Innovations in a small hospital

Have you heard of Goole Hospital? If you have not heard of it, that is not surprising. We generally don’t want you to hear about it/us.  It is a small hospital with about 30 beds and we do not do brain transplant.

We have a minor injuries unit, some medical in-patients, elective services in ophthalmology, orthopaedics, general surgery. There are outpatients and other services – you can check out the website http://www.nlg.nhs.uk/hospitals/goole/

What fascinates me is the number of innovations that have happened in Goole. Why it happens could be the subject of another blog post.

I am defining innovation as, ‘use of a better and, as a result, novel idea or method’ (Wikipedia).

Goole Innovations

Here I write about a dozen innovations that I have seen or been involved in at Goole.

1)      No clinic letter Clinic notes faxed to GPs as is

This when the general surgery clinic’s doctors’ handwritten notes are faxed to the general practitioner (mostly within 24 hours) instead of a letter first dictated then typed and then cross checked before signing and sending. Saves a load of secretarial time and money.

2)      Tests before OPD (USS OGD Flex Sig)

When we know by reading a general practitioner’s letter that the patient would undoubtedly need a particular test, such as an ultrasound scan, gastroscopy or a flexible sigmoidoscopy the doctor who vets the letter orders the test so that the result of the test is available for discussion at the patient’s first out-patient clinic consultation. Allows sensible discussion, often gives answers.

3)      Same day pre-assessment for general surgery and endoscopy patients

When the doctor tells the patient ‘you need a surgical procedure’, the patient if they have the time are pre-assessed at the same first surgical clinic visit. A kind of a one-stop service. Saves a lot of time for patients. We try to do this as often and as many patients as we practically can.

4)      Single Visit General Surgery

For general surgery patients who are suitable for day case surgery the Goole Single Visit pathway offers for suitable patients the option of visiting the hospital just once. Consultation and operative surgical procedure (occasionally some smaller additional investigations) all done in the same visit. Lumps and bumps right up to gall bladders.

See this link http://successinhealthcare.blogspot.co.uk/2011/12/single-visit-surgical-service.html that blogs about the single visit service

5)      Laser Haemorrhoidectomy

Formal surgical operation for piles done with local anaesthesia and laser with patients discharged in two hours. We have been doing this for a few years now. Brief blog about that can be found at http://successinhealthcare.blogspot.co.uk/2011/11/laser-surgery-for-piles.html

6)      Entonox for colonoscopy

Entonox, also known as gas & air can be used instead of sedation for colonoscopy. That is neither special nor surprising. In Goole, at the last look, we found approximately 35% of our colonoscopy patients opted for Entonox when the general published number is 17%. All I can say is our patients and staff are very special.

7)      Straight to test two week wait colo-rectal cancer referrals

Overwhelming majority of patients referred as two week wait cancer referrals end up having a colonoscopy. We have a system where suitable patients have their first consultation and colonoscopy at the same visit. http://www.nlg.nhs.uk/news/one-stop-service/

8)      Own reporting software for endoscopy

External software involves purchase cost, maintenance cost and annual licensing costs. We have created our own reporting software with Microsoft Infopath which was already available in trust computers. We have been using this for a few years. Spending your money responsibly, eh?

9)      Single length endoscopic accessories (0 error)

We use the colonoscopy length accessories for colonoscopy and gastroscopy. This has resulted in zero error hence zero waste (since there is no possibility of opening a gastroscope length accessory for a colonoscopy procedure)

10)  Home enemas

Patients who are for flexible sigmoidoscopy need an enema. To have someone unknown administer an enema in an unfamiliar environment and then have to use the unfamiliar toilet can be bothersome. We ask patients if they want to administer the enemas themselves in the comfort of their own homes.

