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Skip to 0 minutes and 5 secondsHello, welcome to Week 2. This week, we're going to look at the broader organisational and institutional context of healthcare systems. If you like, this is the bigger picture - the wider context that provides opportunities and constraints for the kind of healthcare improvement initiatives that can take place within organisations. We think it's important to understand this big picture in order to appreciate what's possible and what can be achieved in an organisation on the ground.

Skip to 0 minutes and 39 secondsWe're going to look at this in three ways. Firstly, at the macro level. What I mean by this is the essentially overall national arrangements for healthcare systems - the broad governance, the mix between public and private sectors in providing and funding services,

Skip to 1 minute and 0 secondsthe decisions that frame everything else that happens in a healthcare system: choices about how far to have markets, how far to have a bureaucracy, or to coordinate things through networks.

Skip to 1 minute and 14 secondsAt this level, we'll also look at some key reforms that have been taking place around the world, often driven by an approach known as 'new public management'. The next is the meso level, where we'll look at the ways in which some of these choices play out at a regional or health system level, and how they affect the organisational context of healthcare systems at that level.

Skip to 1 minute and 41 secondsAnd lastly, we'll focus on the micro level of hospitals, community services, primary care practices and other healthcare organisations. Henry Mintzberg labelled health organisations 'professional bureaucracies' with characteristics that shape and influence the way that change must be managed, if it's to be successfully delivered. Understanding these issues is central to the effective improvement of services. In this week you'll be hearing from Ian Kirkpatrick, but also from Ian McLaughlin from Monash University. We'll look at some case studies from around the world, including the United Kingdom, United States, reforms of primary care in China, and networks and governance in Australia. Enjoy the week.

Welcome to understanding the organisational context of healthcare improvement

Welcome to Week 2. In this second week we will look at the organisational context of healthcare and how this context may generate both constraints and opportunities for new innovation and quality improvement.

To make sense of this, week two contains three blocks, each relating to a separate level of analysis: macro, meso and micro. As you might expect, the ‘macro’ level relates to the level of the whole health system in each country. Important here are the relationships between different actors involved in funding and delivering health care, including governments, insurance providers, professions and commercial firms. These relationships, which differ between countries, determine the overall shape of healthcare systems, available resources and who has access to services.

In the second block we turn to the ‘meso’ level. Crudely this relates to a middle level of analysis, focusing on the organisational architecture of each health system and how decisions about the allocation of resources and services are made. We also look here at current reforms associated with ‘new public management’ (NPM) and how these are aimed at changing the organisational architecture to make health systems less bureaucratic and more commercially focused.

Lastly, we will introduce you to the ‘micro’ level of analysis. Here we focus on the specific organisations, such as hospitals or community centres, where healthcare improvement initiatives are implemented at the coalface. You will see how these organisations adopt distinctive characteristics of ‘professional bureaucracy’ which generate very significant challenges for managers and clinicians keen to bring about change.

By looking at these three levels (macro, meso and micro) this week highlights the complex nature of the organisations in which healthcare improvement takes place and provides an understanding of why the same policies and practices may work better in some contexts more than others. To develop these insights, week two includes reading materials, short lectures and examples from a range of international health systems, including China, Australia, the UK and the USA.

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Leadership for Healthcare Improvement and Innovation

The University of Warwick

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