Quality of life

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Quality of life
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Changing complex systems

• Complex systems seek stability
• People living in complex systems take comfort
  from stability and fear change
• Attempts to change them often result in
  unanticipated consequences
• Those trying for change get the blame whatever
  the outcome
• We tend, therefore to tinker round the edges
  rather than trying for transformational change

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Complex adaptive systems

• Not machines so no traditional forms of control
• Leadership is distributed. The boss cant control
  everything
• Small changes in one area might have large
  impacts elsewhere and vice versa
• Outcomes are unpredictable so continual
  monitoring and learning and chage is part of the
  process of change

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Changing complex systems

• Challenge the stability of existing behaviours
  and structure
• Set simple, order generating rules
• Expect new insights and ideas to emerge
• Have an open, learning attitude, using plan, do,
  study act cycles
• Keep calm and carry on!

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Albert Einstein

• Insanity is doing the same thing over and over
  again and expecting different results

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Improvement science

• W Edwards Deming (1900-1993)
• In God we trust, all others must bring data
• By what method? Only the method counts.
• Don Berwick
• Some is not a number. Soon is not a time.
• Scottish Patient Safety Programme
• By how much and by what method?

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Hospital SMR 9.3 reduction
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General ward C.Difficile rate(per thousand
patient days)
90 reduction
1.15
0.12
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Central line infection rate (per thousand line
days)
2.8
70 reduction
0.84
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Life expectancy trends
Portugal
Scotland
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Life expectancy trends
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Post industrial regions of Europe
Male life expectancy at birth West Central
Scotland and 10 post-industrial regions
Walsh, D. et al. Eur J Public Health 2010
2058-64 doi10.1093/eurpub/ckp063
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Male mortality 15-75Scotland and 15 other
European countries
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Female mortality 15-75Scotland and 15 European
countries
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Attention to detail
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Suggestions for collaborative working

• Early years and children
• Young persons offending
• Physical activity across the population
• Planning and design of communities
• Entrepreneurship

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Adverse childhood events risk of alcoholism
Hillis et al 2011
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Adverse childhood eventsrisk of perpetrating
violenceBoys experiencing physical abuse
Duke et al 2010
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Risk of heart disease and early adversity
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Social connectedness

• 148 studies comprising 308,849 participants, high
  levels of social integration conferred a 50
  increased likelihood of survival.
• Complex patterns of social integration conferred
  a 90 increase in survival.
• Simple connections such as living with others
  versus living alone conferred a survival benefit
  of 19.

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Enhancing social connectedness
Help to connect people
Coproduction
2. Build communities
1. Light the fire
LAs NHS 3rd Sector
SG
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Risk Factors- mortality Blair et al BJSM 2009
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Risk reduction associated with physical activity
Chronic condition Risk reduction
All cause mortality 30 risk reduction
CVD, stroke 20-35 reduction
Diabetes 30-40 reduction
Hip fractures 36-68 reduction
Colon cancer 30 reduction
Breast cancer 20 reduction
Loss of function 30 reduction
Depression/dementia 20-30 reduction