Rain, risk and redesign

It’s come as a shock to me to discover that teenage cousins in California have a “rain schedule” at school. Basically when it rains, children are kept indoors in their classrooms.  If this were the case in England our children would probably never see daylight!  Rain is seen as bad, something to be avoided – wrong even. Apart from my concern that they are disconnected from the realities and needs of life on earth, I was provoked into thinking about risk and perception.

One of the reasons for the corralling indoors is to reduce the risk of colds and flu (though this is a fallacious one), that they don’t have the clothes for wet weather (really?) and they might slip and injure themselves. We have the health and safety elves in England too, so overly risk averse behaviour is one we know well. However, all learning involves some risk.

In healthcare, I wonder what we are perceiving as so risky that we reduce the ability for anyone to learn. Health services are by their nature risky and much of the safety discipline is about reuing that risk. But is there something else we’re doing that we don’t recognise as limiting learning?

The only thing I can think of at the moment is the way we redesign (improve, change) services. The predominance of the Improvement Model and the attending PDSA cycles are a way in which we reduce risk, and I think, may actually reduce learning rather than enhance it.  I’m open to other thoughts and perceptions about this – please leave a comment on this blog if you feel differently.

Innovative changes to care pathways can increase hospital admissions

Innovative changes to care pathways can increase hospital admissions - really? Well, a report from the Nuffield Trust in March 2011 suggests there is little or no evidence that community interventions lead to a reduction in hospital use.

The report is a good one with a firm research founding - in the absence of any randomised control data. It points out that redesigning pathways can discover unmet need which may account for an increase in hospital attendance.

What caught my attention was that using their own data, each of the eight interventions assessed demonstrated a reduction in hospital use. However, when compared to control groups, there was in fact an increase. This leads me to one of the ongoing issues I have with "innovation" or "improvement" projects. It's easy to come up with a measurement system and set of goals and sample size that has inbuilt biases to ensure good results - and win prizes. But in the end, improvement needs to be tested against control groups.

I recommend you read the full research report, if only to grasp the seriousness of this issue.