11)   In-situ simulation training

First in-situ simulation training with two scenarios, two trainers, one volunteer ‘patient’ and a professional actor, in our organisation with three hospitals. Even before our nearest tertiary hospital could do it (they have since done it)

12)  Local Anaesthesia option for most inguinal and umbilical hernia repairs

Once the patient is considered suitable the patient has the choice to go for local anaesthesia (with or without sedation) or a general anaesthetic. A large number go for local anaesthetic repairs.

13)  Synchronised test-opd

When routine follow up ultra-sound scans are needed to monitor a situation, we used to get them done a couple of hours earlier than the clinic appointment time. Latest information available. One visit instead of two for the patient. We used to do this typically for patients who were being monitored for abdominal aortic aneurysms.

I said a dozen things done differently at Goole but have listed 13; that would be typical of Goole, we try and often tend to over deliver.

There are a number of innovations from our colleagues in orthopaedics, ophthalmology and other departments.

You will not hear too much from Goole, the people there are a bit shy of fame, a bit skeptical about awards, a shade reluctant to talk about themselves; it is a unique micro-culture - more on that later. There are very specific reasons why innovation happens at Goole (though I do not have too high a regard for CQC ratings you may be interested to know that Goole Hospital scores all greens ‘good’ www.cqc.org.uk/sites/default/files/new_reports/AAAA1778.pdf  for its services, we at Goole are neither bothered nor surprised about this).

At this point I have to say that I am one of the very few variant ones for Goole, talking and blogging about these things, I suspect my team often wonders why I am so vain.

Many hospitals in the country could be doing one or more of the above, but I do wonder if all these things happen in a small hospital.

©M HEMADRI 

Follow me on twitter @HemadriTweets

PS: We follow Noble prize winner's Kahneman's methods to improve our patients' experience, I have already blogged about this http://successinhealthcare.blogspot.co.uk/2014/02/kahneman-colonoscopy-and-goole.html

Breaking down monuments

Here are a few examples of monuments that we can break down.

Ultra-sound scan room

There is no real need for in-patient diagnostic USS to be done in a specific room. Put them on wheels and take them to the patient on-demand. Doctors get bleeped for opinions for in-patients and they go to the patient, no reason why diagnostic USS cannot be done by the bedside after drawing the curtains around. This spares physical space for more work do be done (I think the managers call it creating capacity).

USS for outpatients - could it not be done at patients' home? District nurses do dressings at home why not USS?

Flexible Sigmoidoscopy

For in-patients diagnostic flexible sigmoidoscopy can be done in their own beds during ward rounds. For outpatients it should be done during the consultation at which it was thought to be required and in that same consultation's examination room. Why do we think we have the right to ask the patient to come back for something that can be done then and there?

Gastroscopy

In-patient diagnostic gastroscopy could very easily be done at the bedside or in the relevant ward's treatment room. Outpatient gastroscopy should be done in the consultation room at the same time as the consultation at which the gastroscopy was thought to be needed. Have we not heard of ENT surgeons doing nasal endoscopy in OPD? Have we not heard of ultra-thin scopes? Have we not heard of oral sedation if it was indeed necessary?

Oh, by the way, we have not obviously heard of companies willing to provide clean scopes by motorcycle courier delivery wherever we want.

We have this rigid old-world belief that patients should be moved around to where the 'facility' is and when that is not possible clinicians and others should become runners to connect patients and a variety of facilities. We have to stop such thinking and move with the modern world. We used to run to telephones

Arterial Blood Gas analysis

Hand held ABG analysers are available and these ought to be used as POCT (point of care testing). It is well known that blood gas results have to be acted upon within minutes if it needs to make any difference to patients. ABG analysers are situated as some centralised monuments when they should be available near the bedside of any acute patient anywhere in the hospital. We call for a demolition of this monument.
This blog has already argued for improved ABG turn around times as an example of clinical lean  http://successinhealthcare.blogspot.co.uk/2012/03/arterial-blood-gas-turnaround-times.html

Bedside Hemoglobin, WBC and other testing

Hemocue POCT hemoglobin testing has been available for a few decades and has been used by many para-medical services but still not used routinely in many hospital operating theatres and other areas. There is really no reason why this should not be available anywhere in the hospital or be carried around by doctors and nurses. When we can provide treatment in life and death situations using POCT blood sugar testing, we could do these couldn't we?

