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The cynic’s guide to undermining good ideas



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.