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No plan survives contact with the real world

WE know that legacy solutions to the challenges facing health care institutions often fail, a realisation the pandemic demonstrated around the world.

It doesn’t matter what you do, the future will not be like the past or indeed what passes for the present. In fact, the world is sufficiently complex that yesterday’s solutions are unfit for today’s and tomorrow’s challenges. The evidence is compelling.

Our focus is on decision making. This encompasses a large range of issues, but for simplicity and from our experience, comprises understanding

  • how doctors think and the quality of clinical reasoning to reduce or avoid medical errors
  • improve prescribing choices
  • understand the real world dynamics of payer priority setting
  • how providers think and how they structure their service models to deliver high quality care
  • how pharmaceutical and medical device companies think and set market entry strategies or design market access and pricing  models.

Core activities from setting priorities, treating patients, to choosing how to allocate resources are all decisions. Let’s not kid ourselves and think that deciding and choosing are simple and without consequences. Rational decision models taught in university fail when they are confronted with reality. The military have an expression: “no plan survives first contact with the enemy”. This may be the best thing to take on board when modelling decisions.

The increasing use of digital technologies adds the opportunity for new understanding of thinking (insights) and develop new solutions. However, technologies always come with a sting in the tail, as they can add complexity and new risks and of course depend on clinicians and others to embrace the way technologies can change clinical workflow.

It is known that many challenges in health care are often referred to as “wicked problems” because solutions often make matters worse or create new problems. Choice making within the process of decision making requires connecting decision making to real world implementation (assessment and modelling in advance) and how decisions play out in the future.