The Implementation of Improvement Interventions for "Low Performing" and "High Performing" Organisations in Health, Education and Local Government: A Phased Literature Review

Abstract

Background: There is limited understanding about whether and how improvement interventions are effective in supporting failing healthcare organisations and improving the quality of care in high-performing organisations. The aim of this review was to examine the underlying concepts guiding the design of interventions aimed at low and high performing healthcare organisations, processes of implementation, unintended consequences, and their impact on costs and quality of care. The review includes articles in the healthcare sector and other sectors such as education and local government. Methods: We carried out a phased rapid systematic review of the literature. Phase one was used to develop a theoretical framework of organisational failure and turnaround, and the types of interventions implemented to improve quality. The framework was used to inform phase 2, which was targeted and focused on organisational failure and turnaround in healthcare, education and local government settings. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to guide the reporting of the methods and findings and the Mixed Methods Appraisal Tool (MMAT) as a quality assessment tool. The review protocol was registered with PROSPERO (CRD: 42019131024). Results: Failure is frequently defined as the inability of organisations to meet pre-established performance standards and turnaround as a linear process. Improvement interventions are designed accordingly and are focused on the organisation, with limited system-level thinking. Successful interventions included restructuring senior leadership teams, inspections, and organisational restructuring by external organisations. Limited attention was paid to the potential negative consequences of the interventions and their costs. Conclusion: Dominant definitions of success/failure and turnaround have led to the reduced scope of improvement interventions, the linear perception of turnaround, and lack of consideration of organisations within the wider system in which they operate. Future areas of research include an analysis of the costs of delivering these interventions in relation to their impact on quality of care.

The Special Measures for Quality and Challenged Provider Regimes in the English NHS: A Rapid Evaluation of a National Improvement Initiative for Failing Healthcare Organisations

“…Triangulation of interview, observational, and documentary data was informed by literature on change in organisations, [12][13][14] a review on improvement in low-performing organisations, 4 and literature on receptive contexts for sustaining QI in healthcare. 15 The review shaped our analysis of failure, the implementation of improvement interventions and turnaround, as we sought to consider the complexity and continuous transformation of these processes.…”

“…5 Furthermore, limited attention has been paid to the negative consequences of these interventions. 4,5 Healthcare organisations in England rated as inadequate by the national regulator (the Care Quality Commission [CQC]) entered the Special Measures for Quality regime (SMQ) to receive increased support and oversight. The SMQ regime, a national improvement initiative, was a targeted and time-limited regime in the National Health Service (NHS) in England agreed between the CQC and NHS Improvement (NHSI).…”

Is anybody ‘Learning’ from Deaths? Sequential content and reflexive thematic analysis of national statutory reporting within the NHS in England 2017-2020

“…[50,51] A lack of system-level thinking as described by Vindrola-Padros et al ( 2020) is evident throughout the LfDs report, in actions implemented and 'learning' shared. [52] Clinical governance is the major domain cited as an action in the LfDs reports. The ability of NSCTs to undertake effective governance is variable, affected by multiple factors including communication and relationships between Clinicians and Managers.…”

National statutory reporting: not even ticking the boxes? The quality of ‘Learning from Deaths’ reporting in Quality Accounts within the NHS in England 2017-2020

“…Underperforming NSCTs have less time and resources available for new QI programmes, therefore consideration for implementation and what support might be needed should be given. [41,42] Next steps…”