The chapter waiting to be written

Innovations are, by definition, new so their evidence base may be lacking. Should that stop us?

“Can you give us examples of where alliance contracts have been used in the health services” someone asks.

“No” I reply. “They’ve not yet been used in the health and care sector”.

This is a common exchange when I talk about alliance contracting. I usually add something about New Zealand and the alliance approaches just starting up in primary care but I’ve learnt not to duck the question.

I guess any innovation can get accused of not having an evidence base – that’s why it is an innovation. It takes time to build the evidence base and, as Nick Black reminded us back in 2001 in his BMJ article Evidence based policy: proceed with care, trying to cement the link between research and policy is not always appropriate or relevant.

This does not mean that you should not also ‘proceed with care’ when the evidence base is limited. We don’t want to see constant upheaval and disruption (and I use the word deliberately), everyone blown this way or that in the wind of the latest initiative.  Initiativitis as a colleague of mine once called it.

So how do we balance the need for progress through using new ideas and new ways of doing things with the need to ensure we minimise the risks? I’m championing the adaption and adoption of a business practice model used successfully in other sectors. What is important for me is:

–        The values it is based on fit with ours – collaboration, joined up care, shared accountability and risks

–        Its success in other sectors are those we want here – outstanding performance, value for money

–        It represents the direction of travel we are going in anyway –outcomes based contracts and risk share agreements are starting to appear

But I am also aware that:

–        It does not always work in other sectors – and we need to understand the reasons

–        We need to try it out, adapt and learn – be that learning good or bad

It will be a while before I can answer the question posed with long list of examples. I’m helping get the first alliance contract in health and social care in place for this April so have made a start.  It feels as if there is a blank page – the chapter waiting to be written.

Send me a message on Twitter or connect with me on LinkedIn