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The hidden costs of "working at scale"

By Dr. Colin Coulthard |


“Working at scale” is the solution to all our problems. It must be; both NHS England and the Royal College of General Practitioners says so. So surely it must be true?

Well, er, no.

To this author, “working at scale” is a strategic error, that is likely to make things worse, not better. It’s an availability bias-type error.

Apologies in advance, this is quite a technical blog.

Availability bias” is the psychological phenomenon whereby things that are easy to remember or visualise are given undue weight over things that are not so easy to remember. A good example would be side effects from medication. When we don’t have side effects from medication, we don’t remember because nothing happened. When we do have side effects from medication, we do remember, because something did happen. This means that people find it easier to remember the times that they had side effects compared to the times when they didn’t. This has the effect that many people tend to overweight the risks of side effects from their medication when making decisions.

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