DIABETES - WHAT IS THE PROBLEM?

That’s a big question, certainly when you consider the NHS...

I have been talking to a couple of my pharma colleagues over the last few weeks who have an interest in the diabetes pathway. I have heard more than once, that the problem is patients don’t progress along the pathway fast enough. They hang around at the early stages of diagnosis and treatment for far too long. This means that HbA1C results don’t improve fast enough, and they believe that this will lead to long term complications.  I have no doubt they are correct but is this the root problem?

I have been sat at my desk and I’ve been stretching my mind back to my MBA days, a having a look at a few of my books about problem identification.  They talk about three types of problems:

1. Routine problems that we have seen before and already solved, just do it all again
2. Problems where we have ‘less than adequate information’
3. Complex and ambiguous.

NHS problems mostly fall into the third category, and the most difficult are referred to as ‘wicked’ problems.

“A phrase originally used in social planning, this describes problems difficult or impossible to solve because of incomplete, contradictory, and changing requirements, often hard to define. Sometimes those seeking to solve the problems are also causing them. Often one wicked problem is merely a symptom of another one…”

So what do we do about these ‘wicked’ diabetes questions...

My view is to think as small as possible. I can see now my business tutors talking about kaizen – the theory of continuous improvement. This is not about disruptive innovations rather incremental steps which are generally led by the shop floor via ‘quality circles’. Out of interest Maverick[1] by Ricardo Semler is an interesting read on this subject. So with these ‘wicked’ diabetes problems lets start small with  the Spirit family of companies which run three GP practices.  VanGundy suggest the following process[2]

Certainly, for NHS problems I think there is a precursor stage in this process and that is gathering information.

So that is where we are going to start. We will look at national and local guidance and compare that to the reality of day to day practice. We are going to present this information in the form of a patient pathway. Where possible, we are going to provide evidence for the ‘day to day’ pathway from Hospital Episode Statistics and from GP systems.

I will keep you posted as we progress through the project.  If you want to hear more about what we are up to, or have specific questions, please feel free to get in touch.

To find out more or get an update on progress of our diabetes project, contact us on SpiritAccess.Enquiries@spirit-healthcare.co.uk.

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[1] Semler R, Maverick, Arrow books, 2007

[2] VanGundy, Arthur B ;  Techniques of Structured Problem Solving; Von Nostrand Reinhold; 1980