Skip to 0 minutes and 5 secondsWelcome to the course. This course is about health improvement. The need for health improvement has grown in recent years because of concerns about mishaps and failures in the way our health services are delivered. For example, preventable hospital deaths are one of the largest causes of death in the United States at the moment. In our own National Health Service in the United Kingdom, the quality of treatment of conditions such as dementia or cancer varies immensely depending on where you live in the country. Because of this, the discipline of health improvement science has grown in recent years.
Skip to 0 minutes and 43 secondsGenerally speaking, health improvement science is the science of how we raise the quality of our services, of our health services, how we continuously improve the quality in the interest of patient safety, patient experience, and to make those services more efficient. Health improvement science has become associated with some familiar tools and techniques associated with quality improvement, many of which come from the private sector, in particular manufacturing. So for example, Six Sigma, lean systems, business process re-engineering. These techniques are well understood. However, while it's become apparent that these techniques can deliver results, it's also clear that there are many, many problems with implementing these tools and techniques in a rigid and mechanistic and planned way.
Skip to 1 minute and 34 secondsOften clinicians don't listen to advice, or they're too busy to implement these tools or implement evidence based practise. This means that we have to understand the context in which health services are delivered. We have to understand the softer people issues associated with health improvement. How change is actually implemented in the real world. And it's that focus that we will take in this course by drawing on a wider range of theories and ideas, from the discipline of organisation theory and management. To develop these ideas, we will be including contributions from academics from across the spectrum of management and clinical sciences. You'll hear from people like Bernard Crump for example from the Warwick Medical School.
Skip to 2 minutes and 19 secondsYou'll hear from numerous academics from the Warwick Business School, including myself, Graeme Currie, Gerry McGivern, and Nicola Burgess. We'll also hear from leading practitioners around the world. So for example, Lynne Maher previously working for the NHS in England, and John Øvretveit based at the Karolinska Institutet in Scandinavia. They will provide insights into both the theory and the practice. We will also be including cases from around the world. So for example, we will look at primary care reforms in China. We will look at clinical networks in Kenya. We will look at lean systems implementation in Australia and in Italy. This course is going to unfold over six weeks.
Skip to 3 minutes and 7 secondsIn the first week, we will introduce the whole topic of healthcare improvement and change in health systems. In the second week, we'll move on to the topic of organisations and understanding the organisational context. In week three you'll then learn about leadership and alternative notions of distributed or collective leadership. This leads us in week four to the whole topic of quality improvement and the tools and techniques associated with that. For example, lean systems. Week five looks at clinical networks as a source of innovation and improvement within health systems. And last, but by no means least, in week six we will look at the issue of patient participation and involvement, and how patient involvement can actually enhance improvements in our health systems.
Skip to 3 minutes and 55 secondsSo, welcome to the course. We hope that you find interesting, valuable, and useful. I look forward to engaging with you in the weeks ahead as part of our learning community. In the next session, you'll have chance to introduce yourself. I look forward to that.
Welcome to the course
A warm welcome to the ‘Leadership for healthcare improvement and innovation’ course from the University of Warwick.
Thank you for joining our course. Please be advised that the original dates for the course have passed and as such the course facilitators are no longer monitoring activity and responding to comments or queries. We hope this does not impact on your learning or enjoyment of the course, and hope you will continue to engage in the materials. Please keep an eye on the course page to see when the next run is. Many thanks.
The question of how to deliver safer, higher quality and more efficient health services is now high on the policy agendas of most countries. This has been driven by research that highlights significant failures and mishaps in how our health services are run. For example, it is estimated that preventable hospital errors (mistakes in patient diagnosis, referral and treatment) are now the third leading cause of death in the United States. The quality of treatment received may also vary greatly depending on where patients live - the so-called ‘post code lottery’.
In recent times the field of Health Improvement (HI) science has developed to address these often unwarranted variations in the quality and availability of care. Its aims are simple, to ensure: “better patient experience and outcomes achieved through changing provider behaviour and organisation through using a systematic change method and strategies”. Increasingly HI has become associated with more and more sophisticated tools and techniques to help clinicians and managers identify problems, analyse gaps in performance, plan interventions and measure their success. Some of these tools originate from Industry and have a long history, for example lean systems, Six Sigma, total quality management and business process reengineering. Through the efforts of organisations such as the IHI and Joint Commission, these and other methods have been adopted widely in healthcare settings globally.
