The Ritualisation of Healthcare

In the endeavour to improve health care the primary instrument appears to have been to reduce errors. This attempted reduction in errors has included means of prompting the recognition of errors, some small (and perhaps inconsequential) or those of high magnitude (such as recognising clinician incompetence or criminality).

. However, it is clear that the hope for success has been blunted and there are some reasons for believing that corruption within the health care systems has increased rather than decreased.

The tactic which has been emphasised has been an “administrative” one. Such “managerial” efforts have taken the form – as they do in a highly structured societies and communities of whatever denomination – by imposition of “rules”.

These “rules based” endeavours depend upon an ever-increasing complexity of these impositions. This, in turn, ultimately necessitates complex algorithms and ritualized responses.

In healthcare, it can easily be shown that such rigid constructs are counter-productive and increasingly expensive. The administration of these “rules based” structures is expensive and must contribute considerably to the current costs of healthcare.

It is suggested that the entire concept of “rules based algorithms” in healthcare should be revisited and reappraised from the level of the deepest foundations of healthcare training.

It is not appropriate, the context of this letter, to detail this form of reinvention but it is hoped that this can be done in the future, perhaps in collaboration with various organisations which have the primary mission of improving healthcare in this way. This website, which has been visited by hundreds of thousands, and would like to open itself to responses from such organisations, charities, trusts and similar constructs.