General Practitioners as Gate Keepers

In the modern world where information is provided in plenty by Dr Google, where patients are far too knowledgeable than when the NHS was created 60 years ago, patients must have the liberty of seeing any specialists of their choice without having to go through a general practitioner. Seeing the specialist directly happens in other parts of the world especially with post service self-pay patients, in UK having pre-paid patients do not get the same liberties or choices. There are innumerable myths on the gate keeper role of UK GPs which need to be challenged if clinical practice is to be compatible with current expectations.

This in no way an attack on the role of GPs as clinicians providing an invaluable service and is essential; I am only questioning if any value is really provided by the gate keeper function and whether there is any sense in putting hurdles in a particular patient's chosen pathway.


There will always be a 'this is too risky and against the rules/regulations' brigade. I am looking at how we can innovate and improve safely. Yes, if we put it that way, risk and improvement do not make comfortable bedfellows. 

Please add your ideas on what monuments that you would seen broken down in your hospital/clinic by leaving a comment below.

©M HEMADRI 

Follow me on twitter @HemadriTweets

'Nakamura invented the light bulb'

Would Nakamura invented the light bulb if he was working in the NHS?

Nakamura invented the light bulb, that is what we might probably say one day, that Nakamura invented the light bulb or to put it correctly that Nakamura re-invented the light bulb. Shuji Nakamura's inspiring story has been told before but here is an ultra-short version of it

Nakamura gets a masters from a relatively small university in a small city in Japan, goes off to work in a small company in a lab competes against the big companies, discovers many right things and makes products that would not sell.

Times get difficult, his department shrinks. He goes to his boss and wants to make a product that the big boys have tried to make and failed; with his record, he gets turned down. He goes to his boss's boss and gets some support to make it, despite his record of making nothing that sold, his company chairman gives him money, $2mil actually and he reinvents the light bulb. Well, he actually gets the blue component of the LED to work and the rest is history.

What is interesting is that Nakamura was a non-PhD working in the industry as a lab scientist who then gets a doctorate from his local university and within 5 years is head hunted by University of California and becomes a professor.

Nakamuras in NHS?

Let us imagine a scenario of a doctor who becomes a consultant in a DGH in the NHS and wants to do something that the big boys tried and failed.Then the DGH consultant fails as well, fails repeatedly - what are the chances that he will not be performance managed out of his/her activity and driven to the end of his wits.

What are the chances that the medical director or CD will be over-ruled by the CEO or Chairman and a doctor provided funding to carry on despite a record of 'failure'? What are the chances that even after this doctor discovered something interesting a big place will head hunt and make him/her an 'academic'? In fact he/she should be grateful if the GMC and the rest of the regulation did not land on him/her and crushed him/her out of existence.

Getting real

Now a lot of you are going to say that reinventing a light bulb while surely profound is unlikely to involve any damage to real human beings. You might say that any lurking Nakamuras in the NHS if supported could end up hurting patients. Good logical argument. Is that what is really hurting patients? Probably not. It is not any innovation by enthusiastic people that harms patients, it is the bureaucratic nay sayers who use the language of clinical governance and risk yet know very little about process capabilities, refuse to learn shared baselines, practice unimaginatively poor leadership who perpetuate harm in healthcare. They refuse to fix the system instead try to 'fix' the people in the system. Of course the medical profession does not do itself any favours by its ego, jealousy and macho attitude which will aim to shoot down anything that arises outside its hierarchical constraints by treating them as bad apples and recommending the use of evidence the origins of which  can probably attributed to the Abilene paradox.

