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Pride and Joy

Healthcare systems appear complex. Each patient requires the efforts of many different resources—both people and equipment—before they are clinically fit to go home or move to the next stage of their healthcare journey. The most common response to this seeming complexity is to divide the system into parts and manage and measure each part in an attempt to improve the whole. Such an approach may have an impact when the number of system variables are relatively small and the variability within each dimension is relatively small. However, our health systems are an example where almost the opposite extreme is true: we face the perfect storm.

When healthcare spend is rising and rising as a percentage of GDP—which is the case for most countries—the affordability of care comes into question, as we so often see played out in headlines across the globe. The problem is not isolated to the UK. Unless things change, the only way to sustain the position is to ensure GDP grows faster than the growth in healthcare. The other, less palatable, option is for healthcare to be rationed. While, for example, the UK and the US health systems are different, the UK does have a cost of healthcare per head of less than half of that in the US—two countries separated by an ocean are suffering the same underlying dilemma: increase spend on healthcare versus reduce spend on healthcare. It is not a matter of choosing one approach over the other; both have their flaws.

My hypothesis is that it is not the nature of the systems that is the problem, it is the basis of our response.

Pride and Joy is a novel about a struggling, fictional hospital. The first third focuses on answering the questions, 'Why is there a need for change?' and 'What to change?' The analysis is based upon the typical situation found at a local level.

The middle third of the book applies the Theory of Constraints (TOC) to the hospital's major streams of care and links in the healthcare chain. The Theory of Constraints was invented by Dr Eliyahu M. Goldratt and is best known through his book, The Goal. TOC is based on the belief of inherent simplicity—that in any goal-oriented system there are only ever a few places that have the power to affect the performance of the whole system: the weakest link(s)/constraint(s). In Pride and Joy the TOC principles have been adapted to fit the healthcare environment and through logical derivation the reader sees how the ideas are practical, common sense and can be implemented in a short timescale to achieve unprecedented results.

The final part of the book demonstrates how a nation can safely, and in an affordable envelope, achieve a breakthrough in performance at a national level and provides a working hypothesis for a global solution that involves a change in mindset of all stakeholders in the chain.

The book has been written as a novel to address a major point: such a paradigm shift in thinking needs to occur at all levels of the system—preferably simultaneously. As such, the audience for this book is anyone who is involved in, interested in and responsible for health care at a local, national and global level.