“Why?” – the toddler’s favourite question to exasperated parents. From our wizened adult perspective, the whiny why question tires quickly, but when you are young there are so many new things in the world and much you don’t know. When a parent says something like ‘don’t eat things off the floor’ and the child responds ‘why?’ they aren’t doing it to be annoying – well not at first anyway. It’s a learning mechanism – if you respond with ‘because it might have germs on it that can make you sick’ then it helps them to understand why they shouldn’t do something – which makes it more likely they won’t do it again.
This is the idea behind best practice sharing, Aurora’s seventh Access All Areas dependency, and its emphasis on being principles based. The reason we share best practice is in the name – it’s the best way of doing things. However, in a complex adaptive system like our healthcare system, it’s not one size fits all. Processes are non-linear so we can’t always guarantee the same results when best practice from one area is applied to another. If we ask why something is best practice though, then we can understand why the specific protocols in place produce the best outcome. The principles behind best practice can be used to adapt the practice to other geographical locations. Not only that, but questioning why something is considered best practice acts as a failsafe to question whether it actually is best practice or if we have succumbed to a potentially established while wholly ineffective norm.
The need for best practice sharing is due to the regional nature of the UK’s healthcare system. Despite gaining approval from NICE’s Health Technology Assessment (HTA), medicines can still find difficulty securing complete market access. Commissioners in a given geography rapidly assesses guidance, implement the recommendations within their local health system, and put outcome metrics in place to record the impact of this change. The model then remains local, never to be shared and means people constantly have to reinvent the wheel. This then leads to greater inconsistencies in patient experiences and in practices across the system, making it more difficult to apply best practice. In addition it generates huge inefficiencies, and gives rise to concerns of inequity of care.
If we are to make use of best practice, in a complex system it should be principles based. To improve medicine access, best practice would utilise the other dependencies we have covered, even if our day-to-day language frames them differently. Best practice is about ‘leaders’ having the courage to try new approaches; getting planning cycles better aligned; taking a broader view and inviting different perspectives, including those of patients; making better use of real world data; and collaborating around common interests.
Currently, ideas and best practice do migrate across systems, but the goal should not only be to replicate the nuts and bolts of good practice, but equally should be about creating openings in the system, and processes that can facilitate best practice sharing. It is about populating the system with the beliefs and attitudes that can create conditions for good principles and new behaviours to migrate.
Best practice sharing starts with considering how good your own practices are. Here are some recommendations to get you started:
- Consider your own attitude towards sharing good ideas. How proactive are you currently? Is there room to do more both inside your own organisation, and with other organisations?
- As a commissioner, how willing are you to share your hard work, for the common interest?
- Think back to previous successes – what were the conditions that existed? What choices did you make? What patterns did you break? What assumptions did you hold? Were you free from assumptions?
- Think about the occasions that did not work out so well – What lessons might be learned? Upon reflection, what might you have done differently?
- From both successes and failures, what are the principles you can share?
- How can the system be constructed differently to accommodate sharing best practice?
- How can the pharmaceutical industry play a credible role in facilitating best practice sharing? What beliefs need to be overcome for this to happen?
To find out more about this dependency and the other dependencies, read our Access All Areas paper, ‘Creating opportunities for improving patients’ access to medicines,’ available for download here.