Game Theory: chess, Jenga, frailty and the future of the NHS

AIOiSvIVLiz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

During another busy shift last week, I worked with a student nurse who expressed an interest in the complications of older person care. I found the simplest analogy to be that of comparing frailty to the game of Jenga

Jenga is a game which involves removing one block at a time from a tower, until it is only a matter of time before the entire structure becomes so fragile that the whole thing comes tumbling down.

In older people, long term chronic illness is one such block; complications of unsupportive social situations, another. One urine infection, fall, or hospital admission can be the final block which causes their own personal tower to collapse, with devastating and life-changing consequences.

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You can save lives and money

Paul Harriman has recently published his paper Timely care for frail older people referred to hospital improves efficiency and improves mortality without the need for extra resources in Age and Ageing journal. Today he describes his findings on the OUP blog:oupblog

There is a truism in the world that quality costs, financially. There is a grain of truth in this statement especially if you think in a linear way. In healthcare this has become embedded thinking and any request for increasing quality is met with a counter-request for more money. In a cash-strapped system the lack of available money then results in behaviour that limits improvement. However, as an ex-colleague once said “we have plenty of money, we just choose to spend it in the wrong places”. This implies that if we were to un-spend it in the wrong place we would have plenty of spare cash. Continue reading

Quality Mark for Elder Friendly Hospital Wards

Ensuring that we are delivering a high quality service is, or should be, the preoccupation of geriatricians and specialists in health care for older people. But how do we know if we are? As we consider the ongoing implications of the Francis Report, the BGS will be seeking to develop tools and services which help in this quest. There is much more to do but the BGS has assisted with the development of a Quality Mark for Elder Friendly hospital wards in collaboration with the Royal College of Psychiatrists and others. Dr Chris Dyer, the BGS representative on this project (with Peter Crome) shares more details.


At a single ward level, the Quality Mark for Elder Friendly Hospital Wards is a method that hospitals can use to raise standards of care for its most vulnerable group of patients. Indeed, as part of its response to the Francis Report the Royal College of Physicians has recommended use of the Quality Mark. Continue reading