3 key questions for the Cumberland Initiative

This document outlines the questions that emerged following a visit made by Professor Terry Young of the Cumberland Initiative to Sir Richard Thompson, President of the Royal College of Physicians, on March 12, 2012.

Three sets of issues emerged and they are presented here from the a clinical perspective, in the form of a question, a testable hypothesis and the clinical rationale that supports the hypothesis. The challenge for the Cumberland Initiative is to furnish evidence or to run the experiments to illuminate the issues and answer the questions.

2 thoughts on “3 key questions for the Cumberland Initiative

  1. It was not clear to me whether the ‘rationale’ reflects Sir Richard’s view directly but in any event the set of rationales strike me as extraordinarily negative and a disappointing way to start the project. It is also surprising that the starting point for the first two questions (namely that the variation makes each patient a special case – so there are no economies of scale or organisation.) fails to recognise even the most basic ideas of ‘mass customisation’ in engineering. As a simple example, take a look at Royal mail ‘Smilers’ offering. Upload a digital photo of family, pets etc and they will make you a book of legal tender stamps incorporating that photo. Each order will be different and personalised yet Royal mail can achieve mass production economies of scale. My suggestion would be to turn your hypotheses into positives rather than negatives.

  2. I presume the reason that these hypotheses appear so negative is the epistemological approach adopted…

    They are null hypotheses that the researchers are trying to refute! It’s the old “all swans are white” approach taught in much (social science) statistical research methods. This might be justified if these null propositions are very firmly and widely held so that refutation is very obvious (one finds a black swan) and shifts the old paradigm, but it is often misused as a straw man or ‘nil’ hypothesis. Therefore it would indeed be crucial to know whether these hypotheses were directly derived from the beliefs of Sir Richard and his colleagues – one could imagine they were…

    A reappraisal of how (‘hard’) science is actually done (and how statistics should be used in its support) suggests that generally one should instead start with the researcher’s theory and its (positive) predictions as the null and so: if empirical investigations refute it then that stimulates another cycle of building (better) theory, if they fail to refute it then we go through further cycles of testing to build its credibility.

    This is the way ‘improvement science’ works : e.g. the PDCA/PDSA testing and learning cycle; and the way a doctor treats a patient…?

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