Skip to 0 minutes and 5 secondsHello, welcome to week two. 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 take place within organisations. We think it's important to understand this big picture in order to understand what's possible and what you can actually do in an organisation on the ground. To understand this context, we're going to focus on three levels-- what I call the macro, the meso, and the micro levels of analysis. Now, what I mean by this is the macro level-- this is essentially the funding environment of healthcare systems.

Skip to 0 minutes and 49 secondsThey're broad governance, the mix between primary and secondary services that frames everything else that happens in a healthcare system. The mezzo level-- this brings us down to the organisational context, if you like-- choices about how far to have markets, how far to have a bureaucracy, or to coordinate things through networks. At this level, we'll also look at some key reforms that have been taking place around the world, called the new public management, and how they have affected the organisational context of healthcare systems. Lastly, we'll focus on the micro-level of hospitals and other healthcare organisations.

Skip to 1 minute and 30 secondsAnd what we're trying to do here is describe the particular characteristics of those healthcare organisations-- what we call professional bureaucracies-- and how those characteristics really shape the kind of management and change that is possible within them. To understand this topic, you'll be hearing mainly from me, but also from Ian McLaughlin from Monash University. We'll also look at some case studies from around the world, including the United Kingdom, the United States, primary care reforms in China, and networks and change in the Australian healthcare system.

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 the 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 health care 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 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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