, let’s figure out what people want from treatment at a GP surgery or the hospital. Let’s figure out our outcomes before we start re-inventing the on/off button.