Evolution, not revolution –a different approach

When Sir Clive Woodward’s England team won the Rugby World Cup in 2003, his coaching philosophy may well have provided an early clue as to how the NHS could drive improvements in care. Success, he said, was not about doing one thing 100% better, but about doing 100 things 1% better. 

Fifteen years later and the concept of marginal gains is not only familiar to us all; it can be applied to pretty much any strategy for human or business improvement. But in the modern NHS, where technology is so often hailed as the great enabler of transformative change, the evolutionary approach has arguably been kicked into touch and replaced with the pursuit of smash-and-grab ‘digital transformation’. The rhetoric implies instant gratification – the promise that digital ingenuity can quickly and effectively cure all ills. The reality is far more complex. If we want to get over the gain line, it’s time to reset the scrum.

Digital transformation is a great hope but, arguably, an unrealistic aspiration. Technology is not a panacea. There is no ‘single solution’ that fixes everything or ‘transforms’ care overnight. The healthcare gains of tomorrow will come from incremental innovation – and lots of it. Doing 100 things 1% better. To get there, CCGs primarily require two things; a forensic understanding of their patient pathways, and the courage to explore new ways of approaching the challenges within them. The potential solutions will be many – and technology will inevitably play its part. But sustainable NHS improvement will not be found in a magic bullet of digital transformation. It’s about evolution, not revolution.