In healthcare especially in the NHS it is pretty much impossible these days to take an extra breath without CD, CG, R&D, GCP, LREC, NREC, NICE, and every other alphabet in the soup wanting to spoil it for you, while claiming to support you. It is when people who are typically NHS managers and every other hierarchical bureaucrat stops behaving like researchers and most doctors who are not researchers begin to look at operational evidence as a valid method of creating a new practices, innovation and improvement that healthcare will be truly successful.

Allowing and managing 'Nakamuras' in healthcare is not easy but will be rewarding; eliminating the healthcare 'Nakamuras' will allow the managers to sleep peacefully but might push true healthcare innovation into a coma.

If you know of any 'Nakamuras' in the NHS please let me know by leaving a comment below.

©M HEMADRI 

Follow me on twitter @HemadriTweets

Links & reference
The dream of the blue laser diode
http://engphys.mcmaster.ca/undergraduate/outlines/4e03/Nichia%20%27s%20Shuji%20Nakamura%20Dream%20of%20the%20Blue%20Laser%20Diode.htm
Time magazine short feature on Nakamura
http://www.time.com/time/magazine/article/0,9171,1604891,00.html

End of management (long version)

A shorter crisp version (about 600 words) is published in the FMLM (blog http://www.fmlm.ac.uk/blog/makani-hemadri/end-management)  for which this topic was originally written. This is the rambling 1500 word extended narcissistic version. You are welcome to it ...  

It is important to read Alan Murray’s ‘The End of Management’ Corporate bureaucracy is becoming obsolete. Why managers should act like venture capitalists; in the WSJ. Here is the link: http://online.wsj.com/article/SB10001424052748704476104575439723695579664.html

Once you have read this blog post gets its context and then you can read this either as a commentary of the WSJ article as relevant to NHS or on its own. This blog is deliberately off-key, the topic is such, bear with me. Compared to many healthcare systems we do quite well in the NHS. Could we do better? Of course yes but how we do that will define our future.

We are the management and we will tell you how to end management!?!?!

At a broader level, in the NHS there are no examples that I can think of where corporate structure or management has been ‘ended’. The previous government did good work with top down waiting times and so on; the present government is attempting top down radical change in organisational structures. The government is trying to get us do differently. When individuals try to do something creative, the organisations and the NHS as a whole tries to look at 'where and how it fits in with the overall plan'. But in the public sector there is the government not just wanting us to do different but also telling us how precisely to do it; with organisations 'encouraging innovation and creativity' only if it fits in with pre-defined policies. But that is what modern business is trying not to do; modern thinking in management is not telling people what to do but to let people to do things first and the management to amplify the good ideas.

Thinking of me vs thinking of you

At the narrower level, trainees (I am talking about all trainees in the clinical areas- not just doctors) are taught to think of how they are learning and improving themselves; never to explicitly think about their contribution to the organisation. In fact, often people think that their contribution to healthcare as such starts only when they stop becoming trainees. By that time the mind set becomes so fixed in thinking inwardly about the self and not outwardly about others that it becomes very difficult for the rest of their lives. Careerism becomes the mantra for many people in healthcare; we always thought this was the case in the private sector - true but that trend is changing in some areas. 

Best with limits

This leads to people taking very defensive attitudes. Most people in healthcare management are either numerically shy or numerically illiterate. They are unwilling to make a personal numerical prediction on their or their department/division/directorate’s improvement based on a measurable internal parameter due to the fear that they may be unable to stand by it. In any case most of the numbers are geared towards predefined reporting parameters. People who work in the NHS also seem to think that they are somehow very altruistic and have a high sense of entitlement. That attitude is even more profound in the clinicians with clinicians tending to believe that they express their altruism by their very individualistic approaches to healthcare. It is also possible that there are certain kind of people who are drawn to public services (possibly risk averse, change shy, rule-bound, authority loving, service minded and so on) and it would be difficult to use the same methods as for instance in Google to achieve a new management approach.

