Focusing on High Impact changes in the NHS may be damaging. Try MIME instead.

Identifying the "top 10" or the "top 5" high impact changes that NHS organisations can implement - then pushing them to do so, has consequences.

1. Unless the identified high impact change is shown to be generalisable (that is it has been tested in different contexts and a similar result has been achieved), then there is a significant probability that the change may not be high impact at all.  When we take one result from one place, then roll up the possible benefits across all organisations we are making a fundamental mathematical, and change process, error.   If we do want to do large scale mathematics then we need to know the baseline at each potential organisation, the match in context to the originating result, and then do a weighted calculation across the system.

2. Not all high impact changes are equal - in the amount of effort and resource (read ££££) they take to implement. A great result may sound good, but if it takes so much resource to implement that the payback time is 10, 15 or even 20 years, then yes it is high impact - but not in the way intended.  The challenge is to find a way to get the impact - but with less cost associated in the process of doing so.


MIME = Maximum Impact, Minimum Effort.


(and of course, LIME, low impact, maximum effort, should always be avoided)

Do your "high impact" exhortations meet the MIME challenge?