In my other two blogs on how to run the NHS I noted the need to slice the NHS services into those for the up to 18 months of age services, those for people in their last 18 months and all the rest.
All the rest logically splits into accident and emergency services and true ‘health promotion’ services. Those splits come from a reasoned understanding of the different contexts within which the NHS currently works, contexts related to risk (catalytic or progressive), how collaborative change is and how complex the problems and solutions are.
I also noted that for elderly care the thinking processes need to be intuitive and creative, reasoning helps but does not drive the decision making.
So, what about the health side of the health system? That is, what about how we would influence people as the public and the people who provide ‘health’ services’ (not illness services)?
Although the idea of the Nudge is popular, mostly that is how much effect you get, a small movement here and a small change there. It is interesting that the chapters on health and nudging in that book are on prescription drugs, organ donation and saving the planet. Jamie Oliver has huge influence but even he has had to push and push for healthier food in schools and meets parental resistance and student disinterest.
That’s not to say you don’t want to try nudging, and eventually, bit by bit, you get close enough to be able to take more drastic action, as happened and is still happening over cigarettes.
But a short list of what you would like to do suggests that we are going to have to do an awful lot of nudging to get close to improving the health of the nation by more than a few percentage points.
Apart from excessive drinking and eating (and smoking in certain sections of the population, including young girls), and drug taking, illegal and legal, to excess, we have lack of exercise, poor dietary habits (fast food and junk food and calorie rich drinks) negative social skills and unhealthy mental attitudes, high risk behaviours (speeding on the road and a desire for extreme sports without sufficient safeguards) and self harming, including suicide.
The approach to these problems has tended to be rational, surely, those in authority wish to say, ;if we can only inform people about how dangerous these things are then people will change their behaviours’, but of course they don’t. Gruesome pictures of what drugs do to you, how people have died in car crashes, how bad obesity is for your general health including diabetes and bone wear, do have some affect, but not much. When people hit 16 stone they pretty much know they are overweight and even those whose weight is substantially muscle get the picture that this kind of lifestyle is pretty temporary.
This is where adoption of creative thinking is most likely to win out.
Well, as it stands the problems look complicated, but one of the great advantages of creativity is its ability to find shortcuts. Suddenly, instead of looking at something that seems inevitably complex and slow to change becomes open to short term shifts of much bigger magnitude.
The creative feature of a solution may not always be the big part of the design, sometimes it can be a small part. In that kind of situation there was always a solution available but no-one thought it possible to solve some small aspect and so the idea would be killed off.
A good example for me in the anti-smoking campaign was not the health warnings, not the ever increasing prices of smoking, those these helped. The most dramatic shift was not banning smoking in pubs it was making the licensees responsible for ensuring smoking didn’t occur.
Now if you say, well, that is logical, my reply would be that serving alcohol to underage drinkers is illegal, as is serving people who are drunk, but it happens all the time. So it would have been very logical to think that licensees would have taken the same blind eye to smoking, but they didn’t. So they did not rule out the idea of banning smoking in pubs because it would not work that well. And there was a lot of opposition, including from the alcohol industry which forecast mass closures of pubs (which has happened, but not just because of smoking bans).
A creative approach is one which is willing to ask, despite reason, despite evidence which suggests the contrary, despite even an intuition that it might not work, maybe we should try it because this time it might work!
So creative thinking is needed because we need to challenge our reasoning and our intuition,, sometimes, but only when the context is right! Creative thinking can make things worse if applied in the wrong context, with high catalytic risk, that is, get it wrong and it all goes out the window.
We still don’t apply creative thinking to speeding. One oft suggested creative solution to speeding is to place a long spike on the steering wheel so any crash means instant death for the driver! That is the kind of thinking that challenges the status quo. OK, so not a spike, but what if it was a simple picture in the centre of every steering column with a child’s picture and a hand out, saying, slow!
Creative thinking works best when a possibility exists to make huge changes from simple ideas and simple actions. When dealing with people creativity works, sometimes. Reasoning doesn’t often work and intuition sometimes is a good guide and sometimes not.
Where reasoning and intuition are likely to act counter to creative solutions you need good leaders who are willing to go all the way to see if it might be possible to get that simple creative solution. You need good process which avoids the best ideas being dumped early on. I remember once coming to the end of a process of generating ideas for the future of a business and the boss said it was a good session with lots learned, but he was disappointed we didn’t get any really radical ideas.
So I went back to the original ideas sheet and showed him he had rejected all of the really radical ideas, so next time he had to behave differently.
The nation is much much more unhealthy than it needs to be and the cost is enormous and growing. For the NHS there has to be a split so that people who are charged with trying to get to a more healthy population can strike out in creative ways with a different kind of balance in approach to looking for those great ideas. They need to be more like a creative marketing agency, winning contracts with big rewards for success, because we need success.
Success in this field means we can afford decent care for the final stages of life, and the very best responses to the accident and emergency needs, which we might all have to call on from time to time.