Teaching Literature and History of Medicine in the National Health Service

This article responds to Abigail Droge's paper "Teaching Literature and Science in Silicon Valley," which describes the author's experience of teaching literature to students at Stanford, a university with strong links to the tech industry. On reading this paper, I discovered similarities between Droge's aims and experiences and my own experience of teaching literature and the history of medicine as part of a quality improvement (QI) program within the United Kingdom's National Health Service (NHS). My article focuses on one workshop session that took place in September 2017. I discuss the way in which literature and the history of medicine provides case studies that interact with QI theory, addressing several points raised by Droge.

Droge writes that "a company might want to employ an English PhD student because of her problem-solving skills and her writing ability, but not expect or desire that employee to inflect into her work any kind of ethical or historical understanding of the traditional pitfalls of over-confidence in technology, or a critique of the entrepreneurial mindset."¹ I did find myself in this circumstance, but I am fortunate that my company does expect and desire that I exercise my subject specialist knowledge in the role as well as learning to teach QI methodology, and out of that subject knowledge, and working closely with an expert on QI, the session was constructed with the aim of both entertaining and informing an audience of healthcare professionals.

Having completed my PhD in nineteenth-century medicine and the periodical press, I accepted a role as a course administrator and facilitator in the NHS. I work for an organization called Haelo that specializes in delivering and supporting QI programs in the healthcare system. Much of the improvement work in the NHS is undertaken by healthcare professionals on top of their already substantial workload, without any extra assigned resources, driven by enthusiasm plus the knowledge and skills provided by Haelo. Projects commonly aim to improve patient experiences or outcomes by changing processes or implementing new care pathways. Some examples of current projects include introducing a new care bundle aiming to reduce death and severe disability after acute intracerebral hemorrhage, improving the proportion of patients receiving the correct medicines, redesigning an outpatient pathway for musculoskeletal injuries through the implementation of direct discharge protocols, and reducing avoidable harm in the operating theater.

This QI methodology is based on work in an established scholarly field that was developed in twentieth-century America. W. Edwards Deming revitalized the manufacturing industry in Japan after the Second World War by focusing on improving the system rather than assessing the quality of products after the manufacturing process had been completed, thus reducing variation and waste. Today, a toolkit based on Deming's work is used to drive quality improvement in the NHS.

I was asked to cofacilitate a workshop session at a theater safety event for staff including nurses, anesthetists, surgeons, and QI managers. The session focused on common problems teams experience regarding engaging stakeholders and diffusing innovation. I collaborated with Haelo CEO Professor Maxine Power, an expert in QI methodology from a clinical background. My emphasis was on the great leaps in understanding and capacity that took place in medical history because of a perfect combination of circumstances, and other times when potentially landscape-changing advances were missed or delayed because the environment was hostile to innovation. I presented vignettes from medical history, and Professor Power then repositioned these within QI methodology and Rogers's theory of diffusion of innovation. In this article, I focus on three of these vignettes. It should be noted that the term "literature" is used in a New Historicist sense here: as well as Dickens's The Old Curiosity Shop, primary materials comprise personal letters, periodical articles, and a health report.

On teaching literature and science, Droge writes,

It is not enough to be able to adopt tools, skills, and modes of thought from the sciences and the humanities, though that is crucial. Students must also gain a meta-cognition about the institutions and industries in which...