Yesterday I looked in a small way at how reasoning would lead to slicing the NHS into different kinds of organisations, one dealing with from pre pregnancy to 18 months old, another for the last 18 months of life and a third, for all the bits in between, which would also be split into accident/emergencies and positive health.
The splits make sense because the type of complexity and risk varies significantly between these.
The three thinking processes you can apply to tasks can be simply taken as creative, intuitive and analytical/reasoning. If you take a pictorial image of these types you have in the first, creative, anything you like in your picture which moves around however you choose, it is a dream like no rule kind of activity. In the second you dig deep to sense the big picture, and the big picture includes all your feelings and fears and hopes as well as your sensory touch, taste, hearing and seeing. Reasoning moves you into focus mode, trying to see the details down to the minutest level.
For example, if you see a snake crawling across the floor of your bedroom, reasoning might take you into thoughts about how long the teeth are so you choose cloth which would catch the teeth but not your skin. Creativity might get you reaching for your harmonica to play it a tune, and intuition might get you sensing the harm the snake intends, or not, so you decide to stay calm and slowly walk out of the room.
When it comes to the NHS and services for people in their final 18 months of life, as the issues are complex and collaborative and risk is catalytic, (any mistake down to a few microbes can be fatal), intuition is going to play a strong part, many decisions are going to be based on how you feel about what you are doing. For example, to keep the microbes out reasoning might suggest a plastic bubble, but if you only have a few months to live intuition says no, that is no way to live your last months, but that is also a collaborative decision, there may be many people and true feelings would need to be shared. And people find it hard to share feelings when confronted with reasoning and analysis. What would ‘a plastic bubble would reduce risk of infection from 5% to 4%’ really mean?
So the thinking skill most appropriate for this part of the ‘health service’ is intuition, it must be set to hold the final say on all decisions, if intuition is against it then it must be allowed to challenge all decisions.
But this does not rule out the other two. Reasoning has meant that small alcohol based cleansing solutions are placed around hospitals for visitors and maybe staff to use between each patient contact. But some are being stolen for their alcohol content. A creative solution then might be to add a red dye which also tastes foul. That way everyone could see who has cleaned their hands and who has not! A creative marketing of the idea might also be needed.
There are many end of life decisions that need to be made and the combination of thinking process would allow for good consideration of cost savings while maintaining the overall ruling that intuition is the only true arbiter of such complexity. This could well include consideration of who you employ, which might include musicians, artists, comedians as well as the odd priest of course.
Our approach to design often pushes us into Left Brain dominance, reducing everything to reason. Reason has its place, but its place depends on the nature of the problem. Adopting a one style fits all for such a complex set of services as the NHS is totally inappropriate. For elderly care, intuition rules over whatever reason and creativity bring.