Muir Gray has proposed that it is the system and culture of the NHS which we must focus on not the structure. He says this in relation to #nhsreform which many people are worried will harm the systems and culture of the NHS. Tonight he suggested that the VA organisation in the US could be a model for improving outcomes by attending to the culture of the organisation. Below I have quoted from a paper which describes how the VA was 'reengineered' between 1995-1999. Looking at the description it seems that quite a lot of structural change was required to bring about the cultural change which lead to improved outcomes. This included developing a primary care system which had been virtually absent before. I do not disagree that culture needs to change to bring about improved outcomes. The question tonight is if the proposed structural changes to the English NHS are likely to help or hinder the development of the kind of culture we want to see in the NHS. 

.........................................................................................................

All quotes taken from Extreme Makeover: Transformation of the Veterans Health Care System

"Transformation Vision and Principles

The reengineering sought to create a seamless continuum of consistent and predictable high-quality, patient-centered care that was of superior value"

"Transformation Strategies

The proposed reengineering was based on five interrelated and mutually reinforcing strategies: 

Change strategy 1: Create an accountable management structure and management control system. 

Establishment of veterans integrated service networks.

Implementation of the new performance management system

Decentralization of operational decision making.

Change strategy 2: Integrate and coordinate services. 

Implementation of primary care. (they didn't really have any before)

Eligibility reform. 

Other efforts to increase the coordination and integration of care.

Change strategy 3: Improve the quality of care.

Performance management. 

Other quality-improvement activities.

Improving patient safety.

Change strategy 4: Align system finances with desired outcomes.

Creation of the veterans equitable resource allocation system

Expansion of the funding base. 

Change strategy 5: Modernize information management. 

Implementation of CPRS/VistA. (ehr)

Other information management initiatives."

"An acid test for whether a payer or government wants

competition is, ``Are you ready to for losses and for

having hospitals go bankrupt?'' If not, the government

will never recover the initial and extra transaction costs

of switching to competitive markets. "

From Light, D. (2001). Managed competition, governmentality, and institutional response in the United Kingdom.

Social Science & Medicine, 52, 1167-1181.

http://www.ncbi.nlm.nih.gov/pubmed/11281401

I came across this webcast when looking at the sociologist Frank Webster's work on the Information Age (see here). This discussion is around his paper "Making Sense of the Information Age" . I think it is worth listening to if you have a free hour because

• Frank Webster is an interesting person to listen to
• the opportunity to see academics debating in public is still too rare
• the discussion is so wide-ranging that it gets as far as 'what is social thery?' 'what is sociology?' 'what is a discipline?'
• the debate is at a level that a non-specialist can engage in.

What do you think?

The lecture is part of the "Science in Health" series. It is at 7.30 pm in the Large Chemistry Lecture Theatre in the main 

University Building, Park Place.  Coffee etc. from 7.00 pm 

in the Viramu Jones entrance.

You can read more about Julian Tudor-Hart's life here. 

In 1971, he wrote in the Lancet about the "Inverse Care Law", where he stated that those who most needed good medical care were least likely to get it. Nearly 40 years later we hope that is not true but there is still much evidence that it is.

I'd like to make a google form where a postcode could be entered, and the distance from a set point would be calculated, probably using google maps distance calculator. (Yes, it is for expenses claims!) Is this possible?

• I've found a free application for calculating the distance between the first part of two postcodes. It is not so acurate over short distances and I don't know how I would add it into a spreadsheet. But it is still useful.
•  I've found a geocoding site which I think could do what I want but I'm not sure how.
• And I've found a google maps mash-up site that just has be confused.

So is this as easy to do as I think it might be? How? Has it been done already?

Thanks in advance!

I'm thinking about how I could explain what I get out of Twitter and how I could gain even more. I would like to be able to:

• visualise my network
• identify hubs/subnetworks
• label hubs/subnetworks
• see FOAF
• see all of this by interaction rather than just follower/following

Is it possible? Is it free? :)

Something like this from @valdiskrebs