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Norman Swan: Hello, and welcome to the Health Report, with me Norman Swan. Today, algebra, soccer and healthcare. A way of using algebra to make sure that the healthcare system prices in the value of safety and quality up front, and creates the right financial incentives to do the right thing the first time in the right place. You'd think they're doing that now. Well no, they're not, according to one health economist, despite all this talk about reform.

And speaking of the healthcare system, a paper published this morning in the British Medical Journal argues there's a lot to be learned from soccer. Julie Redfern, who's a senior research fellow at the George Institute for Global Health at the University of Sydney is one of the authors. So Julie, welcome to the Health Report.

Julie Redfern: Hi, thanks for having me.

Norman Swan: The paper starts with a photograph of Lionel Messi from FC Barcelona and somebody called Alexander Clark, and compares their soccer performance.

Julie Redfern: Yes, it's been a fascinating paper and Alexander Clark is one of the lead authors, and is a nursing researcher from the University of Alberta.

Norman Swan: But clearly plays a bit of soccer.

Julie Redfern: He does. He plays soccer on a weekend and he's the coach of his son's soccer team.

Norman Swan: And you compared the football outcomes of the two of them, superficially, and showed that they actually got very similar performance.

Julie Redfern: Yeah, you can't judge a book by its cover. Just what people look like in a photograph, you can't necessarily determine what's going on underneath, and we need to think more deeply.

Norman Swan: And their goal-scoring's pretty much the same.

Julie Redfern: That's right.

Norman Swan: Except that one's a nebbish Alberta team and one's FC Barcelona. So there's several things that you talk about here, and one is common outcomes between healthcare and soccer, which sounds extraordinary. What are these common outcomes?

Julie Redfern: Common outcomes are: did something work? Was it successful? Were players doing what they were supposed to be doing? Were healthcare professionals delivering what they were supposed to be doing? Do people get better?

Norman Swan: And in soccer terms do they score goals in their games?

Julie Redfern: Yes. Do they score goals?

Norman Swan: So you described four lessons that are to be learned from soccer for healthcare. One is bring complexity in.

Julie Redfern: Yes. So we have to think about complexity. We can't just look at two pictures of two people in the same jersey and think we can decide which team or who plays for the better team. In football we have to look in complex details. What's the management structure? What's the statistics? What's the pitch like? And various other factors that we do think about in football. But when it comes to healthcare, do we think about all of those things? What professionals are delivering the intervention? Where is the intervention delivered? How is the intervention delivered? To whom is the intervention delivered? So we have to think about all of those things in a complex way, in terms of developing interventions and delivering them.

Norman Swan: Does that matter if somebody gets better in the end? In other words if the outcome...if the goal scored is I go home with my heart fixed and I don't come back to hospital and I don't get an infection from my angioplasty or whatever—goal scored. Do we need to know any more than that?

Julie Redfern: True, in some circumstances no, we may not, and it may not matter. But what works for one person in one setting may not work for somebody else. But are we delivering something in the best way we can in the most cost-effective way we can? Can we get a better outcome for less money, for example.

Norman Swan: And presumably just because you've got one patient who does well one week, it doesn't mean to say when they replay the game next week they do just as well.

Julie Redfern: That's exactly right. So healthcare interventions are very complex. Trying to encourage people with chronic disease to change their life for the rest of their life is very complex. And we tend to simplify things.

Norman Swan: So lesson number two is describe interventions well. What do you mean here?

Julie Redfern: Yes, so this is where we get into, well, if we want somebody else to be able to deliver the same program that was developed, for example, here in Sydney successfully down in Melbourne, we really have to articulate clearly who the intervention is directed at, how it can be specifically delivered, and for what population and by what methods. If we don't do that effectively, there's a good chance that it may not get taken up, for example, in another state or another city or another location, because it's all just too hard.

Norman Swan: So what lies behind that lesson is that we don't describe these things well enough for success to spread.

