Nick Downham – Sept 2020
© Cressbrook Ltd 2020 – All Rights Reserved
In an earlier article I detailed the differences between two dominant types of work (archetypes) in healthcare – and the dangers of not understanding them when embarking on service redesign.
In the article, general practice was used as an example due to it being the first point of access to healthcare for many patients.
The table below details the two archetypes and what capability a general practice needs in order to meet them:
Capability for Linear work:
Low variation of approach between consulting clinicians (aided by decision support tools and templates).
High reliability diagnostic, referral processes (we do what we say we are going to do – and we can prove it).
Systems to measure process reliability.
Measurement of process reliability.
Continuity provided by strong systems (notes), rather than clinical professional.
Highly reliable information sharing and communication.
End to end process times measured.
Clearly documented process and standards.
Direct messaging and remote consultation formats.
Use of QI techniques to improve.
Patient activation measures and development.
Capability for Relational work:
Development of community champions and networks. The practice as a connector.
Asset based approaches – including asset based social prescribing.
Flexible and longer appointment lengths.
Group consultations and clinics.
Direct messaging.
Continuity of consulting professional.
Consulting professional ‘holds the ball’ with the patient. Other services and specialists consult in.
Highly developed network of social care, third sector and community partners.
Investing in CBT and other low acuity MH capability.
Ability to ‘do what matters’ measured (Davis 2016).
Of course one important consideration, is that a patient may move between needing these two types of response at different points in time. It could also be the case that the two are required at the same time.
Finally, a general practice needs the capability to do both really well, where many practices are organised around predominantly Linear work.
Davis, R (2016),. Responsibility in Public Services, Triarchy Press