Has health and care delivery become too transactional for anyone’s good?

I do not know the name of my assigned general practitioner and, if I did, it is relatively unlikely that I would see them if I had an appointment at my practice. I wonder if this is good for either me as a patient or for the GP? When I was young, I knew my GP and he knew me, my family and our circumstances. He was part of the community in a way that I suspect most GPs are not these days.

In many countries, the delivery of primary care (and other contexts) has become something of a transactional process.  Todays’ GP works under high pressure of time and with limited information about the patient in front of him or her. Yes, there is a comprehensive patient record, but does this compensate for a lack of a holistic view of the patient supported by continuity of relationship? All of this makes me think that health care may have become an inadvertent victim of Taylorism.

Fredrick Winslow Taylor was one of the earliest management gurus whose ideas were popularised in the early part of the last century. His Scientific Management theories contained many sensible elements which apply well to the delivery of health and care. Writing in the late 19th century, Taylor himself stated that “Scientific Management consists in knowing what you (i.e., management) want men to do exactly; and seeing that they do it in the best and cheapest manner.”

His four pillars were:

  • Science, not rule of thumb.
  • Harmony, not discord.
  • Cooperation, not individualism.
  • Development of each and every person to his or her greatest efficiency and prosperity.

So far, so good. All sounds very sensible and reasonable, regardless of the endeavour involved. In practice, however, Taylorism often translated into the breaking down of tasks into their simplest elements using time and motion studies and generating processes where the individuals involved were reduced to highly repetitive activity driven by the clock. This extreme interpretation is often described as Fordism where people working in Henry Ford’s factories were reduced to being unskilled cogs in a production machine. Ultimately this had a damaging effect on them as individuals and compromised the very efficiency so eagerly sought. More importantly, it had a deleterious effect on quality.

Can Person-Centred Value-Based Health Care provide some of the answers by attending more thoughtfully, to the individual person’s needs, and those of the clinicians attending to them? Would a more holistic approach reduce the number of transactions and create more effective relationships between the person and their clinician? 

The answer to these questions could be yes; Person-Centred Value-Based Health Care brings together three well-established concepts that frequently work in parallel rather than working together.  These are: Value-Based Health Care (VBHC), Person-Centred Health Care (PeCHC), and Healthy Equity and focus on: the involvement of people, Shared Decision Making, linking values, goals, and preferences to standardised data, and resource allocation. All these concepts are used today; however, they do not typically work together, and they are not systematically applied across health care systems. 

I am not advocating the return to single-handed GP practices where the doctor performed caesarean sections on the kitchen table or appendectomies in the local health centre, but the pendulum could have swung too far in the direction of efficiency as the sole driver and may be becoming inefficient, as well as less effective, as a result. Perhaps it’s time the pendulum starts swinging towards new ways of doing things putting the individual at the centre of value-based care. 

To find out more about Person-Centred Value-Based Health Care or if you would like to get involved, please contact Andrea Srur at or visit the Global Centre for Person-Centred Value-Based Health Care website:

John Wilkinson OBE

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