Some of you may find this intriguing: http://www.cna.org/isaac/intro.pdf

Although written from a military strategy perspective I think it's not
difficult to see parallels with healthcare (as long as you ignore the maths
of the Lanchester Equations)

It describes a system in which.......
"The fundamental building block of most models of complex adaptive
systems is the so-called adaptive autonomous agent. Adaptive
autonomous agents try to satisfy a set of goals (which may be either
fixed or time-dependent) in an unpredictable and changing
environment. These agents are "adaptive" in the sense that they can use
their experience to continually improve their ability to deal with
shifting goals and motivations. They are "autonomous" in that they
operate completely autonomously, and do not need to obey
instructions issued by a God-like oracle.

So instead of an NSF of 200 pages one might instead say
here's the evidence
here's the resources
get on with it the way you think is best for your practice
and keep those around you informed


Which, when you think about it, is pretty much what the innovators who
inform things like NSFs and guidelines already did, albeit by placing a high
value on achieiving this and therefore making the resources available at the
expense of either other practices (scavenging the financial pool for
incentive / initiative schemes), other elements of care, or their financial
or personal profit and time. Look at the Doctor magazine awards ( and
arguably any
"high-achieving" practice) and you will not see anyone who got there by
memorising instructions from head office and carrying them out.

Maybe..


Chris

Dr Chris Burton
Complexity enthusiast
http://www.complexityprimarycare.org