Redesigning health systems for quality: Lessons from emerging practices

The RAND Corporation, Santa Monica, California, USA.
Joint Commission journal on quality and patient safety / Joint Commission Resources 12/2006; 32(11):599-611.
Source: PubMed

ABSTRACT It has been five years since the Institute of Medicine (IOM) report, Crossing the Quality Chasm, proposed systemwide changes to transform our health care system. What progress has been made? What lessons have been learned? How should we move forward?
Semistructured telephone interviews were conducted with 16 health care providers and researchers at organizations involved in system redesign. The findings were supplemented with a focused literature review and discussions from a national expert meeting.
Many promising and innovative examples of redesign were identified. However, even delivery systems that are redesigning care in pursuit of the six IOM aims face daunting challenges, reflecting the need to align system changes across multiple levels and to integrate redesign efforts with ongoing system features. Four success factors were reported by providers as crucial in overcoming redesign barriers: (1) directly involving top and middle-level leaders, (2) strategically aligning and integrating improvement efforts with organizational priorities, (3) systematically establishing infrastructure, process, and performance appraisal systems for continuous improvement, and (4) actively developing champions, teams, and staff. A framework that integrates these success factors to facilitate a systems approach to redesigning health care organizations and delivery systems for improved performance is provided.
Successful system redesign requires coordinating and managing a complex set of changes across multiple levels rather than isolated projects.

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    • "Our findings corroborate and complement both the conceptual literature and studies in other health fields that address impediments to QA and QI implementation. These works emphasized lack of organizational buy-in (Deming 1986; Walton 1990; Wang et al. 2000), insufficient financial and technological resources (Wang et al. 2000; Alexander et al. 2007), and an inadequately trained workforce (Crosby 1979; Pande et al. 2000). In a study that compared a local 'participatory' approach and a central 'expert' approach to quality improvement in depression treatment in primary care settings, limited buy-in was identified as a disadvantage of the expert approach (Parker et al. 2007). "
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    Administration and Policy in Mental Health and Mental Health Services Research 12/2011; 40(3). DOI:10.1007/s10488-011-0393-5 · 3.44 Impact Factor
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    • "Instead of a single-level change approach, the literature suggests a strategy that involves actors at all organisational layers--from physicians and nurses to management and executives [17-20]. The MQC designers shared this perspective and included a leadership programme. "
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    ABSTRACT: Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.
    Implementation Science 03/2011; 6(1):18. DOI:10.1186/1748-5908-6-18 · 4.12 Impact Factor
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    • "Finally, even a qualitative assessment of innovative healthcare services cannot conceal that successful reorganization of the system, which is often necessary for the implementation of innovations, involves the coordination and management of a complex process and not merely the realization of an isolated project [23]. "
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