Friday, November 13, 2015

Respect the outcomes



Irreverence...always has been my calling card. Many a times it's been mentioned and to be honest, I have never been one to hide that either. A question automatically comes...do you respect anyone? To perhaps the utter bemusement of some, I actually do..and unquestionably so. Let's take the world of diabetes...foot care? Mike Edmunds. Paediatric diabetes care? Fiona Campbell. Pituitary disease? Will Drake. There's actually a theme there...it's called outcomes and what they have done. Technology? Iain Cranston- I work with him, see what he does, the respect is total, it's unflinching, it's unshakeable...and it doesn't have to be someone old or in a position of authority...take pumps...without batting an eyelid, it would be Pratik Choudhury..it's the work they do and the outcomes they get. A theme there...respect has to be earned. A position means nothing to me, never has, never will. It's about what have you done.

What about in the wider world? Well, in the NHS, to be honest, it's most Chief Executives I know. We throw brickbats at them from the sanctuary of Twitter or a blog, but let's be perfectly clear...these guys take an enormous amount of beating- and collectively, all of these folks decided to take the hit on financial issues rather than compromise care, not hire locums, not go to agency staff when needed. For that, respect is high..it's about the outcomes they have decided to deliver..not on the spreadsheets but on the issue of care. Sam Jones, Umesh Prabhu some other names stand out...bold enough to step up to the mark and not being a paper leader...enough time in my world to have respect for that.

So what about its relation to World Diabetes Day? It's relation is to what we could do, as a community to do exactly that...improve outcomes. A fixation on targets, a non evidence based approach to diabetes care has brought us to the state where as a country about 60% of diabetes patients are having their basic checks...yes..that's 60%. We are in a state where we froth over technology and Google glasses when we over treat the elderly and cause hypoglycaemic events, hospital admissions and much harm. Someone, albeit admittedly in a different context, mentioned recently that some medicine need to be taken without evidence. No- that's called homeopathy.

As a country, what stops us as a community to saying we can improve this, and we will stop doing unnecessary stuff? The tariff system associated with QoF targets ( once a great tool now a mere hindrance for an ageing population) has left integration firmly on the glossy power points. Only a few handful of excellence sits amongst us all....integration has stayed away from reality. Patients implore us just to talk to each other..we still struggle to have IT systems which interact smoothly between hospitals and rest of community.

How about for a change we try something different? How about, we, as specialists, say it's time for us to improve things? Not point lazy fingers but genuinely try? Do Vanguards provide an opportunity to flatten the barriers..or have we dismissed them already as another fictional policy? How radical can we be? How passionate are we about system wide improvement of care? How motivated are we to judge ourselves, not anyone else, on outcomes? Not HbA1c, not number of hospital appointments, but hard outcome measures...amputations, retinopathy, myocardial infarcts, hospital admits? How about we measure our hospital services based on how many incidences of insulin errors we have stopped in hospitals? How many specialist centres can stand up and say in antenatal Diabetes care they have achieved the St Vincent declaration?  1989...we promised the outcomes of a pregnant woman was to be the same as one without diabetes...26 years later, what has stopped us from doing so?

Negativity is around us..but we need to be careful that we don't suck ourselves into a echo chamber. Every day I meet people who a doing some amazing work, but in silos, in pockets...we must get to scale...we must be able to flatten the hierarchies and improve care.

On World Diabetes Day, why don't we all as a community say we will genuinely try and improve outcomes? Measure ourselves on the reasons why we went to medical or nursing school? I didn't go there to drop a number, I went there to improve amputations, lessen admissions....and that's what we should be bold enough to measure ourselves on. Do you know why? Because if you do so, you bring many of the doubters on board. Doubters not very dissimilar to me when it comes to "names" and "personalities". The title means little to me if you can't show me outcomes ..without that..it's empty rhetoric at best. We, as a community, should be mindful of that..when we say we wants patients to work with us, work together to improve care..it must, and absolutely must be more than empty rhetoric. It must be based on genuine outcomes, outcomes that improve care..outcomes that justify why we do what we do.

Let's give it a try...next year, this day...I shall hopefully write a blog mentioning how far we have come since November 14 2015.

Happy World Diabetes Day.

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