At both the above levels, healthcare and NHS is thought to be too important and too costly to be creative or innovative; the phrase used is 'risk'. Healthcare especially in Europe and even more so in UK has innumerable external controllers and bodies telling people what to do and how to do it that it simply chokes off creativity even before it begins. In other industries there is an obligation to do some degree of statutory reporting with no real controls on how they do their business.

So, it seems like what the above WSJ article is saying is not possible in UK healthcare at all. There seems no space that is available or can be created for those concepts to happen without falling foul of something or someone. But there lies the opportunity as well to ‘end management’ and create self-sustaining systems.

Blue skies

Hence, I can now boldly enter the imaginary world to explore how the 'wisdom of the crowds' can be harnessed. I think the way to do it is to disengage from current conventions and demonstrate its success. That does not mean rebelling, non-cooperating, behaving illegally, not concentrating, becoming disenchanted or any such thing. It is using our own methods to satisfy our requirements and our clients’ requirement rather than using a method or doing a thing to satisfy an external definition. 

For instance when the roads around Birmingham were choking instead of building a new road, they opened the hard shoulder to traffic which in other roads is actually illegal; peak time traffic situation has improved since in that area. Compare that with an example of the situation in some hospitals where they buy yet another business intelligence interface/data-mining tool to provide information at service line specialty level when the managers and clinicians often feel that human connectivity was the issue that needed resolving to enable their older software to be used effectively. Often the tool is not really the problem, our thinking is.

Let us assume for example that one of our services is not accredited by some specialty society because we did not meet one or more of their requirements in the way they wanted. Normally the tendency would be either to stop that service or to work very hard to meet that accreditation standard. However, if our results in that particular specialty or aspect is better than anywhere else, would we as an organisation, anyone in the specialty society or the general society as a whole be unhappy? Certainly not. In this scenario the badge of not being accredited becomes a badge of honour. The problem is we do not think like that in the NHS. We probably should.

Like the Birmingham roads, what 'illegal' things could we do to make ourselves better?

Obviously we should disengage and develop only if it is beneficial to our hospital and patients and we are able to track it and prove it contemporaneously.

Is this an example of wisdom of the crowds in the real world of healthcare?

     Finally let me try a hypothetical yet hopefully practical proposition to disengage and demonstrate. There is a focus on Unplanned emergency re-admissions and we may not get paid for such re-admissions. I am aware of some of the things that we have started doing to tackle this issue. Let me put to you a potentially disruptive solution in the 'end of management' mode 

     

      a) not offering routine follow-ups for any patient who is discharged from the ward (medical, surgical, post-operative) 

and instead

b) Guaranteeing a clinic slot within a defined time (48 hours to one week as agreed) should the patient choose to contact us.

My hypothesis is, this approach will reduce unplanned emergency readmissions as the issue is often/mostly to with patient concerns on access (rather than real life-threatening matters); the 'routine' follow up itself is mostly to satisfy clinicians habit rather than a scientific finding that all complications in all patients happens precisely 3 months after seeing the doctor and hence patients need a 3 months appointment. This will also clear up the 'congestion' we have in our clinics. 

Okay, where is the 'wisdom of the crowd' here? The crowd in our example is the patient; and the wisdom is the patients’ knowledge about their own health on what is wrong with them and they should be able to access us when they find something wrong with them. This is of course one step further than the current thinking on 'crowd' which is usually the employees in a large organisation. We even need to change the definition of crowd to suit our requirement. 

Rambling ambiguity and the threads of new systems

We can predict that the conventional management methods will not work in the 21st century. End of management as we know it is not chaos as many would like us to believe. New models are not apparent or clear yet. Perhaps there may not be one new model; possibly there may not be a well defined model at all. There are emerging themes; democratisation of data, data mining, crowd sourcing, coping with anti-knowledge, cloud care and dumb-terminals, many more............ It is not these themes that are important; it is how we implement these themes that are relevant. We can be told how to do it thus not ‘ending management’ or we can show how we do it.

