The way big organizations work, whether they be public or private sector, there's often little incentive to explore cheap but effective ways of improving performance. There's little glamour attached to mundane ideas and, where status is correlated with budget size, little reason to adopt them when there's a more expensive option available. This mentality, of course, is encouraged by an environment in which outcomes don't matter. But when people do care about outcomes, there's a surprising amount of low-hanging fruit available for the plucking. Here's the result of using checklists for surgical procedures for 8000 patients for six months:
In every hospital major complications were reduced by 36 per cent and the death rate was halved. One minute with Atul Gawande, 'New Scientist', 20 FebruaryThis is outcome-based policy at its best. (See here for more.) All 167 hospital trusts in the UK are now adopting this simple innovation.
A Social Policy Bond regime would similarly encourage the adoption of efficient techniques, even if they are unglamorous. It would build efficiency incentives into all activities aimed at achieving the targeted goal. As Dr Gawande's work indicates, the scope for improvement under the current system is quite astonishing.
This blog has moved to http://socialgoals.blogspot.com. I am working on an automatic redirect.