Bad news-the words ‘good’, ‘quick’ and ‘cheap’ are incompatible. There are no short cuts in this business. To be a successful innovator you have to be intimately familiar with the healthcare business, you have to evaluate your innovations within the very strict rules that govern how to test ideas in health and you have to enlist and fund the support of a team that can negotiate the hurdles along the way.
It takes years to develop something that might make a difference in clinical practice. First and foremost you have to know something about the business you hope to improve. Those who are more likely to become frustrated have a very limited understanding of the paradigm which operates in healthcare. In particular those who develop well meaning ideas to improve ‘prevention’ in primary care. There is a growing focus on this from the misguided view that we could all be healthy if only our family doctor would tell us to notwithstanding the many other factors that are operating to keep us fat, drunk and smoking.
As our team reported last week there is little or no redundant capacity or ‘spare time’ in the short primary care consultations to devote to delivering effective health promotion advice. In fact the attempt may harm the patient because that would take time away from a focus on the symptomatic patient’s ideas, concerns and expectations. It is possible, on some occasions that the patient is specifically seeking advice on how to lose weight, stop smoking or reduce their alcohol consumption but that is unusual. Therefore innovations that are aimed at increasing the effort on health promotion or worse still policy that redirects the doctor’s efforts in that direction may distract from the core business of communicating effectively and devoting time to the patient’s agenda rather than a public health agenda. As was reported by Richard Wender:
Practitioners and patients face three types of obstacles: provider-specific obstacles; patient-specific obstacles; and health care delivery system obstacles. Provider-specific obstacles include lack of time, distraction by other health issues, lack of expertise, lack of positive feedback, and disagreement with recommendations.
Secondly ideas that are likely to work have to be tested and shown to be promising but sadly lack of data rarely discourages people from thinking they can become rich and or famous from their latest brain wave. Testing innovations in healthcare is a painstaking and often frustrating business. Several things can and do go wrong: it is difficult to find a suitable place to test ideas; it can be challenging to get approval to test ideas on ‘real’ people; it can be difficult to source consenting subjects to test ideas in the relevant clinical settings; it requires skill to collect and interpret the data and it can take a long time to get data published following review by an independent set of experts in a reputable forum. Research in primary care in particular is not for the faint-hearted.
Finally what you need most is a team, led by a determined champion who have worked out how to negotiate the many obstacles towards a clear outcome. Such teams are rare and must be funded. Therefore it is not possible to deliver successful ideas for healthcare quickly and those who attempt it will do more harm than good.
Picture by Neil Moralee