Thank you for getting to this sentence of the blog. If you thought this was rambling ambiguity, I am grateful for your attention and will do better next time. If there are some threads that we can build on then I have achieved my aim.

©M HEMADRI 

Follow me on twitter @HemadriTweets

Guarantees in Healthcare

I would like you to take a moment to think about what is the longest guarantee period offered for a product that you know of. Months, years, decades? What about life-time guarantee? For instance Toyota offers an 8 year guarantee for their Prius battery for the electrical motor part of their hybrid system. Some manufacturers and some body works repairers offer life time rust proof guarantee. Pizza companies say that you can have the pizza for free if it does not reach you within a defined time after your order. Well you can surely name a few more yourself.

Here is a jaw dropping guarantee. 2000 years.

Yes, you read it right The Sweet Little Sugar Softener offers a 2000 year guarantee. Yes that is offered for a product that is very simple. Okay, I am not sure if any of us are going to be around for 2000 years to vouch for this. But just imagine the confidence of the manufacturers in their product that they are able to offer it. It is a product made by simple artisans in rural America, not highly educated, with no great facilities etc


Guarantees in Healthcare

Health care is full of educated, highly intelligent and motivated people. Many if not all clinicians would have two post-graduate degrees. Healthcare managers and insurers are very large players in terms of the total money spent on healthcare especially in the western world. What kind of guarantees can healthcare offer to patients? As far as I know, none. In fact, professional bodies may not look at you very kindly if you started offering any guarantees, they will come down on you with a tonne of heavy scientific bricks and with a high moralistic tone accuse you of potentially misleading patients. Why is that? Why is it that healthcare which consumes so much of our resources unable to offer any sort of guarantees to our patients?

It is high time that we started backing our intelligence, education and skills and experience to think about what guarantees we can offer our patients and how we can make those guarantees work. We then need to put some money to back those guarantees. Doctors should perhaps take the lead on this one. Doctors always claim that they are consistently in the top 2% of the top performers in the society - well that is indeed true. If the top 2% performers cannot guarantee any of the activity they do and back it with some money we do need to either question their performance or their motives.

Healthcare needs some guarantees, patients need some guarantees. Yes, you healthcare folks, time to up your game, I know you cannot yet reach the level of guarantee offered by rural native American artisans but surely you could start with something small. How about no charge for patients if their bowel anastamosis leaked? How about completely free care if you did not meet the expected discharge date? How about paying a penalty to the patient every time you cancel or postpone their appointment/operation/etc.

Healthcare just dazzling and blinding people with asymmetrical power, high intelligence and skills is not simply good enough any longer. It has to be matched with some performance guarantees.

Being the change you want to see - the oft repeated Gandhian saying; on that basis let me go first.


OFFER OF MONEY BACK GUARANTEE IN HEALTHCARE
(possibly for the first time in the world)

One day the whole of healthcare especially doctors including me may be able to offer guaranteed clinical end results; right now it seems we cannot. So what can I guarantee can I give my patients? Before we get into that let me also explain that I work in the NHS on a salaried basis in a surgical department. NHS allows me to do private practice but I am not in regular/routine private practice. I cannot as an NHS doctor offer any individual guarantees to my patients. I am like the rest of the British people, own the NHS but do not run it. However I can offer some guarantees to my potential private patients.

Here are the guarantees I am willing to offer to any private patient who cares to find me and pay me a fee for service (self paying private patients).
Open primary inguinal hernia repair: if you have a recurrence within 3 years I will refund you the my fee i.e. the surgeon's fee.
Colonoscopy: if I do not reach the caecum (provided it was not poor bowel preparation or a confirmed bowel narrowing) and hence you had an incomplete colonoscopy I will not charge you my personal fee for the procedure.
Obviously all other charges will apply, have to be paid for and not be refunded.

