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The cynic's guide to undermining good ideas

From Dr Ivan Benett, Manchester

I love Yes Minister. Sir Humphrey’s aim in life was to thwart any progress or to make any changes. He reminds me of my old PCT Finance Director who famously had ten ways of saying ‘no’. So for your information, here are ten ways of undermining 'good ideas':

  1. The outcomes are the wrong ones. They don’t apply to our population. They are not measurable. They will take too long to achieve. They are intermediate outcomes that don’t guarantee improvement in mortality, morbidity, or hospital activity. The success criteria are too ‘soft’.
  2. It’s already been tried before, and it didn’t work. Someone is bound to have tried something similar and failed, or didn’t entirely deliver the expected benefits.
  3. There isn’t the capacity to do it. There will be ‘double running’ to begin with. Something else will have to be stopped. We can’t do everything.
  4. The staff aren’t trained. Whatever the idea, staff will need to do things differently, and that will require training. In turn that will need more money and will probably be resisted.
  5. There isn’t an evidence base, and we have to have an evidence base. If there is evidence it is unconvincing, or poor quality.
  6. The negative impact is unknown, and there are always unforeseen consequences. These will be, well, unforeseen.
  7. Where it seems to have worked before, the population was different. They were older/younger, inner city/rural, wealthy/deprived, take your pick. The evaluation was suspect, or worst of all, ‘qualitative’.
  8. Previous success depended on an enthusiastic champion (pain in the arse), or was conducted under research conditions that don’t apply here.
  9. It is unaffordable, not cost-effective, unsustainable or the money will be better spent elsewhere. Not all costs have been considered, like equipment, space or IT.
  10. Patients won't like it. If you assert this three times, especially supported by anecdotes, it makes it true. Ask Donald Trump.

The natural cynic will already know these points. They will be using them in their every day life. They will have established them in their own practice and will be sucking the creative energy out of their own staff and their initially enthusiastic partners.

So if you do really have a good idea, pre-empt these challenges, by preparing the answers in advance. Get your retaliation in first.

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Readers' comments (17)

  • I have no problem with good ideas. The problem is discerning them from the increasing number of bad ideas which seem to pass the above tests without a hitch.

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  • I have two problems with this list of ten statement by Dr Ivan Benett. Firstly, there is no mention of ethics (and the principles of). Secondly, I do not think that it helpful to conflate critical thinking with cynicism.

    Dr Peter J. Gordon

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  • Ivan Benett

    Peter J Gordon 9.18am. Its meant to be amusing, not a definitive text. Anyway, have a lovely day and remember to balance your patient's autonomy with what you think is best for them, and what might do them harm. That's if you can afford the time and expense without jeopardising other things you want to do. Oh and lighten up.

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  • Dr Benett this is an unnecessarily personal reply.

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  • Great piece, thumbs up for me!

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  • An understandable conclusion is :
    If you don't agree with the establishment, you are against it. The establishment is always right and you have to put into practice what they say. Sell your soul if you have to but accept it even if all points from 1-10 apply. Applying common sense is heresy - you'll be burnt on the stake just like Joan D'Arc.

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  • Thinking all of ones ideas are 'good ideas' is an arrogant presumption. Maybe the idea is just a bad idea?

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  • doctordog.

    Hell hath no fury like a vested interest masquerading as a moral principle .

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  • Spuds

    Ha ha I love the irony of Ivan telling someone else to lighten up! Over-reaction, Ivan?

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  • Lenin thought all his ideas were fantastic and that everyone else was wrong..... that other democratic parties were a threat to the revolution and had to be eliminated..... I would tag that onto an old saying of Abraham Lincoln... "Our critics are our friends... they show us our weaknesses"- if you have what you think is a good idea/ i.e. hypothesis, you must test it fairly to see if it actually indeed does work and leave it open to scrutiny.... I feel it is fair to say that a lot of readers were not convinced of the success of the authors pilots in which he was involved. I think its only right that readers are allowed to make critical observations in a period when opinions seem to count more than fact in this 'post-truth' era.

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