And yet, despite the popularity of HI, the evidence base to demonstrate real and sustainable improvements in service quality has remained patchy. There are also significant problems of implementation, with busy clinicians often unable or even unwilling to adopt what they consider to be ‘off the shelf’ or programmatic solutions to the problems they face. This has led to calls for alternative approaches to HI which are grounded in an understanding of organisations as political systems and of intergroup relationships and dynamics. Many have called for a shift away from HI models that only consider the ‘hard’, systems dimensions of change, to those which are also concerned with the ‘softer’ people side of improvement and a greater emphasis on the context.
In this course we will address these concerns head on to champion this more inclusive approach towards healthcare improvement. To do so, we draw on a unique combination of knowledge and expertise from across the academic disciplines of Warwick Business School and Medical School. Together these departments have worked closely together in a unique partnership to promote impactful research through the West Midlands Collaboration for Leadership in Applied Health Research and Care (CLAHRC), funded by the National Institute for Health Research. Unlike many other courses, we will also be strongly international in focus, building on our collaboration with colleagues at Monash University (Australia), through the Monash Warwick Alliance. We will look at examples of successful healthcare improvement from around the world, including the UK, Australia, New Zealand, Kenya, Italy and China.
What will we study?
Together, in the weeks that follow we’ll explore six general topics:
- The nature and origins of healthcare improvement and the challenge of change. Why has HI attained such importance in recent years? Is change possible and if so how should we understand it?
- The organisational context of healthcare improvement. Here we look at how the characteristics of organisations such as hospitals and the wider health systems in which they are embedded shape the possibilities for change.
- The critical importance of leadership for implementing healthcare improvement. How can clinical leadership make a difference? How useful are alternative, shared or distributed forms of leadership?
- Quality improvement tools and techniques and their implementation. We will explore initiatives such as lean systems, how these have been applied in different health settings and how the potential for successful change can be enhanced.
- The role of clinical networks in supporting healthcare improvement. What are the different forms that networks can take and how do they contribute to the development and successful spread of new innovation in healthcare?
- Patient involvement in healthcare improvement. How might patents contribute to service redesign through co-creation and co-production? What conditions support of hinder successful patent involvement?
Who are we?
My name is Ian Kirkpatrick, the Monash Warwick Professor of Healthcare Improvement & Implementation Science (Organisational Studies) at Warwick Business School, and I am the lead educator on this course.
For many years my research has focused on the management, organisation and performance of health services, both in the UK and internationally. I have published widely on this topic, including various books focusing on the new public management and the management of social care services. In 2006 I led a national Inquiry into the changing relationship between management and medicine and later served as the Chair of a Framework 7 European COST Action, focusing on that topic. More recently my research has used a variety of routine and administrative data sources to profile the nature and effectiveness of different forms of governance in the UK NHS and other health systems (including Spain, Italy and China).
In the weeks that follow you will be hearing from me and other colleagues involved in the course, based at the UK’s University of Warwick and Australia’s Monash University. Some of the main contributors include
- Graeme Currie, a Professor of Public Management at Warwick Business School. Graeme is a highly published expert on the topic of leadership and clinical networks. He has led on many National Institute for Health Research funded projects and previously served as Director of CLAHRC for Nottingham, Derbyshire and Lincolnshire.
- Bernard Crump, a Professor at Warwick Medical School. Bernard originally studied medicine at the University of Birmingham and has taken on many public roles including CEO of Shropshire and Staffordshire Strategic Health Authority and later the first CEO of the NHS Institute for Innovation and Improvement.
- Eivor Oborn is a Professor of Health Care Management. She originally trained as a clinician, before turning to a successful academic career. Eivor is a well published expert on the topics of change management, leadership and digital health.
- Gerry McGivern is a Professor of Organisational Analysis at Warwick Business School. Gerry’s research focuses on understanding professionals’ knowledge, practice, identity and leadership. He has worked on numerous projects including those funded by prestigious bodies such as the General Medical Council, National Institute for Health Research and General Osteopathic Council
- Nicola Burgess is an Associate Professor of Operations Management. Nicola’s research activity is focussed in healthcare, conducting a number of projects in the NHS in the areas of service improvement, Lean, RCA, patient safety, patient involvement, organisational learning, knowledge brokerage and leadership.
- Rick Iedema is a Professor in Healthcare Improvement at the Monash Centre for Health Research and Improvement, Monash University. He specialises in health reform policy, front-line implementation, uptake of that policy and is a recognised expert on patient safety.
- Charlotte Croft is Assistant Professor of Healthcare Improvement at Warwick Business School. Her research focuses on issues of professional identity and organisational behaviour in healthcare systems, and has been published in a number of high ranking journals, and has helped collate case studies and research used to develop this online course. Prior to beginning an academic career, Charlotte worked as an Intensive Care nurse.
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