As I have already said, right now I am not in active private practice. But if there were any patients who paid me privately for these two procedures that is the money back guarantee I am able to offer. If there were takers for this service/offer I might be stimulated to think of what further guarantees can be designed in healthcare.

What is important is if many others in healthcare provision are able to offer firm money back guarantees in healthcare. That might be a disruptive innovation in clinical provision. Let us go for it.

What are the guarantees that you are able to offer your patients?


Update: 1 Nov 2012: W Fischer informs me that there are guarantees in healthcare at Geisinger, Danville, PA since 2006. Very nice to know. So obviously I am not the first or the only. Here is a write up on their warranty: http://www.ihi.org/knowledge/Pages/ImprovementStories/GeisingerWarrantyonCABGSurgerySignalsCommitmenttoExcellence.aspx There are press stories about it, find it on the net. They do not seem to pay the patients any money back (I suppose that will be an issue for the insurers) but they do not charge the insurer to fix any complications.

©M HEMADRI 

Follow me on twitter @HemadriTweets
 

No mosquitoes in UK so our healthcare is costly

No Mosquitoes in Great Britain, hence our healthcare is costly

A groin hernia is surgically repaired by placing a synthetic mesh on the weakness and fixing it in place. In UK the mesh currently costs from £20 to more than £100.

This is obviously a significant cost which the rural areas in the developing and poor countries cannot afford. The doctors face an ethical dilemma. Should they refuse to operate since the mesh is unaffordable? Should they do a non-mesh repair which is generally thought to have a many times the recurrence rate of the hernia compared to mesh repair?

Tongaonkar and Reddy, doctors from two small towns in India innovated by cutting mosquito net cloth to shape, sterilised it by autoclave and used it on patients (http://www.bioline.org.br/request?is03018). They had very good results that compare well with standard international/western results for groin hernia repair. They also had the mosquito net cloth mesh analysed by labs which generally showed it to compare well with commercially manufactured meshes like the ones we use in UK. 

The mesh costs a few pennies; it was 3688 times cheaper than the commercial mesh.

Of course surgeons in India accused the Indian Journal of Surgery of blasphemy for publishing Tongaonkar's paper.

Now here is the good news, a UK surgeon Prof Andrew Kingsnorth uses the mosquito cloth net mesh for hernia repair. The not so good news is that he does not use it in the UK, he uses it in a hernia charity in Ghana which he leads/supports www.operationhernia.org.uk  

One of my friends who has interacted with this blog wrote to Andrew Kingsnorth and the conclusion was that red tape will prevent us from using it in UK. I have discussed this with a number of people, at the very end of the discussion we always wondered why we in UK would not take this up even if we save money. Groin hernia mesh is only a £5million market with already many fingers in the pie. £5 million for the NHS is possibly small change. Our discussions normally end at that point.

We are a developed, rich economy, it may well be that our development and our wealth which prevents us from taking up innovations that save money. You would have never guessed that the lack of mosquitoes in UK was one of the reasons for our healthcare being costly!

Hemadri

Personalise your cuisine in this restaurant

Personalise your cuisine in this restaurant. Where can you get truly personalised healthcare?

There is a very unique restaurant in Hull that works on amazingly innovative concepts. Its purely vegetarian which in itself is a rare thing for a native British restaurant, it is open only when they have enough bookings, serve only buffet, the first person to book for the day gets to choose the buffet menu, the menu can be from anywhere in the world and many more extraordinary features. Recommend that you checkout their website: http://www.hitchcocksrestaurant.co.uk/

 

I have been there, it is certainly not the greatest place on earth in terms of decor, service or food. But I still hold that their concepts are unique, praiseworthy and successful.

Wonder what is the lesson from this to healthcare? How can I learn from this? How can I personalise the care I provide to the patients I deal with in a way that is determined by the patients at a very low price, close to home, be profitable, while at the same time having my individuality stamped on it?

I have no personal interest of any sort in this restaurant. I am just amazed by their fabulous and exclusive concepts.