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Could crowds manage healthcare?

14 December 2016

Could crowds manage healthcare?

Sir Francis Galton is probably best described as a Victorian explorer and scientist with many interests. In 1906 he attended the West of England Fat Stock and Poultry Exhibition and noticed a weight judging competition. Members of the public were placing wagers on the weight after it had been slaughtered of an ox on display. Galton subsequently analysed the 787 entries, which included some from farmers and butchers but the majority were from people with little expert knowledge of cattle.

After it had been slaughtered and dressed the ox weighed 1,198 pounds. The average of the guesses of the weight of the ox was 1,197 pounds – closer than any individual guess. Arguably, Galton was the first to discover the wisdom of crowds or, in the subtitle of James Surowiecki's book on the subject, "Why the Many Are Smarter Than the Few".

Utilising collective good judgement already exists in healthcare – Health Wisdom crowd "creates patient healthcare with a network to focus the wisdom of effort of crowds across the United Kingdom", with California based CrowdMed "Harnessing the wisdom of crowds to solve the worlds (sic) most difficult medical cases". In an open article entitled The Wisdom of Social Media Crowds, Rosy Matheson wrote: "Social media has been shown to increase the timeliness and sensitivity of disease detection in conjunction with traditional surveillance methods".

The wisdom of crowds has applications in many other fields including, as Surowiecki notes, companies. He states: "Far more important than stock options would be the elimination of rigid managerial hierarchies and the wider distribution of real decision-making power."

What interests me is whether the wisdom of crowds can be utilised in healthcare management – particularly practice management. Practice managers in primary care are invariably isolated, working among colleagues with little in-depth knowledge of their role and the options they have to consider when making decisions. Wouldn't it be a good idea to draw on greater wisdom for some of these decisions?

Many practice managers will argue that they have formal and informal networks of colleagues in other practices to draw upon for help and guidance. Indeed, as part of its £6m practice manager development programme, NHS England organised four half-day networking events around the country for primary care practice managers. These were billed as: "… an opportunity to network with colleagues from around the region and share challenges, ideas and encouragement".

But that's a bit like asking only the farmers and butchers to guess the weight of the ox whereas it's a wise crowd which invariably finds the best answer. Surowiecki states there are four elements to a wise crowd:

  • diversity of opinion (each person should have private information even if it's just an eccentric interpretation of the known facts),
  • independence (people's opinions are not determined by those around them),
  • decentralisation (people are able to specialise and draw on local knowledge) and
  • aggregation (a mechanism exists for gaining a collective decision from private judgements).

Perhaps the NHS England practice manager development programme should seek a wise crowd rather than set up more networks?

Afterword: Crowd sourcing as a delivery mechanism for transformational change was discussed at an NHS Transformation 2016 event in January entitled: Crowdsourcing: Do the people know best? Capturing the collective wisdom of the crowd to innovate and redesign care. For transcript go to:

About the author

Amanda Atkin is a change management consultant focusing on the healthcare sector in which she has considerable expertise and experience. Amanda's skills range across contractual management, performance management, operational delivery and leadership development to strategic planning as well as governance and regulatory compliance.


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