What can the NHS learn from the theory of marginal gains?
There are many management theories on how to turn systemic failure into sustained success. Some are complex, others remarkably simple. One that’s captured the imagination in recent years is the theory of marginal gains, famously used in track cycling.
Back at the London 2012 Olympic Games, the British cycling team reasoned that if each element of competing on a bike – including kit, aerodynamics, diet or components – could be improved by just 1 per cent, the combined effect could make a winning difference. Over time, these marginal gains notched up the team’s performance to the point that they became virtually unbeatable.
Like many of the best ideas, the principle was simple enough for almost anyone to apply. Soon, luminaries of business management like the Harvard Business Review were espousing it and it quickly became a darling of management theory.
But what about healthcare? A healthcare system, like a large business, is a complex machine of many moving parts – human, mechanical and technological – contributing to overall performance. Could a focus on marginal gains help the crisis-ridden NHS improve quality and/or costs?
Imagine if each decision made by a clinician on the medical frontline – in primary or acute care – could be slightly improved, one by one, over time.
Perhaps it’s a GP deciding not to refer a patient to hospital. Or a hospital consultant deciding against an unnecessary test. Or a junior doctor making the right call on a drug prescription. On one end of the spectrum, the better decisions have the potential to improve the effectiveness of care. On the other, they could help avert errors.
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We should take a moment to consider the cumulative cost of errors. A 2016 report by the British Medical Journal concluded that medical errors should rank as the third leading cause of U.S. deaths.As well as costing lives, mistakes are also putting health systems under intolerable financial strain.
In the UK, health service leaders warn that pay-outs to victims of medical negligence are becoming “unsustainable” for the NHS. Worryingly, a fear of litigation is now said to be creating a culture of exaggerated cautiousness (sometimes referred to as “defensive medicine”) among clinicians, worsening the bottlenecks in patient care.
So, what can we do? Cyclists can change their helmets and skin suits. Where are the marginal gains for the NHS? They may lie in addressing the millions of daily decisions made by front-line caregivers. Cumulatively, helping them to arrive at better decisions can make a massive difference.
We need to equip frontline clinicians with the evidence and tools to help, such as clinical decision support (CDS), software tools that assist clinicians in making the best decisions. Does it work? Many studies have demonstrated that CDS can improve decisions, potentially leading to better patient outcomes.
A recent study published in the International Journal of Medical Informatics found a significant association between use of a popular form of CDS (UpToDate) and reduced diagnostic errors. Physicians who used UpToDate® had a diagnostic error rate of 2% compared with 24% in a control group without UpToDate
Clearly, there is real progress to be made – some decisions may lead to small mistakes, others are potentially life-threatening. Added together, improvements in the myriad of clinical decisions made each day could surely start to make a difference. There are no gold medals in health, but perhaps there is a big win on the horizon if we can gradually make healthcare work better, one decision at a time.
Check Point: Securing the future of enterprise IT
Cybersecurity solutions provider Check Point was founded in 1993 with a mission to secure ‘everything,’ and that includes the cloud. Conscious that nothing remains static in the digital world, the company prides itself on an ability to integrate new technology with its solutions. Across almost three decades in operation, Check Point, with its team of over 3,500 experts, has become adept at protecting networks, endpoints, mobile, IoT, and cloud.
“The pandemic has been somewhat of an accelerator in the evolution of cyber risk,” explains Erez Yarkoni, Global VP for Cloud Business. “We had remote workers and cloud adoption a long time beforehand, but now the volume and surface area is far greater.” Formerly a CIO for several big-name telcos before joining Check Point in 2019, Yarkoni considers the cloud to be “part of [his] heritage” and one of modern IT’s most valuable tools.
Check Point has three important ‘product families’, Quantum, CloudGuard, and Harmony, with each one providing another layer of holistic IT protection:
- Quantum: secures enterprise networks from sophisticated cyber attacks
- CloudGuard: acts as a scalable and unified cloud-native security platform for the protection of any cloud
- Harmony: protects remote users and devices from cyber threats that might compromise organisational data
However, more than just providing security, Yarkoni emphasises the need for software to be proactive and minimise the possibility of threats in the first instance. This is something Check Point assuredly delivers, “the industry recognises that preventing, not just detecting, is crucial. Check Point has one platform that gives customers the end-to-end cover they need; they don't have to go anywhere else. That level of threat prevention capability is core to our DNA and across all three product lines.”
In many ways, Check Point’s solutions’ capabilities have actually converged to meet the exact working requirements of contemporary enterprise IT. As more companies embark on their own digital transformation journeys in the wake of COVID-19, the inevitability of unforeseen threats increases, which also makes forming security-based partnerships essential. Healthcare of Ontario Pension Plan (HOOPP) sought out Check Point for this very reason when it was in the process of selecting Microsoft Azure as its cloud provider. “Let's be clear: Azure is a secure cloud, but when you operate in a cloud you need several layers of security and governance to prevent mistakes from becoming risks,” Yarkoni clarifies.
The partnership is a distinctly three-way split, with each bringing its own core expertise and competencies. More than that, Check Point, HOOPP and Microsoft are all invested in deepening their understanding of each other at an engineering and developmental level. “Both of our organisations (Check Point and Microsoft) are customer-obsessed: we look at the problem from the eyes of the customer and ask, ‘Are we creating value?’” That kind of focus is proving to be invaluable in the digital era, when the challenges and threats of tomorrow remain unpredictable. In this climate, only the best protected will survive and Check Point is standing by, ready to help.
“HOOPP is an amazing organisation,” concludes Yarkoni. “For us to be successful with a customer and be selected as a partner is actually a badge of honor. It says, ‘We passed a very intense and in-depth inspection by very smart people,’ and for me that’s the best thing about working with organisations like HOOPP.”