Transformational change in health care systems

Abstract

The conceptual model holds promise for guiding health care organizations in their efforts to pursue the Institute of Medicine aims of fundamental system redesign to achieve dramatically improved patient care.

Transformational change in healthcare: an examination of four case studies

“…8,10 Although our findings are broadly consistent with these papers, the present article examines more diverse, international case studies, including two that, in our view, are the most ambitious and recent examples of transformational change in healthcare. The following discussion summarises the common themes that have arisen from this review and then considers in more detail the issues around leadership and complex systems.…”

“…24 As noted by several authors, a key advantage of this approach is that practitioners themselves often provide ideas and leadership and can be usefully engaged in problem solving. 10,25 Another recurring theme is performance management. Most authors, both in the present and previous studies, agree that an overarching vision for change is required, but this must be combined with clear delineation of responsibility and appropriate performance measures and incentives.…”

“…This was also identified in one of the reviews from the USA. 10 Following from this, a well-communicated narrative (with evidence-based arguments) about why change is needed 24 and a clear vision of how things will be different, is necessary. 27 In most cases there was also exceptional engagement and consultation with patients and staff.…”

“…Most authors, both in the present and previous studies, agree that an overarching vision for change is required, but this must be combined with clear delineation of responsibility and appropriate performance measures and incentives. 8,10,27 This includes financial accountability:…”

“…[2][3][4][5] Therefore, healthcare leaders in Australia and around the world are calling for a transition to a new system with new sources of value and new sites and models of care. 1,[3][4][5][6][7][8][9][10] This would not occur overnight (estimates suggest at least a decade 4,11 ), but it would result in a fundamentally new system rather than 'tinkering' within the existing model, as has occurred to date in the NHS. 7 Transformational change is difficult and complex, particularly in systems providing essential services, in which people are understandably risk averse.…”