What gets you out of bed in the morning?

I’m feeling slightly abashed this evening. It’s been diabetes blog week and I’ve only managed one contribution… Well, that’s better than none, but I want to squeeze in a quickie before the week’s end.  Here goes, subject: what can get Healthcare professionals moving?

Get out of bed

Take a look at this YouTube video, https://www.youtube.com/watch?v=lOP2oxGigFQ

Focus on what he says 5 minutes 20 sec in.  It has the potential to change the face of health and healthcare delivery…

In his excellent presentation on improving patient safety Dr Peter Pronovost tells us how there are three things that may get healthcare professionals ‘out of bed in the morning’-

  1. Coercion- e.g. more/stricter regulations, more frequent CQC visits…
  2. Financial incentives- e.g. carrots if you work in primary care, sticks if you work in hospital care.
  3. Trying to inspire- coproduction: patients and healthcare professionals working together as part of a social movement

We use the first two rather a lot, but there is not much evidence that these work in the way in which they are intended.

Roy Lilly’s blogs at www.nhsmanagers.net regularly makes the strong claim that

“you cannot inspect quality into systems”.  

Businesses that understand this have learned to use quality control & management techniques to good effect, rather than inspection.

There is some evidence that incentive payments to GPs such as the quality and outcomes framework, or QoF, can have an effect. Yet look more closely and there is also a story of how incentives can lead to gaming & shifting of the goalposts.  If you don’t believe me, take a look at GP Contract website, you can look up the QoF figures and outcomes for all the conditions with incentives.

Look closely at the diabetes figures for your own practice and try and work out why a proportion of people with diabetes are excluded from a number of the indicators.  I sometimes show figures to individual practices and even they scratch their head.  Figures for diabetes care at my own GP surgery can be found here.  Why, for instance, are 62/387 people excluded from DM17 ‘cholesterol under 5.0’?  There are certainly some legitimate reasons for some patients to be excluded, but when I’ve looked at these returns, which are all linked to payment, none of this is transparent or open.

Financial reliance upon incentives creates a mindset to oppose any further developments until new extra incentives are offered.  One recent example is the move towards opening up record access to patients.  Things are beginning to happen because of incentives specifically for making and changing appointments and ordering prescription repeats.  Even though most GP systems could allow records access right now, it is rare to find this happening.  A notable exception to the rule is GP Dr Amir Hannan, his practice website is open to all and makes inspiring reading.  From next April, there will be extra incentives for all GPs to offer… very limited record access.

So how about we try number 3? It surely must be worth a go?

I do so admire that famous Margaret Mead quote:

“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.” 


Could this be the right time for a social movement that brings together patients with long-term conditions like diabetes along with healthcare professionals?

I understand many barriers stand in the way; it’s probably a good thing that I doubtless do not know them all.  What I do not accept is that these will ever be removed by fear/coecion or by being incentivised to do.

Let’s start a social movement.  Hang on… a revolution has already started.

“A social movement that only moves people is merely a revolt. A movement that changes both people and institutions is a revolution.” 
― Martin Luther King Jr.Why We Can’t Wait


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