Over the holidays my wife and I were invited to a neighbour's party for drinks and nibbles. Unfortunately, I dropped a canape down my shirt but fortunately, it led to a conversation with a scientist. He mentioned that he'd been part of the team that developed washing detergent that works at low temperatures. It sounded niche, but the more he explained, the more fascinating it became.
It was a combination of chemistry and biology that fundamentally changed things, not a series of incremental improvements. In fact, these new washing detergents don't work at higher temperatures. They were designed for a different way of washing altogether.
When the team cracked it, they thought they'd landed a win-win. Lower temperatures meant cheaper washes, less environmental damage, and clothes that lasted longer. What wasn't to like?
Quite a lot, as it turned out. Even when people bought the new detergents, attracted by the price or the green credentials, they kept setting their washing machines to 60 degrees. When their clothes didn't come out as expected, they didn't blame the temperature setting, they blamed the product. The science worked, but behaviour didn't change.
That conversation stuck with me, because I think healthcare is facing a remarkably similar problem. We now have credible alternatives to traditional, building-based care. These approaches are often cheaper, lower carbon, and in many cases safer for patients.
Yet, we still see record numbers of people turning up at A&E, and GP surgeries remain the default first port of call for almost everything. On paper, the value proposition of these new models is strong. In practice, behaviour hasn't shifted nearly as much as we'd hoped.
Just like with washing, the problem isn't that the innovation doesn't work. It's that we keep running it on the old settings.
When you look at the washing detergent problem, there were three possible responses.
The first was to keep explaining. Better instructions, clearer messaging, more marketing. This turned out to be harder than it sounds, because most of us have a deeply ingrained association between cleanliness and heat. Information alone didn't undo decades of habit.
The second option was to force the change, only sell washing machines that worked at low temperatures. Aside from being commercially unattractive, this also ignored reality: sometimes, you genuinely do need a hot wash.
The third option was to keep improving the science, so the detergents worked across a wider range of temperatures, accept a period of dual running, and wait for behaviour to shift over time.
Healthcare faces the same three choices. We can keep explaining that there are alternatives to hospital and surgery-based care, and hope people change their minds. That's important, but experience tells us it won't be enough on its own.
We can try to enforce new pathways. But once someone has turned up at a hospital or GP surgery, it's almost impossible, and often inappropriate, to redirect them elsewhere. Enforcement tends to create friction, cost and frustration for patients and staff alike.
Or we can accept that, for a period, we will need to run new digital and community-based pathways alongside traditional ones, while behaviour, trust and confidence slowly evolve.
The third option is the least tidy, the hardest to explain. However, I think it's the only viable one. If we're going to do it, we need to be honest about what it means. Dual running isn't a sign of failure; it's the cost of transition. It will look inefficient in the short term. That means we also need to rethink how we measure success. Instead of focusing solely on absolute numbers, we should be asking different questions. Of patients with similar needs, how many are choosing alternative pathways this year compared with last? How often do people return to virtual or remote options once they've tried them?
Perhaps most importantly, we need to accept that some of this change is generational. Defaults shift quietly, not because of policy documents, but because systems make certain choices feel normal.
When I asked how they eventually ‘solved' the washing problem, his answer was telling. They did a bit of everything. The marketing narrative changed from ‘kill germs' to ‘care for your clothes', washing machines were gradually preset to lower temperatures and the science improved so the detergents became more forgiving. Over time, a new generation came along that wasn't so attached to the old ways of thinking.
Healthcare transformation may require the same humility. We can't explain our way out of habits, and we can't enforce our way to trust. What we can do is design parallel pathways deliberately, measure progress honestly, and give ourselves permission to accept complexity before simplicity emerges.
If we keep blaming the detergents for not working at 60 degrees, we'll miss the bigger opportunity. The technology is ready; we don't need to always wash hot. The harder question is whether we're willing to change the settings and give it time.
