A costometer in overdrive

In the last 3 years the National Clinical Director for NHS Scotland has been representing NHS Scotland in the following countries (in date order):

London, Hong Hong, Florida, Gothenberg, Brisbane, Singapore, Mexico City, London, Denmark, Florida, Massachusetts, Kuwait, London, Qatar, Dublin, Kuala Lumpar, Belfast, London, Denmark, Stormont, Amsterdam and the Faroe Islands.

In between all this, the National Clinical Director for NHS Scotland has presented at TEDx 2017 and hosted TEDx 2018.

The following is a list of some of the events that the National Clinical Director for NHS Scotland has attended.

[if there are any errors in this list please let me know and the record will be amended]

• April 2015, London IHI Forum, Joint chair of seminar panel.
• September 2015, Hong Kong, IHI Forum. Speaker together with IHI Derek Feeley: “Person Centred Health Care.”
• December 2015, USA Florida, IHI Forum, Speaker
• April 2016, Gothenburg, IHI Forum, Speaker with Derek Feeley: “High Impact Leadership & Newest Thinking for Sustained Improvement.”
• May 2016, Brisbane, Australia, College of Surgeons: Masterclass, on Quality & Safety in Surgical Practice: “How to do a Q.I. Project.”
• September 2016, Singapore, IHI, Debating panel: “The Patient knows best.”
• October 2016, Mexico City, Speaker: “Patient Safety experiences.”
• November 2016, Sweden, IHI Conference
• November 2017, London. Annual Royal Free Marsden Lecture: “Scotland’s Approach to Quality Improvement.”
• November 2016, Denmark. Meeting with Danish Health Minister: discussing safety in social care,
• December 2016, Florida, IHI, Conference Speaker
• February 2017, Massachusetts, USA. IHI: Update on IHI QI systems
• March 2017, Kuwait. Sharing “NHS Scotland’s quality story”
• April 2017, London. S. & Q. Forum
• May 2017, Doha, Qatar, IHI Conference, Speaker
• May 2017, Dublin, IHI. Leadership Academy
• August 2017, Kuala Lumpar, IHI Conference, Speaker.
• September 2017, Belfast, IHI Alliance Conference, Speaker
• September 2017, London, IHI Event, Speaker & Facilitator
• October 2017, Denmark, Speaker
• November 2017, Stormont, Northern Ireland, QI Showcase: “Sharing thoughts on Scotland’s QI journey.”
• November 2017, Edinburgh, IHI: “All teach, all learn” with Derek Feeley
• May 2018, Amsterdam, International forum on Quality and Safety in Healthcare: “High-Impact Leadership in the Real World”
• May 2018, Faroe Islands, Safe Settings: “Quality Improvement across the public sector – lessons from Scotland”
• June 2018, Hosting TEDx Glasgow
• June 2018, “IHI Summer Immersion” camp where one contributor claimed that “there can surely be no other country in the world with a political leader as fluent in the language of improvement as Nicola Sturgeon”

Below: FOI response from the Scottish Government dated 11 December 2017 (the initial FOI request was refused by the Scottish Government) and this information was only received after challenging the Scottish Government's interpretation of FOI legislation.

‘What matters to you?’ day occurs each year at the beginning of the summer and aims to encourage and support more meaningful conversations between people who provide health and social care and the people who receive it. A reminder like this can only be a good thing but we should be careful about making claims that this idea is somehow novel.

I am an NHS doctor and an artist. I have, in the past, been a patient. I have tried to convey some of what matters to me in my writings and films.

As a doctor of more than 25 years NHS Scotland matters to me. In this short film I will express my concerns about the increasing dominance of the Institute for Healthcare Improvement (IHI) in NHS Scotland. This Boston based company celebrates Scotland to the world as the leading example in using its methodology. This methodology was developed in the engineering and manufacturing industries. It is only within the last decade that IHI has promoted this methodology as the founding basis to improving healthcare. It is thus relatively untested.

Healthcare Improvement Scotland follows the IHI “mantra”. It is to be celebrated that some aspects have gone well, such as patient safety with medicines in primary care. What is far less clear is whether the reductionist methodologies that improvement science takes, approaches which generally prioritise data over people, will be just as suitable for more complex healthcare situations.

IHI methodology has been introduced to Scotland by a very small group of Fellows of this American Institute. One of the Fellows, was formerly the Director General for NHS Scotland and is now the President and Chief Executive Officer for IHI. Two other Fellows, who have been key to the progressive dissemination of IHI methodologies in NHS Scotland, occupy the most senior positions in the Scottish Government’s Department of Health and in Healthcare Improvement Scotland.

The headlines used in this film have appeared in Scottish newspapers in the period that IHI’s influence has gathered pace in NHS Scotland.

At a time when NHS Scotland budgets are under intense pressure it is not at all clear whether the continuing involvement of IHI is providing value for money.

Improvement science is relatively untested in healthcare settings and it is therefore concerning to learn that these methodologies are currently being introduced to Scottish Schools.

It matters to me that the NHS continues to follow the vision with which it began 70 years ago and does not become subsumed by big business interests.

This is what matters to me. If it matters to you too please consider sharing this film.

What matters to me:

To play my response to Jason Leitch and Derek Feeley please click here or on the image above.