23rd June 2014: Startup of the week: The Cumberland Initiative

For this 'Startup of the week' post, I caught up with UK based, Professor Terry Young, chair of Healthcare Systems at Brunel University.

[Disclosure: I have no commercial ties with The Cumberland Initiative or Brunel University]

1. What is the Cumberland Initiative?
The Cumberland Initiative brings three groups together around healthcare delivery. It started with academics interesting in modelling health, but the more important communities now are clinical and commercial. We are a distributed network around the UK and abroad, and hope shortly to take possession of a building, rent-free for three years, to serve as a centre for service science in care provision.

2. Could you explain the Cumberland Initiative’s core values?
Just now we are making the transition from an informal talk-shop to an organisation capable of effecting change – so values are critical to our success.

Our first aim is a step change in the quality and cost of care provision. Comparison with other sectors is a fraught business, but taking a systems approach has transformed retail supply chains, while the military simulates heavily in developing new ideas and for training. There are ways to put numbers behind our planning and health operations, we are committed to that vision. This should carve costs out and staff, patients, indeed the country as a whole, would benefit from less stress and more health. But since health isn’t a production line or a logistics hub, the key piece of learning is how to adapt and adopt from the best.

Our second aim is an economic stimulus. New technology and systems should create new jobs around health. Why, for instance, are some people who know most about the system – carers! – so often forced out of a job to accommodate their role, and then denied the means of charging for their knowledge to make the system better. With advanced information systems we ought to be able to turn knowledge into income in this sector. And, since people in work are generally healthier than people out of work, this adds massively to the health-wealth dynamic.

3. You are hosting a Festival of Evidence in October (20-24th) 2014 at Runnymede by the Thames, what's that all about?
For decades, now, people have been trialling drugs and clinical procedures and we now enjoy a huge evidence base describing what works and what does not work, with infrastructure and literature devoted to curating and analysing this evidence. We want the evidence around the organisation of care, the choreography of care, if you like, to reach a similar position.

What evidence there is at present is scattered: in journals, across internal reports and guidelines, but especially in people’s heads. Our aim is to create an event that draws a picture of what evidence there is and builds the community of those committed to creating it. We plan to create a report on the state of the evidence for one of our event sponsors, the Health Foundation.

4. What's the business model you're operating under?
Since we are in a state of transition, only parts of the business model are in place. We are signing up universities to share in the cost of infrastructure and to hire a business development director. We are also signing up small companies to do the modelling. Our first aim is to socialise modelling by getting maybe 30 small UK projects up and running. For the Cumberland Initiative there is a levy model on business generated. For the companies, there is income. For the universities, a chance to offer consultancy and short-term services alongside continuing development services and a chance to see what the new shape of graduates in the field will be – and to respond accordingly with more tailored courses.

5. Why isn't anyone else doing what you're doing?
Kaiser Permanente in the USA has its Garfield Innovation Center and innovation spaces are springing up around Europe and in the UK. Our contribution is to offer what does not currently exist, namely a neutral space in which to ‘play’ at scale and ubiquity. Health is so complex that experimenting within the context of the clinic or the ward is necessary but not sufficient. We need a living lab to game at the scale of a region but also to explore what real-time models running all the time could mean in moving the accent from reaction to prediction and, critically, to manage exceptions against the prediction, rather than simply waiting to see what comes along.

We are also unusual in terms of our desire to create space for clinical, commercial and academic experts to play together and create ideas that are genuinely fit for purpose. Finally, we are catholic in our tastes and are not committed to any particular mode of modelling – computer-based, mock-ups, walk-through and even virtual reality, are all fine by us.

6. Was there one moment which compelled you to begin the Cumberland Initiative journey?
I led RIGHT, an EPSRC-funded research programme into healthcare simulation, from 2007 to 2009. It was a collaboration of 5 British universities: Brunel, Cambridge, Cardiff, Southampton and Ulster. The most worrying finding was that 90-95% of modelling papers in the literature had no real health situation in view, a disturbing gap between what was possible and what was being used. In July 2010, we hosted a 2-day event, firstly with academics and then with some companies to see what could be done. We met at Cumberland Lodge on the Great Park at Windsor and it grew from there.

7. What have reactions to the Cumberland Initiative been? Do different people perceive it differently?
Yes, of course. Most people in health have high levels of personal commitment, so there is interest from the start. To some, the Cumberland Initiative represents the barbarians at the gates – all technology and no heart. However – and particularly over the intervening years since we first met – even these people are realising that we have to make it easier to do the right thing.

The most encouraging community are the clinicians who believe there has to be a better way of doing things and which is reading all it can get on management science, lean thinking and even trying some modelling. In between are people who see the Cumberland as a possible solution and are watching to see what will happen.

8. Given the NHS’s reputation for innovation, it's inspiring to see the UK leading the world here. How do you see the UK plc building on this?
We are in danger of treating innovation – anything new – as a good thing. Let’s not forget that the banking crisis was in part due to adopting innovations that were poorly understood. Snake oil was, in its time, an innovation – it was a cheap way of making a lot of money for the unscrupulous.

The UK has a working system with a reasonable degree of protection against the wrong type of innovation, because of NICE and other regulatory agencies. It is also in the unusual position of having a whole system that works very well most of the time, but that is coming under unbearable pressure. Therefore, this is THE place to develop whole-system products and services and to reap the benefits internationally.

9. Two years from now, in 2016, what would success for the Cumberland Initiative look like? What are the barriers to success?
Success would look like 50 completed simulation and modelling projects with quantified, sustainable benefits. It would look like one distributed product undertaken at scale to transform a significant element of the service – unscheduled care, perhaps, or care of the frail elderly – over a large slice of the UK. Finally, it would look like 3 or 4 successful Grand Challenges in our new centre – serious gaming at scale with perhaps 50 clinicians at a time to solve a few critical problems at the coal face.

10. What help do you need to achieve this?
I don’t think I’m going to get this started on a traditional grant – too many partners and too diffuse a method. So I need a donor interested in bringing a new discipline around health into being. How much? £3-5M ($5-7.5M) should get us off and running.

Click here for the Cumberland Initiative website.