Improving the Quality of Health Care in the United Kingdom and the United States: A Framework for Change

Abstract

Fueled by public incidents and growing evidence of deficiencies in care, concern over the quality and outcomes of care has increased in both the United Kingdom and the United States. Both countries have launched a number of initiatives to deal with these issues. These initiatives are unlikely to achieve their objectives without explicit consideration of the multilevel approach to change that includes the individual, group/team, organization, and larger environment/system level. Attention must be given to issues of leadership, culture, team development, and information technology at all levels. A number of contingent factors influence these efforts in both countries, which must each balance a number of tradeoffs between centralization and decentralization in efforts to sustain the impetus for quality improvement over time. The multilevel change framework and associated properties provide a framework for assessing progress along the journey.

Outcomes of a Partnered Facilitation Strategy to Implement Primary Care–Mental Health

“…[4][5][6][7] Implementation Facilitation (IF) has shown promise in implementing programs and practices, particularly at locations that would otherwise be unable to conduct quality improvement efforts. IF strategies that bundle evidence-based implementation interventions 8 usually also focus on building relationships and partnering with sites.…”

Role of Data in Improving Care within a Health System: A Case Study of the Australian Health System

“…The challenge is to find ways to create a system which collects, manages, and shares data effectively within a health system. This can occur if we can visualize how data and data systems function within larger context of a complex, multilevel healthcare system comprising of numerous moving parts [35] [36] [37]. Without a vision for our data and data systems we will have what we already observing today -highly fragmented data silos, often built to meet narrowly defined objectives of a few stakeholders [30] [34].…”

“…[35] The "Factory" framework was more appropriate in describing the state of healthcare as technology started making its presence felt in this industry. Lessons from other industries (e.g., aviation, manufacturing) were incorporated and technology was used to achieve standardization of routine business/administrative processes and the use of advanced technology to guide care; however, the processes of care remained largely customized.…”

“…Multi-level analysis can help understand the various levels through with changes to health care delivery mechanisms are produced and propagated (noted in the boxes on the side) thereby enabling us to design a portfolio of solutions [88]. One key study [35] suggested the multi-level (individual, group/team, organization, and environment) approach to improving healthcare delivery as a potential way to achieve system wide changes. This framework proposed not only making changes at one level but to also considered how that change would impact and react to everything else that is occurring at other levels.…”

“…and "sustained with difficulty" [35] [118] [119]. It can be argued that our attempts at improving care delivery through "narrow, single level programmatic changes" have been a "limited" or "moderate"…”