It's often said that doctors act like they're gods. They believe they are right, have the solution, can totally understand the problem. Ok this is a caricature but it has a basis in health systems. We often believe that there is a right answer, that we "know" the right thing to do in any situation. Our science of evidence based medicine simultaneously destroys and supports this view. It destroys the god complex by providing proof of the effectiveness of an intervention in any clearly defined, tightly controlled situation. However, armed with "the evidence" it delivers cast iron certainty that we are right, totally, infallibly correct.
The trouble is that health systems are not simple randomised double blind controlled trials. They are complex adaptive systems which do not respond in linear ways to defined, evidence based interventions. Complex systems require us to let go of the approach which says " I alone have the answer" and further more "this solution is the only one way to succeed".
Considering the NHS in it's current reformation it would appear that our solutions to the Nicholson challenge will emerge not from the top, not even the political direction of the Houses of Parliament, but instead from those near the front line who are able to experiment with the system, take chances on a trial and error basis, tinkering with the system to rapidly follow examples which provide good outcomes, rapidly abandoning features which produce lesser outcomes.
It won't be easy for us to shift from evidence based certainty to evidence based action not because it requires doctors and politicians to admit that they are not correct, but simply because it requires them to admit that they don't have the answer but are willing to learn.