The winter vomiting bug has done its rounds in our household and my daughter was the last to succumb. As I prompted her to drink more, she asked me which was healthier – water or milk? I thought about it for a few minutes and then told her it depends what you want to achieve. If you want to be hydrated, then water is healthier, but if you want calories and protein, then milk is healthier. She immediately declared she was dehydrated and went off to fetch herself a cup of water.
This simple conversation made me reflect on the outcomes we focus on in healthcare. It seems obvious to want to offer patients what they wish to achieve, but there is evidence of a mismatch between what they want and what is genuinely of benefit.
I want to talk about the concept of ‘failure demand’ – something discussed in Beyond Command and Controlby John Seddon et al and which I find really compelling.
This idea is that much of healthcare work (and many other areas) is driven by demand created by failing to address the issues that matter most to people. Our systems create blocks and obstacles that make it very difficult to resolve people’s most pressing concerns quickly and fully. It creates further ‘shock waves’ of demand, as people seek alternative ways to navigate the obstructive system.