Last night I went to a health service discussion event. Roy Lilley was interviewing Lord Carter. He who has just written a report about improving efficiency in the NHS. His report has had a significant effect: Carter Reform is becoming a big thing. Some of Lord Carter’s words were still with me at breakfast this morning: “We’re doing everything right somewhere… sharing at scale is the problem.”  He meant that there are plenty of examples of things being done efficiently in the NHS and the challenge is to share that good practice widely, and quickly.

If we take a mechanistic view of things then the answer would be a process of distilling lessons learned, producing tool-kits, getting experts on the road to spread inspiration – and then driving the change through with strong management and consulting help.

With Rio not long off, I keep thinking of parallels with sporting performance.  Very few athletes can ever hope to come close to the performance of the best. The good are good because of genes, parenting, life events, the people they have around them and the luck to have avoided injury at crucial times. Their training is obviously crucial, but so is the path they have trodden.

And – set me straight if you think the analogy is poor - so I think it will be with improving the NHS. What individual organisations can achieve will be constrained by facilities, the population they serve, their staff and the culture that has emerged over time. With determination, the right help and time – the morbidly overweight may possibly get fit enough to make a reasonable job of putting a shot; but there is little point in showing them videos of Jessica Ennis-Hill belting over 100m-worth of hurdles. In complex situations it is always possible to improve things, but only by thinking systemically and working with the local grain; and particularly with the humans who are that grain.

Luckily, we wouldn’t be daft enough to take a mechanistic view…

More information

• Lord Carter's report - Operational productivity and performance in English NHS acute hospitals: Unwarranted variations (pdf)
• What does ‘good’ look like? - a write up of a previous HealthChat
• FabNHSStuff – who organised the (excellent) event