Primary Care Training Ikea NHS

A bit of luck

Going into a teenager’s room is the same as going to IKEA. You go in just to see what’s new and come out with 10 plates, three cups and a pair of socks.

Doncha just love it?

IKEA is the eighth most valuable retailer in the world, making it the most high-worth furniture retail brand, valued at over a $23bn. The business operates 458 stores around the world and has 50 e-commerce markets. Roughly 882 million customers visited IKEA in 2022, and…

… one out of every 10 Europeans were conceived on an Ikea bed!

Phenomenal… a carefully thought out strategy based on flat-pack furniture.

The story goes like this;

Ikea sold furniture and one day an Ikea manager happened to look out of the window, from the store, onto the car park and saw a customer unscrewing the legs from a table, so it would fit into the back of his car.

The birth of IKEA’ strategy… ‘we don’t sell it unless the customer can take it home’.

Last year the IKEA Foundation donated €20 million for humanitarian assistance to UNHCR and the UN Refugee Agency, for people affected by the conflict in Ukraine.

Pop-up kitchens in Shoreditch, second-hand shops and a chance for other small retailers to trade in IKEA premisses. And, the IKEA effect… when labour leads to love.

A strategy, leading to a vision, leading to a culture. Wow!

All from an accidental observation and the assumption, most people can work a screwdriver.

Closer to home I can see another ‘strategy’ emerging. This time in the NHS. The result of the junior doctors’ strikes.

So the story goes, when the front door of A&E is staffed by consultants admissions are fewer, transit through the department is quicker and queues are reduced.

On the wards discharges are faster and length of stay shorter.

Consultants know more, are more experienced, less risk averse and get stuff done.

Junior doctors are… well… not as experienced (why would they be), more risk averse (why wouldn’t they be) and are cautious (good) about how they get stuff done.

An NHS strategy to put our best people into bat first, is being born.

IKEA and the NHS… two really interesting takes on strategy. The problem is…

… neither is completely true.

Flat pack furniture existed long before IKEA. The change came when the pack was carted home by the customer instead of incurring the high transportation costs of heavy furniture and damage in transit.

The beneficial presence of consultant grades at the blue-light, front-door of the NHS is already a well known phenomenon. Very familiar to the likes of the Emergency Care Intensive Support Team (ECIST) and the GIRFT people… getting it right first time.

They know this stuff and they also know a lot about flow through emergency systems and discharge.

Relatively few hospitals have put a consultant at the front of the process.

The General Surgery GIRFT report as far back as August 2017, highlighted that the availability of senior decision makers in the A&E department, reviewing surgical patients, reduced the admission rates by 30%.

In Sheffield ECIST helped match geriatric capacity to demand more effectively, by extending on-call consultant cover.

Strategy… overrated. I’ve never been a fan. Not in the operation sense.

In the ethereal sense, maybe. The clue is in the derivation; The term ‘strategy’ is derived indirectly from the Classic and Byzantine (330 A.D.) Greek, ‘strategos,’ which means ‘general.’ The German military pinched it and the rest is the stuff of MBAs.

Real operation success can be found in tactics and techniques.

The tactics of avoiding the clumsy and costly postal-delivery-service and…

… the technique of including instructions and screwdriver in the package, is what really gave us IKEA and their delicious meatballs.

The tactics of putting your best people into where the greatest demand, complexity and risk are, irrefutably better and works along with…

… the techniques required to reorganise healthcare to make it happen.

That’s the story of most so-called strategies. Anyone who tells you different is a fool or a charlatan.

Strategising; blueprint, grand design, managing, planning, organising, coordinating and controlling…

… yeh, right.

Most of the time it’s observation, common-sense and…

… a bit of luck.

News and Comment from Roy Lilley
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Reproduced at by kind permission of Roy Lilley.