Some believe that innovation is a high risk strategy with a high probability of failure, and that success is governed more by luck than judgement.

Unfortunately, that limiting belief creates an emotional barrier to change and will trap us in a perpetual maelstrom of disappointment, frustration and anxiety. The Victim Vortex.

So, here is an uplifting story that challenges this limiting belief.

The context is delivering urgent health care in the midst of the COVID pandemic.

How to design and build a care system: from jargon to achievement

Care in your Car

The first innovation was a drive-thru-care service for people urgently seeking help. They were not Accidents or Emergencies so did not need to spend hours waiting in A&E. And they could not be managed with just a telephone consultation; they needed to be seen by someone.

The second innovation was that this service was specified, designed, tested, built and implemented by the people who delivered the care. And they got it right first time. It worked exactly as they designed. Straight out of the box.

The third innovation was to abandon the traditional “suck-it-and-see” approach to healthcare improvement called Plan-Do-Study-Act or PDSA. Instead, they used the systems engineering approach called a Study-Plan-Do cycle which sounds similar but is fundamentally different. It starts with Study. Look Before Leap. First, they studied the behaviour of the system using a variety of simulation techniques to play with ideas in prototype before implementing them in practice.

It sounds simple and obvious but it is not business as usual in health care.

The drive-thru-care design included some other innovations. One was the booking system – it was done on line and patients were given timed-tickets. This sounds like a recipe for risk for an unscheduled urgent care service until we remember that if people just turn up when they feel like if then we can quickly get chaotic queues. Waiting in a queue for urgent assessment is scary. That is how congested A&E departments cause risk and harm.

Another innovation was to study the proposed delivery process; to simulate it using actual staff, actual equipment, a few bits of cardboard and some actors playing patients – and to actually measure the flow-capacity with clocks. Then to use this evidence to plan how to allocate the timed-tickets. Guesswork is not required. Only then did they plan and do. And it worked. Right first time. No queues. No chaos. No extra risk. No frustration. Just calm efficiency and delighted clients.

Making the creative leap: a healthcare case study (ICJ, April 2022)


The first implementations of this radical care-in-your-car concept were in some hastily assembled facilities in car-parks around East Birmingham using converted shipping containers and awnings. The first one was in South Car Park 5 at the NEC and went from design to delivery in three weeks; just in time for the first COVID tsunami that peaked Easter 2020.

Two years ago.

And it worked exactly as designed. Right first time. No queues. No chaos. Safe, calm, efficient and effective.

In fact, it worked so well that the commissioned provider (a local out-of-hours primary care service called Badger Medical) decided to invest in and implement a permanent drive-thru-care facility which is shown in the photo above. This was constructed in a disused warehouse and was officially opened in late October 2021 by Mayor Andy Street. Just in time to help mitigate the most recent waves of the COVID epidemic.

It too was designed by those who deliver the care – and it worked right-first-time.

And it included other evolving innovations such as an online booking system that allows patients to choose, cancel and change their timed-ticket – without needing to phone anyone!

Innovation does not need to be high risk; and in health care it cannot be allowed to be high risk. Creative leaps can be made in the safety of a simulation and the emergent “plan” informed by the learning from the study. Then the “do” works Right First Time. On Time. In Full. In Budget.

This is systems engineering. It works inside health care just as it works outside.