Comment: Why a US management guru has vital questions for the NHS

What can a US management guru, who is best known for inventing and popularising business process re-engineering, possibly have to teach the NHS? In fact, the argument that the English health service can learn from business or other countries is looking a bit tarnished. Enthusiasm about the Evercare system has been dampened by a critical BMJ report, for instance.

So why have we devoted four pages to a discussion of Michael Porter's book, Redefining Healthcare? Simply because it has caught the imagination of many of the most influential voices in NHS reform and has been occupying minds at the highest level throughout this year.

Porter's argument is that the US health system is so high in costs and low in quality because it features competition in the wrong place.

The system is based around episodes of care rather than medical conditions and the ability to create a market in patients.

Porter also argues strongly for the central role that wide access to information, and patients switching as a result, has in improving performance. That need to focus on and measure added value was a powerful message for the reformists and commentators we spoke to.

They were somewhat less impressed with some of Porter's solutions and omissions, most notably a failure to tackle public health and long-term condition management.

There were also doubts about whether the kind of retooled competition he envisages would be enough by itself to shift vested interests. They were concerned that his imagined system would be better at shutting the wrong kind of operators than encouraging the right kind to open.

Does Porter's book by itself redefine how the NHS should plan its future? No, but it does focus on the important questions and in that it is a rewarding read for anyone serious about healthcare reform.