Kaleidoscope has just reached its second birthday. Throw confetti, chow down on some cake or create a cotton masterpiece – any and all forms of celebration welcome.
Now that we’re the wise old age of two, we’ve started to ask ourselves the serious questions. Can we still call ourselves a start-up? When do we become just an ‘up’? As a former (or possibly still present) start-up, have we really drunk enough hipster coffee or tried our hardest to work a man bun?
Are you the same person at work as you are at home? Some? A bit perhaps? This might matter to you immensely, or not at all, but almost all of us would see there being some difference between how we think personally and professionally.
Sometimes this is helpful (not everyone needs to know about your Panini sticker fascination), but sometimes it’s not. The annual NHS Providers conference is an extravaganza of the complexity of healthcare policy. Critiques of control totals, tinkerings with tariffs, and processes to produce plans abound. This is peak-profession conversation (I don’t know how your household runs, but it probably doesn’t have much room for marginal rate emergency rules).
The world is increasingly dichotomous, issues and solutions are presented and processed as either black or white. The divide between competing ideologies is widening and the grey area is shrinking as people cling firmly to the right or left.
However, dissemination of research is universally promoted, clung to and agreed upon as vital to policy, practice and all users of research. We also seem to agree unanimously that bridging this gap between health research producers and users is hard. We agree on the importance of producers and users uniting in this endeavor and that cross-disciplinary discussion catalyses unification, but the struggle of actually doing this is real and felt equally by all sides. Why can’t we overcome this impasse?
What if we’ve been going about it all wrong all along?
Language is a crucial marker of tribal identity. Both ethnic and professional tribes use language to recognise members of their own tribe and to exclude members of other tribes. Two ethnically related tribes may be distinguished by their use of different languages, but in other cases the linguistic differences may be subtle.
Small but significant linguistic markers of identity are known as shibboleths, after the Old Testament story in which the pronunciation of this word was used to identify members of an 'out-group.'
Where two tribes share a genuinely common language, tribal politics may encourage the creation of artificial shibboleths. Serbs and Croatians share what used to be a common language, but Serbs chose to write it using the Cyrillic (Russian) alphabet while Croatians adopted the Latin script. Over time, small differences in usage have evolved.
Someone somewhere once said you can't teach an old dog new tricks. But who said anything about new tricks?
I recently had the immense pleasure of visiting my family in Australia. I'll admit, it's a familiar route for me, but this time was different; I was on a mission. I had arranged that while I was in Melbourne I would film my Grandpa for a TEDxNHS talk. He is quite something. Old Jewish Grandparents are supposed to bore their friends kvelling over their average to over-achieving grandchildren but the tables have most definitely turned in this case.
My grandfather was one of the first NHS surgeons, becoming a consultant ophthalmologist in North Wales in 1948; my father was a consultant physician in London and Bristol from the early 1970s; and I - well, I suppose you could say I am a consultant of sorts at Kaleidoscope, which is not part of the NHS but functions, we hope, as a benign disruptor in its ecosystem.
Seventy years after its birth, the NHS continues to exert a strong gravitational pull on my family, and on so many other families.
And my family is an early example of another NHS phenomenon that has grown in importance over the generations - and, like the NHS as a whole, is perhaps at a turning point. Since its inception, the NHS has been a generous employer of migrants.
We recently spent two stimulating days at HSRUK 2018. Our colourful tablecloth, quirky leaflets and coffee maker attracted a lot of great people and we asked them all the same question: "What gets in the way of research, policy and practice working together?"
The good news: people not caring is not the issue.
Nonetheless, there is a range of factors that people in health services research seem to run into on a regular basis: misaligned agendas and languages, a perceived lack of time because everyone's always busy, not knowing how to engage properly, logistical problems such as different locations and timescales, and the absence of clear logic models ahead of implementation.
At the Health Services Research UK 2018 Conference, plagued with mid-conference excitement, I cannot help but ponder the curious way we talk about and go about disseminating research: as dedicated but inexpert gardeners, and as children holding dandelion blossoms, respectively.
Dandelions can do more than sully your pristine lawn; they can be used in both savoury and sweet recipes and are loaded with health benefits. But if you want to cultivate them for such purposes, you wouldn’t grab the stem, blow the seeds and wait for your salad and tea in the kitchen. Wishful thinking.
What drives successful (and sustainable) system change? This won't stop being a relevant and compelling question. We should perhaps acknowledge though that, at least in terms of healthcare, we have a prevailing orthodoxy - that top down, mandated and performance managed changed is the default method.
The healthcare system has been trained to receive and act upon the annual operating plan. That plan describes the what, the how, the 'by when', and the 'how much'.
I watch and read a lot of dystopian fiction and one of the grimmest things about the world to come is the extremes of 'identity': think red cloaks in The Handmaid's Tale, unseeing Ul Qoma in The City and the City, or a replicant in the persistent rain of 2019 Los Angeles. People do like to categorise.
I include myself in the catch-all; anyone who's ever seen me present on analytical matters will often hear me kick off by apologising for being a career analyst (it can be an awkward admission to make, especially in taxis) as a way of laying out my stall.