Glenn Robert

Quality collaboratives: lessons from research

Quality improvement collaboratives are increasingly being used in many countries to achieve rapid improvements in health care. However, there is little independent evidence that they are more cost effective than other methods, and little knowledge about how they could be made more effective. A number of systematic evaluations are being performed by researchers in North America, the UK, and Sweden. This paper presents the shared ideas from two meetings of these researchers. The evidence to date is that some collaboratives have stimulated improvements in patient care and organisational performance, but there are significant differences between collaboratives and teams. The researchers agreed on the possible reasons why some were less successful than others, and identified 10 challenges which organisers and teams need to address to achieve improvement. In the absence of more conclusive evidence, these guidelines are likely to be useful for collaborative organisers, teams and their managers and may also contribute to further research into collaboratives and the spread of innovations in health care.

Experience‐based design: from redesigning the system around the patient to co‐designing services with the patient

Involving patients in service improvement and listening and responding to what they say has played a key part in the redesign of healthcare processes over the past five years and more. Patients and users have attended stakeholder events, participated in discovery interviews, completed surveys, mapped healthcare processes and even designed new hospitals with healthcare staff. However, to date efforts have not necessarily focused on the patient’s experience, beyond asking what was good and what was not. Questions were not asked to find out details of what the experience was or should be like (“experience” being different from “attitudes”) and the information then systematically used to co-design services with patients. Knowledge of the experience, held only by the patient, is unique and precious. In this paper, attention is drawn to the burgeoning discipline of the design sciences and experience-based design, in which the traditional view of the user as a passive recipient of a product or service has begun to give way to the new view of users as integral to the improvement and innovation process.

Diffusion of Innovations in Health Service Organisations.

Diffusion of innovations in health service organisations , Diffusion of innovations in health service organisations , کتابخانه دیجیتال جندی شاپور اهواز

Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study

This article argues for a major shift in focus from the strong management orientation of organization development (OD) to a more “user-centric” OD, one that seeks to mobilize and privilege change on behalf of the consumers or users of an organization’s product or service, involving them at every stage of the design process, from problem diagnosis to solution generation and implementation. This reconceptualization of OD draws its inspiration from the rapidly expanding field of experience-based design (EBD), a subfield of the design sciences whose distinctive features are direct user participation in the design process and a focus on designing experiences as opposed to systems or processes. The article reports on an original EBD intervention methodology designed and tested by the authors and colleagues in a cancer clinic within the National Health Service, which following successful “proof of concept,” offers OD some promising new directions for the future.

An open letter to The BMJ editors on qualitative research

Seventy six senior academics from 11 countries invite The BMJ ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

The next phase of healthcare improvement: what can we learn from social movements?

To date, improvement in health care has relied mainly on a “top down” programme by programme approach to service change and development. This has spawned a multitude of different and often impressive improvement schemes and activities. We question whether what has been happening will be sufficient to achieve the desired scale of change within the time scales set. Is it a case of “more of the same” or are there new and different approaches that might now be usefully implemented? Evidence from the social sciences suggests that other perspectives may help to recast large scale organisational change efforts in a new light and offer a different, though complementary, approach to improvement thinking and practice. Particularly prominent is the recognition that such large scale change in organisations relies not only on the “external drivers” but on the ability to connect with and mobilise people’s own “internal” energies and drivers for change, thus creating a “bottom up” locally led “grass roots” movement for improvement and change.

Adopting and assimilating new non-pharmaceutical technologies into health care: a systematic review

Objective: To explore what is known about organizational processes that determine whether (and the extent and rate at which) new non-pharmaceutical technologies are adopted and assimilated into routine health care. Methods: Electronic searching of four databases, hand searching of six journals and electronic citation tracking searches of three key research papers. A narrative synthesis was conducted. Results: Ninety-nine empirical studies and seven narrative overviews informed the findings. The majority (62%) of the studies took a deterministic approach (mainly using cross-sectional mailed questionnaires) and typically studied the impact of organizational variables - such as organizational size - on the rate of adoption of technological innovations. The remaining studies were process-based using a single- or multi-case study approach. The organizational processes that determine whether and how technological innovations are adopted and assimilated into routine health care practice are dependent upon the specific innovation concerned, the different actors involved at various points in time, and the particular organizational context in which decisions are made. It is important to see ‘adoption’ and ‘assimilation’ as part of an ongoing process rather than discrete events, and as a process that comprises both ‘formal’ organizational and ‘informal’ decisions by individual users (the latter often shaped by discussions with their peers and colleagues). Conclusions: Further process-based studies are needed to provide a clearer evidence base for recommendations on how to facilitate the adoption and assimilation of beneficial new technologies. Three theoretical perspectives could form the basis of such studies and produce practical advice for managers and practitioners.

Patients and staff as codesigners of healthcare services

Glenn Robert and colleagues describe an approach that aims to ensure that healthcare organisations realise the full potential of patients—the biggest resource they have for improving the quality of care

Using patients' experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?

BackgroundPatients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process.MethodsOne dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified.ResultsThere were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions.ConclusionsOur analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience.

Experience-based Co-design and Healthcare Improvement: Realizing Participatory Design in the Public Sector

ABSTRACT Over the last decade, growing attention has been paid to the potential value of design theory and practice in improving public services. Experience-based Co-design (EBCD) is a participatory research approach that draws upon design tools and ways of thinking in order to bring healthcare staff and patients together to improve the quality of care. The co-design process that is integral to EBCD is powerful but also challenging, as it requires both staff and patients to renegotiate their roles and expectations as part of a reconfiguration of the relationships of power between citizens and public services. In this paper, we reflect upon the implementation and adaptation of EBCD in a variety of projects and on the challenges of co-design work within healthcare settings. Our discussion aims to contribute to the growing field of service design and to encourage further research into how co-design processes shape—and are shaped by—the power relations that characterize contemporary public services.