ALL human life can be seen at the Queen Elizabeth hospital in Birmingham, much of it precariously in the balance. A huge critical-cases ward treats the human wreckage of car accidents, victims of knife and gun crime and young men who have lost limbs in Afghanistan and Iraq. Many of the injuries would have been familiar to Florence Nightingale. But the system for organising and monitoring patients' treatment is novel.

A few years ago David Rosser, medical director of Birmingham University Hospitals trust, which runs the Queen Elizabeth, and Julie Moore, the trust's chief executive, paid a visit to the local BMW engine assembly factory. There they learned that over 99.9% of tasks were completed flawlessly. Carmakers were busy chasing up the 0.1% of failures, focusing on misaligned screws. Such thoroughness impressed Ms Moore, who notes that big health-care systems routinely tolerate many more errors. “As long as no one dies or there's no big fuss, nothing gets done,” she says.

The trip inspired a bespoke computer system, designed to bring a German quality-control regime to hospital wards. PICS, which stands for “Prescribing, Information and Communication System”, looks like a complex car dashboard loaded on to a computer screen in every in-patient ward. Needles on the dial monitor performance on such measures as infection levels following surgery and falls by frail patients. The timing of drug doses is recorded, as is the diagnosis and treatment of bedsores—an indicator of neglect.

A dial registers green to show that performance is getting better. A fall in efficiency (benchmarked against comparable wards and recent performance) earns a red or amber rating, to remind staff that they are lagging. All of this—and the response of the ward sister and matron—shows up on senior managers' own dashboards, allowing them to chase up lapses quickly. The system also irons out the mistakes which arise from staff misreading handwriting, a common cause of wrong dosages.

PICS is not cheap: it cost £3.5m ($5.4m) spread over five years. But Dr Rosser argues that the investment is recouped in fewer readmissions and wasted prescriptions. Another advantage is that his medical teams can quickly assess the effectiveness of treatments. Coronary patients taking beta-blockers, for instance, fare much better in heart operations if a dose is given shortly before surgery. Dr Rosser thinks other parts of the health service, including family doctors, would benefit from a similarly rigorous approach.

The Birmingham experiment has been cautiously welcomed by Britain's health-care establishment. A report by the Journal of the Royal Society of Medicine concluded that mortality rates had fallen, and noted that the new system had helped reduce the sort of errors which lead to poor patient care. Attracted by its results, some hospitals with poor outcomes in fields like oesophagal cancer have contracted out their treatments to Birmingham.

Yet that is where the experiment has stalled. In theory, the NHS likes spreading what public-sector folk call “best practice” through the system. In reality, innovations like the one in Birmingham tend to remain isolated. Small, gadget-based ideas, like a mobile kit to test for the MRSA superbug or a new iPhone app for diabetes sufferers which allows patients to record their treatment digitally can spread. Bigger changes to systems do not. John Appleby of the King's Fund, a health think-tank, says there are “a lot of interesting ideas from the bottom up” in the NHS, but they rarely move beyond a single hospital.

Too clever by half

Bold thinking is not a priority at present. The NHS is preoccupied by austerity: it must find £20 billion worth of efficiency savings by 2015. It must also implement a fiddly and divisive health-care bill, intended to make it easier for private providers to compete against established services, which has been greatly eroded by its brutal passage through Parliament. And the health service is still reeling from a failed central-computer project that has ended up costing over £12 billion.

But the main reason innovations do not spread is that the NHS has no mechanism for ensuring they do, or for rewarding the inventive. The service is centrally funded and emphasises the universality of its care rather than its results. Such a system is likely to prove better at controlling costs than at encouraging good ideas to thrive. Countries with more private providers may be more welcoming to innovations that offer a competitive advantage. Insurance-based systems often do better at prodding hospitals to show better care than competitors, for lower cost.

Despite attempts by New Labour a decade ago to give hospital managers more autonomy by setting up foundation trusts to run them, hospitals do not directly compete against each other. Nor is a high-performing trust like Birmingham's University Hospitals allowed to take over another one, unless the weaker institution is deemed to be in dire financial trouble. It is thus hard for managers to test innovations on a large area, or to bring costs down by spreading their use more widely.

Something needs to change. The British Social Attitudes survey reported on June 12th that public confidence in the NHS had slipped. Hospitals are struggling to maintain current levels of productivity with less money. Places like Queen Elizabeth hospital show how innovations can bubble up through the NHS. What is needed now is a new push at the top to remove the obstacles blocking their spread.