Reflections on unintended consequences and apparent backfires

Safety giant Shojania wrote this editorial to accompany a study where predictive risk stratification was introduced into primary care in order to help Welsh GPs make preventative plans for patients at high risk of an emergency admission. The intervention actually increased the use and cost of NHS services.

Unintended consequences in general are considered, followed by a focus on situations where a change produces the opposite of its intended goal. I am not going to summarise or critique it, just highly recommend you read this entertaining article – so you too can reference the cobra effect or the Streisand effect!

The message though is that face validity is not enough – just because something ‘should work’ doesn’t mean it does. This is the reason why we need rigorous research accompanying qualitative improvement initiatives.

The new word Shojania offers is good: Verschlimmbessern: German word meaning to make something worse in an effort to improve it

We all should learn how to pronounce this word and start using it because without this consciousness, its more likely that our work will produce such results.