Design and delivery for productivity in health and social is made difficult when there is a lack of consensus on exactly what is being produced and how. Evidencing quality can also be difficult because of the overheads associated with individualised measurement.

I suggest that from the customer perspective two inter-related entities are produced: 1) relative differences in outcome; and 2) experiences. Customers perceive quality if their own goals are met through a set of positively experienced touch points.

But economic scarcity and a limited human resource pool restrict what we can throw at interventions to maximise goal attainment and experience in an equitable way. 

There are further interrelated products from an system/organisational perspective: productivity is also enhanced when the system is improved (e.g. through waste minimisation), and staff experience is positive.

The attached diagram explores system-wide drivers for achieving the best possible outcomes and experience for the lowest cost. The capability to sustain delivery of these products lies throughout the whole system: from person-centred intervention design through to organisational leadership. I argue that a whole system view is essential for positively influencing the complex adaptive health and social care system in the right direction.