In Disney’s the Lion King, the evil Scar hatches a nefarious plot to murder his brother Mufasa and claim the throne for himself. He recruits the hyenas as henchmen with promises of prizes and exhorts them in a rousing song to ‘Be Prepared’.
From an Implementation Science perspective, it is unsurprising that Scar succeeded. He applied all the key quality improvement principles: setting a clear goal; keeping team members engaged in the change process; defining roles and responsibilities; and taking specific actions to implement The Plan.
Most important of all is that Scar understood, in the words of louis Pasteur, that ‘chance favours the prepared mind’. But what does it mean to be prepared? Banzai, one of the hyena minions, enthusiastically responded: ‘Yeah, be prepared! We’ll be prepared! For what?’
In the last few months Australia suffered raging bush fires, inundating floods and the COVID-19 pandemic. Lessons will undoubtedly be learned when the inevitable enquiries conclude. One of the main findings will almost certainly be lack of preparation. There is already overwhelming evidence of significant variation in the levels of preparedness of individuals, regions, states and organisations, including health care.
Preparedness is the desirable state of being fit, set or primed for an action or experience. It is the product of individuals, teams, organisations or systems being: Willing, Able and Ready (the WAR model of preparedness).
People who are willing are motivated, confident, and favourably inclined to an action or response. The sentiment of willingness is expressed as: ‘yes, I want to do this’
Being able means to possess the necessary operational knowledge and skills to perform tasks. It is expressed as: ‘I know how to do this’. Ability can be enhanced through experience and training.
People are ready when they are equipped with the structural support, time and resources they need to be available and to participate in a response. It is expressed as: ‘I am going to do this’.
Preparedness requires at least a modicum of all three elements because they are recursive, inter-related and susceptible to contextual factors and intrinsic characteristics of individuals, teams and systems.
We often hear that the specialty of General Practice, GPs and general practices must be prepared. The COVID-19 pandemic provides a practical example. Some practices were willing to establish Respiratory Clinics. HealthPathways helped to increase the ability of clinicians to assess and manage patients. The availability and provision of PPE determined the degree of readiness.
When it comes to integrating care and building a sustainable health care system, primary care and general practice are, for the most part, willing and able to do more. Unfortunately, the chronic lack of investment means that we are not ready. Yes, we can and will do more to prepare. However, policy makers and funders have an essential role too!
To paraphrase Banzai: ‘Yeah, be prepared. General practice is willing and able to do more. We’ll be prepared – just help us to be ready’
QI preparedness VS
Preparedness in wider sense – funding/policy
Natural response when we see people ‘not engaged’ – we tend to blame in order – willingness, ability and then readiness. In reality, it is usually readiness first and foremost – at least in healthcare. Ability and willingness difficult, but likely ability and then willingness.
Why – when people are able, they are more likely to be willing; inability makes people unwilling.
Increasing readiness will increase willingness and then ability
Giving money incentive, will make someone willing to do it and then go and find out how to do it.
Example – termination of pregnancy. In this instance, willingness was legitimised. There was already ‘readiness’ – pt contributions. What was needed was ability – so GPs skilled up.
With developmental paeds – no ‘readiness’ hence no willingness. Simply can’t afford the service.
Misunderstanding the reason for lack of preparedness can cause huge loss of resources, efforts but also goodwill. If we are not ready, keep trying to make us more ‘able’ will not be effective. Train and explain solutions do not work for lack of readiness!