Heroes Not Zombies

Another of Charles Handy’s useful concepts from his Empty Raincoat is the ‘doughnut principle’. He says to imagine an American donut (see how I changed the spelling to the American one?) but to invert it so that instead of a hole in the middle, you have a core, and outside of the core you have an area bounded by the donut’s edge.

He says the core is what’s essential. It’s the agreed given of a job, or a project, or a person. And the outside of the core is the potential. The potential is variable and you can develop as much or as little of it as you want. But it does have a boundary, or a limit.

Without a boundary it is easy to be oppressed by guilt, for enough is never enough.

This is a good model in health care. The core might be the essential health outcomes you’d hope to achieve eg a normal blood pressure reading, but the outer ring of the doughnut represents the potential which might be achieved – how might this person’s health be improved, not just their blood pressure?

Societies which overemphasise the core can be too regulated.

This is his warning and it’s so true. It’s the danger inherent in a system of targets in health care. The ‘Quality Outcomes Framework’ at the heart of UK General Practice is the core, but if it consumes all of the doctors’ attention and energies, we’re going to lose an awful lot of good medical practice that sits out there in the potential.

There’s also something in this idea of a core which reminds me of the concept of virtues, where the focus is on developing character rather than on tasks and duties.