Bøger i Elements of Improving Quality serien

"Healthcare policy frequently invokes notions of cultural change as a means of achieving improvement and good-quality care. This Element unpacks what is meant by organisational culture and explores the evidence for linking culture to healthcare quality and performance. It considers the origins of interest in managing culture within healthcare, conceptual frameworks for understanding culture change, and approaches and tools for measuring the impact of culture on quality and performance. It considers potential facilitators of successful culture change and looks forward towards an emerging research agenda. As the evidence base to support culture change is rather thin, a more realistic assessment of the task of cultural transformation in healthcare is warranted. Simplistic attempts to manage or engineer culture change from above are unlikely to bear fruit; rather, efforts should be sensitive to the complexity and highly stratified nature of culture in an organisation as vast and diffuse as the NHS"--

"Positive deviance is an asset-based improvement approach. At its core is the belief that solutions to problems already exist within communities, and that identifying, understanding, and sharing these solutions enables improvements at scale. Originating in the field of international public health in the 1960s, positive deviance is now, with some adaptations, seeing growing application in healthcare. We present examples of how positive deviance has been used to support healthcare improvement. We draw on an emerging view of safety, known as Safety II, to explain why positive deviance has drawn the interest of researchers and improvers alike. In doing so, we identify a set of fundamental values associated with the positive deviance approach and consider how far they align with current use. Throughout, we consider the untapped potential of the approach, reflect on its limitations, and offer insights into the possible challenges of using it in practice"--

"Operational research is a collection of modelling techniques used to structure, analyse, and solve problems related to the design and operation of complex human systems. While many argue that operational research should play a key role in improving healthcare services, staff may be largely unaware of its potential applications. We explore operational research's wartime origins and introduce several approaches that operational researchers use to help healthcare organisations: address well-defined decision problems; account for multiple stakeholder perspectives; and describe how system performance may be impacted by changing the configuration or operation of services. We draw on examples that illustrate the valuable perspective that operational research brings to improvement initiatives and the challenges of implementing and scaling operational research solutions. We discuss how operational researchers are working to surmount these problems and suggest further research to help 6 operational researchers have greater beneficial impact in healthcare improvement"--

"Many healthcare improvement approaches originated in manufacturing, where end users are framed as consumers. But in healthcare, greater recognition of the complexity of relationships between patients, staff, and services (beyond a provider-consumer exchange) is generating new insights and approaches to healthcare improvement informed directly by patient and staff experience. Co-production sees patients as active contributors to their own health and explores how interactions with staff and services can best be supported. Co-design is a related but distinct creative process, where patients and staff work in partnership to improve services or develop interventions. Both approaches are promoted for their technocratic benefits (better experiences, more effective and safer services) and democratic rationales (enabling inclusivity and equity), but the evidence base remains limited. This Element explores the origins of coproduction and co-design, the development of approaches in healthcare, and associated challenges; in reviewing the evidence, it highlights the implications for practice and research"--

"This Element introduces and critically reflects on the contribution of implementation science to healthcare improvement efforts. Grounded in several disciplines, implementation science is the study of strategies to promote the uptake of evidence-based interventions into healthcare practice and policy. The field's focus is threefold. First, it encompasses theory and empirical research focused on exploring, identifying, and understanding the systems, behaviours, and practices that influence successful implementation. Second, it examines the evaluation of strategies to address barriers or enablers to implementation in a given context. Last, it increasingly seeks to understand the process of implementation itself: what actually gets implemented, and when, why, and how? Despite the growing body of evidence, challenges remain. Many important messages remain buried in the literature, and their impact on implementation efforts in routine practice may be limited. The challenge is not just to get evidence into practice, but also to get implementation science into practice"--

"Collaboration-based approaches to healthcare improvement attract much attention. They involve networks of people coming together to cooperate around a common interest, with shared goals of improving care and mutual learning. Longstanding examples of collaborative approaches have been associated with some success in improving outcomes and reducing harm. The evidence for their effectiveness and cost-effectiveness, however, remains inconsistent and contingent on the circumstances in which they are deployed and how they are used for what purpose. Several models for collaboration have been developed, varying in structure, format, and balance between internal leadership and external control. We focus on two approaches: quality improvement collaboratives and communities of practice. We explore evidence of their impact on health outcomes, and evidence about how best to organise and implement collaboration-based approaches. Using examples of more and less successful collaborations, we offer guidance on the key challenges involved in using collaboration-based approaches to improve healthcare"--

"Highlights successes and promising approaches but also the challenges in generating and using evidence to address overuse. This title is also available as Open Access on Cambridge Core"--

Historically simulation was used as an education and training technique in healthcare, but now has an emerging role in improving quality and safety. Simulation-based techniques can be applied to help understand healthcare settings and the practices and behaviours of those who work in them. Simulation-based interventions can help to improve care and outcomes ¿ for example, by improving readiness of teams to respond effectively to situations or to improve skill and speed. Simulation can also help test planned interventions and infrastructural changes, allowing possible vulnerabilities and risks to be identified and addressed. Challenges include cost, resources, training, and evaluation, and the lack of connection between the simulation and improvement fields, both in practice and in scholarship. The business case for simulation as an improvement technique remains to be established. This Element concludes by offering a way forward for simulation in practice and for future scholarly directions to improve the approach. This title is also available as Open Access on Cambridge Core.