Published: 20/12/2001, Volume III, No.5786 Page 30 31

Making the Right Connections The design and management of health care delivery By Anthony Harrison

Publisher: The King's Fund.

ISBN: 1857174402. 285 pages.£17.99.

Anthony Harrison's book Making the Right Connections seeks to test how well health services in the UK meet patient needs, interests and outcomes in terms of their design and function.

An early conclusion seems to be that the most we might hope for is that thinking about the future of healthcare delivery should take account of the scale and complexity of the systems involved, and how they might interrelate and impact on effective practice.

Early chapters set out a depressing list of enquiries and reviews that have led to organisational change while making little difference to the system as a whole.But the author acknowledges the potentially greater benefits of systems thinking, as exemplified in service frameworks such as Cancer Care.

There is a real attempt to identify each of the key elements across organisational boundaries that need to be aligned if quality service is to be provided to any particular group of patients.

The disconnection between organisational development and professional development (particularly doctor, education and job design) is highlighted throughout the book and receives appropriate comment.

The author accepts that finding the best overall structure for a healthcare system necessarily involves a series of compromises between forms of integration.

He observes that the health system is no different to a large business corporation that has to decide whether to structure by geography, product or function, whether to focus on one core function, and whether to buy in the other services it needs.

As you would expect from a policy analyst, the book is well referenced and will be of relevance to all students of healthcare organisations.

For those looking to understand more fully the complex system that is the NHS, this book is worth reading and having as a part of one's own reference library.

For politicians and their advisers, the message is to be careful and considered about organisational change, as history suggests that, at best, it will have limited impact, and at worst, will divert attention from improving service quality.

Finally, the book lends considerable support to the proposition that 'for every complex and difficult problem, there is someone propounding a single simple solution that is invariably wrong!'