There is a basic opportunity for improvement (AKA weakness) in most Health Systems.
In the common model of decentralised health systems there is usually an embedded health department and government culture of “devolved governance”. Whilst this can be espoused as empowerment of the system-players to be responsible, it also inevitably absolves the department of direct responsibility for outcomes. Bureaucracy is typically about regulation, setting standards and making rules for systems and this is very much the case in health…
However, the real issue if you are on the pointy end of the scalpel is the verification of the application and outcome of those rules (or policy, guidelines, regulations, advisories, standards etc).
Having rules about clinical outcomes (i.e. policy, guidelines, protocol) and measuring nebulous KPI’s does not mean that a system is safe or prepared – even though it may tick boxes and achieve ‘accreditation’.
The challenge is often in the next step: making CERTAIN that the policy framework translates into correct and reliable outcomes.
The answer lies in an effective reboot of a central (departmental and government) mindsets away from old fashioned bureaucratic ‘set and forget’ to: validation, measure-and-improve, personal accountability – and application of this approach from minister to front-line provider.
Some steps have been taken in this direction but some leaps are required.
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