Julie Redfern: No. So we often don't describe things. We often break things down to the most simple part, and that is part of the problem in terms of translating things more deeply.

Norman Swan: But of course in soccer if you've got a successful team you don't necessarily want people to know what your intervention was in your opposing team. And is that really what's working also in healthcare? You think it's competition?

Julie Redfern: Potentially. But that's a problem. We don't want that to come into healthcare and what we do and don't deliver. We want everybody to be able to get the maximum benefit out of any interventions that are available, and we want as much equality as possible for people.

Norman Swan: So lesson number three you say 'why': don't just describe outcomes, explain them.

Julie Redfern: It's not good enough just to say yes, somebody did or did not survive a year after a heart attack, for example. We need to think about why, where did they live, what can we do better, and learn from those things and describe the intervention along the way. It's not really good enough in healthcare to just say yes or no.

Norman Swan: So the end point that I described, which is somebody goes home with their artery opened and they don't come back to hospital, may actually hide the fact that they're not very happy, they might be depressed, and not going through a very happy circumstance and might have been traumatised while they were in hospital—and that's not clear.

Julie Redfern: Absolutely. And there's nothing to say next week they may not have a problem, or their mother, their father, their daughter, their son, their brother may have a problem that could be looked at if we thought about things more deeply as well. So health comes with a lot more complexity, obviously.

Norman Swan: So the analogy here with soccer is you might have scored the goal, but you want to know the series of passes and circumstances that led to the goal.

Julie Redfern: Yeah, and at high level soccer we do tend to look at all of those things in great detail, and we really do tease out the statistics. But we really don't do that to that same extent, obviously, in a lot of our healthcare interventions.

Norman Swan: Of course the science behind knowing what the...and even in soccer I imagine, knowing the elements that work—the manager, the team, the support, the effectiveness of the striker without a supporting team and all the elements—a lot of it's still intuition, isn't it?

Julie Redfern: I mean there's some intuition there, but I think you will find a lot more money is invested in terms of high level soccer. For example, over in the UK and in Barcelona, what will and won't work for whom and when, and we just don't have that same level of investment and engagement for healthcare interventions.

Norman Swan: And your final lesson is entitled 'Opportunity: learn from failure and success.'

Julie Redfern: Yes. So with soccer things are heavily scrutinised if there is failure or if a goal is missed or a match is lost. But in healthcare interventions, as many of us know, when it comes to publishing papers or implementing interventions, we tend to not be successful in terms of getting failed studies published. And that's really crucial here, that...

Norman Swan: So in other words if the story's not positive, if it's negative, journals aren't interested

Julie Redfern: Generally speaking. There are some that will say they won't, but there's definitely usually a positive spin put on whatever can be found if possible. And that's a real problem that we face.

Norman Swan: That goes from a clinical trial which might have found that a drug doesn't work, to actually giving a case study of a disaster which other people might learn from.

Julie Redfern: Yeah, absolutely. And you know, even to the level of policy. People don't really think about what did and didn't work in terms of what's available in a hospital today and why.

Norman Swan: And I suppose the final thing to get from soccer is that—it's old-fashioned, but they work as a team.

Julie Redfern: They do work as a team, and it's not just a team of the players on the field, but it's the management, it's the coaches, it's the team support and everyone else that goes with it. And we do tend to focus healthcare on individual people or individual roles.

Norman Swan: And in fact, talking about a coach, there was a fascinating article by Atul Gawande in The New Yorker not so long ago talking about how in fact what healthcare needs, including team playing, is actually coaches. Doctors need coaches.

Julie Redfern: Yes, and who is responsible, this is another question. It's all very intertwined. I think we can learn a lot from soccer, and this has been a fascinating experience, writing this paper.

Norman Swan: We'll have to find out what Lionel Messi thinks about it.

Julie Redfern: Yeah, well, that remains to be seen!

Norman Swan: Julie Redfern, thanks very much for joining us.

Julie Redfern, who's at the George Institute for Global Health.