Week 4 reflection
Thank you for completing Week 4 of the course. In this week we turned our attention to some of the core tools and techniques that have become associated with healthcare improvement and how these can sometimes imply a redesign of services, breaking away from the classic model of professional organisation described in week two. Specifically we addressed three main concerns.
First, we introduced you to the emerging field of healthcare improvement science. Following Professor Øvretveit, who we met in week one, quality improvement is defined as “changing provider behaviour and organisation through using a systematic change method and strategies”. We saw how this had been associated with a plethora of tools and techniques, many of which were first adopted in industry. We also note how in more recent times these tools have been used in healthcare, pioneered by Don Berwick in the United States, one of the founders of the Institute for Healthcare Improvement (IHI).
Our second concern in week four was to explore in detail one of the tools that have been used extensively in healthcare organisations across the world: lean systems. We heard from Dr Nicola Burgess, from Warwick Business School, how lean originated from the Toyota model of manufacturing and was popularised in the text: The Machine that Changed the World. We also looked at examples of lean implementation in different health systems, including Australia (Eastern Health) and the English NHS. These examples illustrate the transformational potential of lean methods to reduce waste and improve quality, especially when they are part of a longer term strategy. However, as we also heard from Professor Amrik Shoal of Monash University, lean principles are often very hard to implement in practice and even harder to sustain over time.
Lastly, our objective this week was to reflect on some of the bigger questions that are raised by quality improvement tools such as lean for the way health organisations are designed and managed. As we heard from professor Federico Lega at Bocconi University, many health services are now moving beyond small scale QI initiatives to more radical forms of organisational innovation which question the whole basis on which hospitals have been organised and managed to date. Implied here are new ways of organising clinical work which cohere around pathways, activities or patient populations rather than professionally defined specialisms. This kind of change also has implications for workforce and human resource management policies, which we considered in the final step of week four. However, it is clear that all of these changes are still at the inception stage and that for the time being, other ways need to be found of enhancing the ability of clinical professionals and organisations to generate improvements and innovations in healthcare.
One such method are clinical networks which we will now go on to consider in Week 5.
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