The Distillery

The Distillery 2018-03-09T16:20:23+00:00

Wisdom Distillery from Professor Gray

These updates will include essential books, essential glossary items for understanding value in health and healthcare. For each book there is the full reference, the distilled message (the essence of the book in the author’s own words) and why this book is important (the relevance of the book and other related titles or key terminology to note).

102, 2018


‘Optimality is reached when resources or productivity create maximal benefit with the least harm.’

Significance: There are two different uses of the term optimality, both important.  One developed by Vilfredo Pareto describes the best possible allocation of resources. When Pareto Optimality is reached it is not possible to get more value by switching a pound from anyone budget to another.  Another term for this is allocative efficiency, which is different from the technical efficacy with which each budget’ s resources are used.  The other meaning is from Avedis Donabedian’s work because he used the term to mean the rate at which a service is being delivered that gives the best balance of benefit to harm to a population.

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102, 2018

Setting Limits Fairly: Learning to Share Resources for Health

Daniels, N. and Sabin, J.E. (2008) Setting Limits Fairly, Learning to Share Resources for Health. (p44) Oxford University Press.

Distilled message:

“Accountability for reasonableness is the idea that the reasons or rationales for important limit-setting decisions should be publicly available. In addition, these reasons must be ones that ‘fair-minded’ people can agree are relevant to pursuing appropriate patient care under necessary resource constraints. This is our central thesis, and it needs some explanation. By ‘fair-minded’, we do not simply mean our friends or people who just happen to agree with us. We mean people who in principle seek to cooperate with others on terms they can justify to each other. Indeed, fair-minded people accept rules of the game –or sometimes seek rule changes –that promote the game’s essential skills and the excitement their use produces.”

Why is this book important?

This is one of the most important texts to help you think about decisions that affect allocative efficiency or trying to reach “A situation in which it is not possible to improve the welfare of one person in an economy without making someone else worse off.”

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1804, 2018

18th April 2018: Paper of the Month

Muir Gray’s paper of the month is: ‘Complexity-compatible’ policy for integrated care? Lessons from the implementation of Ontario’s Health Links

Grudniewicza,∗,A et al (2018) Social Science & Medicine 198 (2018) 95–102 Agnes Grudniewicz, Tim Tenbensel, Jenna M. Evans, Carolyn Steele Gray, G. Ross
ISSN 0277-9536,

The Bottom Line

We found that the complexity-compatible policy design successfully stimulated local dynamics of flexibility, experimentation, and learning and that important mediating factors include leadership, readiness, relationship-building, role clarity, communication, and resources. However, we saw tensions between preferences for flexibility and standardisation. Desirable developments occurred only in some settings and failed to flow upward to higher levels, resulting in a piecemeal and patchy landscape. Attention needs to be paid not only to local dynamics and processes, but also to regional and provincial levels to ensure that learning flows to the top and informs decision-making. We conclude that implementation of complexity-compatible policies needs a balance between flexibility and consistency and the right leadership to coordinate the two. Complexity-compatible policy for integrated healthcare is more than simply ‘letting a thousand flowers bloom’.

The Clearest Example of the Meaning of the Term 

“Certain nonlinear systems attracted the attentions of scholars as a potentially useful avenue for analyzing natural and social phenomena. They are commonly described as being Complex, because their behavior is defined to a large extent by local interactions between their components. When such systems are capable of evolution they are also known as Complex Adaptive Systems.”

Source: Rihani, S (2002) Complex Systems Theory and Development Practice. Understanding non-linear realities. Zed Books Ltd. (p.7).

102, 2018

Realising Realistic Medicine

Realising Realistic Medicine –

Cath Calderwood – CMO Scotland, read her latest blog on the second annual report – ‘Realising Realistic Medicine’

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No one will ever read all the books that they need to read or could read in their particular topic. It is far more important to know about a book and its core message, preferably in the author’s own words, and to understand how that book fits into the culture and relates to other books and concepts then not to know that a book existed.

This is the principle behind our essential book list.  At Better Value Healthcare we provide a distillation service whereby the core message from 1000+ books are presented in the author’s own words with an additional commentary from Sir Muir Gray about the importance of the book and how it relates to other key published material.

Confusion about language and the meaning of the terms being used is one of the main causes of arguments, fruitless arguments, which disappear if everyone shares the same

understanding of the term. At Better Value Healthcare we developed the 21st Century Healthcare Glossary with the principles of clarifying the meaning of commonly used terms to improve dialogue and decision making. The glossary consists of 1000+ terms and their meanings in use. Some of these ostensive definitions are long and can be unwieldy for everyday use so we have, where appropriate, presented a shorter, more useful definition, which we call the bottom line for that term.