Posts Tagged ‘health’

Historians tell us that in the Middle Ages about 25 million people, one third of the population of Europe, were wiped out by a series of Plagues! We now know that the cause was probably a bacteria called Yersinia Pestis that was spread by fleas when they bite their human hosts to get a meal of blood. The fleas were carried by rats and ships carried the rats from one country to another.  The unsanitary living conditions of the ports and towns at the time provided the ideal conditions for rats and fleas and, with a superstitious belief that cats were evil, without their natural predator the population of rats increased, so the population of fleas increased, so the likehood of transmission of the lethal bacteria increased, and the number of people decreased. A classic example of a chance combination of factors that together created an unstable and deadly system.

The Black Death was not eliminated by modern hi-tech medicine; it just went away when some of the factors that fuelled the instability were reduced. A tangible one being the enforced rebuilding of London after the Great Fire in Sept 1666 which gutted the medieval city and which followed the year after the last Great Plague in 1665 that killed 20% of the population. 

The story is an ideal illustration of how apparently trivial, albeit  annoying, repeated occurences can ultimately combine and lead to a catastrophic outcome.  I have a name for these apparently trivial, annoying and repeated occurences – I call them Niggles – and we are plagued by them. Every day we are plagued by junk mail, unpredictable deliveries, peak time traffic jams, car parking, email storms, surly staff, always-engaged call centres, bad news, bureaucracy, queues, confusion, stress, disappointment, depression. Need I go on?  The Plague of Niggles saps our spirit just as the Plague of Fleas sucked our ancestors blood.  And the Plague of Niggles infect us with a life-limiting disease – not a rapidly fatal one like the Black Death – instead we are infected with a slow, progressive, wasting disease that affects our attitude and behaviour and which manifests itself as criticism, apathy and cynicism.  A disease that seems as terifying, mysterious and incurable to us today as the Plague was to our ancestors. 

History repeats itself and we now know that complex systems behave in characteristic ways – so our best strategy may the same – prevention. If we use the lesson of history as our guide we should be proactive and focus our attention on the Niggles. We should actively seek them out; see them for what they really are; exercise our amazing ability to understand and solve them; and then share the nuggets of new knowledge that we generate.


This Sunday I was listening the Aled Jones on Radio 2 – as he was interviewing Mark Kermode of BBC.TV’s Culture Show. Mark posed a profound question:

When you visit the cinema, do you like to watch the kind of film that starts with a caption saying “This is a True Story” or maybe you prefer the kind with a caption saying “This is a story inspired by Actual Events”?

He suggested that it’s best to assume that the first kind is largely a fiction, whereas the latter is almost completely so. Personally, I don’t mind which ever kind it is, for sometimes I actually enjoy being fooled as long as it’s good harmless fun and it’s entertaining – AND as long as I don’t think someone is deliberately fooling me. But then I started wondering: How would I know if they were trying to fool me? Or more worryingly, whether I was fooling myself?

Since the 1850s there have been various “Realism” movements in the fields of cinema, art and literature – featuring the search for literal truth and pragmatism – a representation of objects, actions, or social conditions as they actually are without idealisation or presentation in abstract form – each of these movements was based upon a philosophy that universals exist independently of their having been thought up, and that physical objects exist independently of their being perceived. In this age of political and media “spin” maybe there’ll come a return to such a philosophy? In the mean time, as long as we are aware that the film we’ve chosen to watch is intended as fiction, and is billed as such, most of us won’t mind – indeed we might even view it as escapism – yet in many situations wouldn’t it be nice to feel that we are connected to a representation of events that’s more real, rather than just some one else’s imagined story?

When a patient in the healthcare system, I think I’d rather be treated by professionals who check and double check what they’re doing, and are working within a system that someone has designed to be fail safe – and is measured to be so. I’m hoping that the medics, nurses and administrators know the difference between what’s real and what is imagined. On this week’s Panorama (BBC March 8th 2010) it was suggested that some hospitals have much higher mortality than others, so this isn’t an insignificant hope. The three hospitals featured had all been flagged as having high mortality rates, yet had all been rated “Fair” or “Good” by the Care Quality Commission. This left me thinking that their may be more imagination around in the NHS than hard data.

The thing is, most everyone relies on data (via their 5 senses or their intuition) as if pure and unfiltered – under the assumption that this is all there is. But there’s always more to be known, and some of that missing knowledge may literally be the difference between life and death.

Numerical data in particular is actively avoided by many – even by professionals, be they the designers of the system or an individual who works within it. Many people left school determined to avoid numbers for the rest of their lives – when confronted by even the simplest statistic or numerical puzzle they will happily tell you “I don’t do numbers.” Since seeing the Panorama programme I’m now wondering how many people (clinicians, managers, inspectors) working within the health sector take such a view. Or maybe there’s a full-proof test that every prospective healthcare worker must pass before they’re allowed to practice? Can anyone reasure me about this?

A few weeks ago some very powerful yet delightfully accessible software was launched – called BaseLine©. It has been created so that people can have a kind of 3rd eye perception that mitigates the tendency to fictionalise – so that people can together assess what’s really happening. It’s designed to be a kind of dispassionate “fly on the wall” or a well-positioned “security camera” – and has been designed to be so easy to use that even the numerophobic will want to use it.

It’s actually free software, and even the full version costs under £50 – this is deliberate in order to maximize the possibility of it becoming a health sector standard. Having a standard tool will mean that people won’t have to debate the validity of the statistics, and can move directly to discussing the reality of what’s been happening, what’s happening now, and more importantly what’s likely to happen if nothing changes. Let’s see how long it takes clinicians and managers to discover its power?