Understanding service improvement in healthcare
Understanding service improvement in healthcare

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Understanding service improvement in healthcare

1.1 The value of doubt

It is sometimes suggested that academics and researchers are doubtful by nature, and that they rarely make a bold assertion, because they can always imagine circumstances that could undermine their claim. That may be true, but it is a relatively unhelpful stance to adopt in day-to-day healthcare service improvement. You need to proceed with an element of trust and consultation, but nor can you remain paralysed by speculation. That said, an element of doubt about what you know, what you think and what others argue, will stand you in good stead if you continue to study this topic.

Activity 1

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Skip transcript: Socrates: Genius of the Ancient World

Transcript: Socrates: Genius of the Ancient World

BETHANY
We're told that he marched by shop stores in his shabby robes saying, how many things I don't need. He saw wealth as impermanent, a distraction from the search for absolute values. Socrates believed you couldn't buy knowledge and wisdom didn't come from listening to long speeches. It could only come through something else-- dialogue.
APOSTOLOS DOXIADIS
So Bethany, I understand you're here to do a documentary about Socrates.
BETHANY
Yes.
APOSTOLOS DOXIADIS
Why are you making this documentary?
BETHANY
His Socratic method worked something like this. Socrates would engage someone in the street. I can learn something more about Socrates and I can share that knowledge with the people who are watching it.
APOSTOLOS DOXIADIS
These are big words, knowledge and truth. Should we take one of them? What would it mean?
BETHANY
He'd ask them an ethical question.
APOSTOLOS DOXIADIS
So what is this thing, knowledge, that you want to impart?
BETHANY
In my book, knowledge is love of what it is to be human. The person would attempt to define the concept, but Socrates would find inconsistencies in their answer.
APOSTOLOS DOXIADIS
Knowledge is--
BETHANY
Is love. Yeah.
APOSTOLOS DOXIADIS
OK. So if you wanted to have an operation for an appendicitis, would you go to a woman who was full of love, but knew nothing about surgery?
BETHANY
No.
APOSTOLOS DOXIADIS
OK. So I would say that the definition of knowledge as love is not good enough.
BETHANY
They would be forced to withdraw their definition and to reformulate and refine their ideas.
APOSTOLOS DOXIADIS
So let's try it again. Is there one kind of knowledge or many kinds of knowledge?
BETHANY
Knowledge is one--
APOSTOLOS DOXIADIS
Take your time. I don't know the answers to this.
BETHANY
Maybe knowledge is one thing, but knowing is many things. This process would spiral into a dizzying round of question and answer.
APOSTOLOS DOXIADIS
To know how the stars move and to know how the liver operates is the same thing.
BETHANY
No. They're not the same thing.
APOSTOLOS DOXIADIS
Does the person who possesses knowledge in a big way know everything? Between those two, who is probably the best clockmaker?
BETHANY
The one who-- I don't know. I don't know.
APOSTOLOS DOXIADIS
Come on.
BETHANY
I give up. I give up. Socrates likens his role to that of the midwife who helps to nurture and deliver the thoughts of others. But it was never an easy birth. I have to say, the one thing you've proved to me is that I know nothing.
APOSTOLOS DOXIADIS
Ah, no, no. That's me. I'm the expert at making other people know things, but I'm no good. I know nothing and that is the only knowledge I claim for myself.
BETHANY
That Socratic method is fascinating and stimulating, but it is also infuriating.
APOSTOLOS DOXIADIS
Yes, because it's in an oral context the way we do it, and Socrates famously believed in the supremacy of the oral over the written. And that also stirs up the emotions.
BETHANY
Yeah.
APOSTOLOS DOXIADIS
First of all, his pretence of being the fool, that ignorant.
BETHANY
Of knowing nothing, yeah.
APOSTOLOS DOXIADIS
Yes, and because that is his tool that he turns, in fact, against his friends, or opponents, as you may take it, and makes them admit to things that they don't want to admit to by playing essentially the fool, saying, I know nothing. I know nothing. I can only ask you to tell me because I know nothing. So he laid an emphasis on definitions, then on what he called dialysis-- division of breaking down a problem into little part, analysing parts, analysing it, and then attacking each one separately; and then trying inductively to group them back together into a more general concept. So Socrates uses that to make people become aware that things they consider simple and elementary and basic and that they know, they in fact don't know.
End transcript: Socrates: Genius of the Ancient World
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Socrates: Genius of the Ancient World
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Watch this excerpt from a BBC programme on the ancient Greek philosopher Socrates and consider the following questions:

  • How helpful do you think this method is when considering service improvements?
  • What ‘tips’ would you take from Socrates in facilitating dialogue with others in your healthcare setting, as you debate service improvement?

Discussion

You may have realised that central to Socrates’s thinking was empathetic and rigorous argument. This might well be helpful to you when planning a service improvement though it would need careful handling. What you glean from the literature, from theory, or from an expert speaker, is information. It is only as you use that information, and discuss and debate it with others, that learning, development and improvement take place. Learning how to argue and debate exercises your critical faculties, and (suggests Socrates) helps develop a sense of humility. In sharing a rhetorical argument with colleagues or other stakeholders in a healthcare service, you might discover a lot about yourself and the situation. It need not be a contest, a combat, a ‘game of chess’.

The ease of communicating via email, social media and online forums now means that it is possible to conduct ‘dialogues’ in new ways that are not literally face-to-face, adopting Socrates’ principles and using ‘netiquette’ in your discussions with others. The tips from Socrates are valid in any medium:

  • Don’t simply think it, discuss it. Only in this way will you deepen your command of ideas.
  • Approach your discussions with a spirit of discovery, wondering what this might teach you. There may be no right or wrong, absolute best or worst perspective, only a diversity of rich perspectives that you can then deliberate upon.
  • Be prepared to ‘turn around’, to question your comfortable and familiar assumptions. While you might fear that others will judge you as weak because of this, it means that others note your openness and thoughtfulness.

Having explored the difficulties of knowledge and speculated over the claims about what constitutes knowledge, you are ready to consider the concept ‘service’ in the next section. If you are engaged in service improvement, then you need to be prepared to consider what ‘service’ is.

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