Shouldn't we know how well do our health services REALLY work?

Imagine the value to decision-makers of understanding the viability of our health services; it would allow us to do so much more than we can today. And it is not difficult. It just needs us to view the services from a systemic perspective.

Those of us that have had direct experience of working in the UK health service tend to have an opinion as to how well it is working. Even then, we have our own biased and small view of our experience - hardly representative.

If we look around at the measure that are used for the NHS, we find that they are primarily based around the mechanistic and financial view of a rigidly defined set of services. Somehow thinking that measuring funds spent against an arbitrary target as being is in any way useful is simply folly.

But for those who are outside it - the public, and perhaps leaders and politicians who are distant from it - how would they actually know of the state of the health services? Would it not be important to have agreed and measures aspects of the services, so that we could have empirical knowledge to base potential decisions on?

Having thought about it, using a systems approach to understanding and viewing services, it is perfectly possible to have a set of metrics and indicators that are designed to evaluate the viability and 'brokenness' of the health services.

So, to start with one example. How would we measure say, the viability of nursing? Well, looking at this from the perspective of the nurse, how well are they able to do their job, and how does nursing fit as a role? We already know that we have a problem with nurse numbers, and the traditional mechanistic view is to employ foreign and cheaper nurses.

One example that is bouncing around my head:

1. The % of nurses who leave after the first five years of starting work, together with the real reason they left (this could easily be done on a very small random sample to get quality information)

This would indicate the fact that you have people who have trained for several years, and who should have a viable job that they want to do for perhaps the rest of their lives.

Anyway, that measure would help point us to the parts of the system that need attention, that we simply do not have today. It would aid in decision-making becoming freer from political whims, and focus on what drives value, sustainability and good outcomes.