A hero of mine, Enrico Coiera, once wrote a paper entitled "When conversation is better than computation" you might expect that kind of title from a luddite, with anti technology principles, but at the time Enrico was a Vice President at Hewlett Packard in their special research division.

Enrico argued that despite all the computational power available there were times when developing a relationship and establishing communication was the right thing to do. I would like to suggest that the same principle might apply to commissioning. We have services that could be improved by stepping back, starting again with a clean sheet of paper and buidling the perfect pathway. Although this risks the God Complex, it will be appropriate at times.

What would happen with conversation?

If there was an outcome which was less than expected it could be talked through and the incremental changes required could be put in place without the need to start again, spend hours redefining and re-procuring the system.

Cynic will argue that talking will just support the status quo, but they miss the point, the incremental change means that the status quo moves whether it wants to or not.

Perhaps the next time you have a letter from a hospital which asks you to look up blood results on the same hospital system the consultant could use, and furthermore to send it to the consultant, rather than moaning about being made to act like a house officer (F1) you could always initiate a conversation- try it, you'll be surprised.