ABSTRACT
One of the curious aspects of the discussion of healthcare policy is how much of it seems to be about structures, incentives and a range of issues that are some distance from the actual delivery of care. Some unexplained variation in clinical work is unavoidable because of its complexity and the impossibility of controlling all the variables that may produce it. Most of the measures required to improve the safety, quality and efficiency of healthcare relate to improvements in the systems supporting provision or the extent to which care is delivered in a systematic way. Surveys by the Picker Institute indicate some fairly serious shortcomings in the experience of patients. Systematisation is a key part of an approach to creating greater patient involvement in the way care is designed and delivered as well as meaning that they can take much more responsibility for much more of their own care management.
