Transformational change in healthcare: an examination of four case studies

Abstract

Objectives. Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences.Methods. We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form.Results. Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership.Conclusions. Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare.What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

An overview of healthcare improvement: unpacking the complexity for clinicians and managers in a learning health system

“…Integrating existing evidence 24,58 allows extraction of ‘simple high‐level rules’ of transformational improvement to enhance success: (i) blended leadership (designated with distributed); (ii) established feedback loops; (iii) attention to history; (iv) engaged physicians; and (v) inclusion of patients and families, and (vi) understanding the importance of context. These observations are also supported by case study research and are summarised in Table 6 59,60 . It should be noted that failures of healthcare transformation are also described 53 with glaring lack of stakeholder engagement, limited evidence and guideline integration that feeds into implementation research and HCI as is critical in an LHS.…”

“…These observations are also supported by case study research and are summarised in Table 6. 59,60 It should be Table 6 Lessons from case studies about transformational improvement 59,60 • A strong and clear impetus to transform and improve • Establishment of leadership commitment and capability of striking a balance between dominant, authoritarian approaches and distributed leadership • Exceptional, active and authentic team engagement in problem solving, design of solutions and improvement processes • Facilitation of sophisticated data management systems…”

Everyone matters; everyone contributes; everyone grows: a pilot project cultivating psychological safety to promote growth-oriented service culture after the Oakden Report

“…Developing distributed leadership models, promoting engagement and encouraging continual learning are factors sustaining culture change. 16,17 Consistent with conceptual roots in the DDO approach, the program did not remove existing linemanagement responsibilities, but intentionally reconsidered relationships, seeking to remove impediments to communication and provide everyone a voice. 7 Continual evolution and adaptability are critical to success in culture change efforts.…”

“…7 Continual evolution and adaptability are critical to success in culture change efforts. 16 Flexibility to deviate from the planned agenda to identify and apply what worked supported success. This was demonstrated in the commitment of the project team to continue phase one beyond anticipated timeframes and adapt phase two to suit staff needs.…”

Self-Determination in Health Research: An Alaska Native Example of Tribal Ownership and Research Regulation

“…93-638) codified self-determination of Alaska Native and American Indian (AN/AI) people by allowing tribes and tribal organizations to contract directly with the United States federal government for health and education grants and thereby exercise greater control over their own welfare [ 1 , 2 , 3 , 4 ]. Many tribes and tribal organizations have since exercised the right to own and manage federally funded health services and programs under this process of self-governance [ 5 , 6 , 7 , 8 , 9 ]. Awareness of health disparities experienced by the AN/AI community compared with other U.S. populations has also spurred many tribes and tribal organizations to invest and engage in health research [ 7 , 10 , 11 , 12 ].…”