Paul Bate

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.

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.

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.

Using a Design Approach to Assist Large-Scale Organizational Change “10 High Impact Changes” to Improve the National Health Service in England

A team of practitioners, university researchers, and health care policy makers has been working to develop and apply “design sciences” thinking within the challenging context of a national system aiming to bring about a “revolution in health care.” As members of that team, the authors share that thinking and early findings with those interested in the concept, theory, and practice of design as an approach to large-scale organizational change. The article builds on what to date has been a somewhat abstract debate around the design sciences, its aim being to forge stronger links between the concept and the practice of design. Using empirical data from the English National Health Service as a case study, the article seeks to demonstrate how design sciences may first, expand our thinking around organizational theory and practice and second, offer organization development some new methods, approaches, and processes around the “doing” of large-scale change.

Redesigning mental health services: lessons on user involvement from the Mental Health Collaborative

Objectives  To explore the involvement of mental health service users in the redesign of in‐patient mental health services in six Trusts participating in a multi‐regional NHS modernization programme.

Bringing the Design Sciences to Organization Development and Change Management: Introduction to the Special Issue

This special issue on “Bringing the Design Sciences to Organization Development and Change Management” began life in quiet and humble fashion as a professional development workshop (PDW) at the 2005 meeting of the Academy of Management. On this occasion, presenters outnumbered audience members, a fact not altogether surprising given the balmy temperatures of that wonderful Hawaiian afternoon and the competing attractions of sun, sea, and surf in the day that remained before the main meeting. My recollection is that few, if any, of the people present, apart from the presenters, were organizational development (OD) scholars or practitioners. The reason for this became clearer at a bigger and much better attended organization development and change (ODC) symposium the following day when Jean Bartunek, the chair of our PDW on the previous day, asked how many people had heard of the design sciences and disciplines (as opposed to design) and not a single hand had been raised. Although the design sciences had reached organization studies (OS) by then (this being reflected in the growing number of conference symposia and special journal issues and articles on the topic), clearly this was not the case with regard to its close neighbor. One year on, and the 2006 Academy meeting in Atlanta, and the world is dressed in different colors. The original PDW has metamorphosed into a showcase symposium at the main meeting, jointly sponsored by the ODC and Management Consulting Divisions, and trailed as one of the program highlights. More than a hundred people are present, plus a large panel consisting of the authors whose work appears in this issue and Dick Woodman, the editor of JABS, as discussant. The session is informal

Turtles all the way down

Writing a book about cultural change is a daunting task. One cannot simply take the advice of the storyteller or policeman and ‘begin at the beginning’, and tell it ‘how it happened’. In matters of change there is rarely a clear beginning — nor, for that matter, a discernible middle or end, and few people ever agree on what ‘really happened’, or if indeed anything happened at all. Even fewer will be able to say with any certainty what change is, or precisely what has changed, especially where matters of cultural change are involved. And, as we are well aware, the concept of culture is itself surrounded by a myriad of problems relating to meaning and definition. Therefore, put ‘culture’ and ‘change’ together and the chance of anything coherent emerging becomes all the more unlikely.

Studying Health Care “Quality” Qualitatively: The Dilemmas and Tensions between Different Forms of Evaluation Research within the U.K. National Health Service

The authors tell the story of an attempt to depart from a tradition of evaluation research (ER) and to address the research-practice interface in a different way through a more hands-on, action research (AR) approach, which combines qualitative and quantitative methods. In doing so, they raise issues about the role and nature of evaluation for development and, especially, about the place of qualitative research in such evaluations; the identity of future ER; “paradigm wars” between the positivists and the phenomenologists; and the politics of conducting policy-based evaluations in health care settings and of what happens when qualitative researchers try to help an improvement process.

Choice : More can mean less

Under this Delta Dental plan, you may see any dentist. However, your out-of-pocket Out-of-Pocket Limit/Maximum (OMP)The maximum amount of money you will pay for covered medical services during the plan year. These costs include deductibles, copays and coinsurance. This maximum is designed to protect you from catastrophic health care costs. After you reach this amount, the plan will pay 100% of the allowed amount. [2] costs are lower when you use a dentist on Deltas Preferred Provider Option (PPO)Preferred Provider Organization (PPO)A health care plan that has a contractual agreement with providers to offer health care services at discounted, negotiated fees within a network. The PPO plans may require some cost-sharing with deductibles, copays and/or coinsurance. [3] list. Once you meet the deductibleDeductibleAn amount that you are required to pay before the plan will begin to reimburse for covered services. [4], you will be responsible for a percentage of your covered costs, known as coinsuranceCoinsuranceThe portion of expenses that you have to pay for certain covered services, calculated as a percentage. For example, if the coinsurance rate is 20%, then you are responsible for paying 20% of the bill, and the insurance company will pay 80%. [5]. Adults, age 19 or older, are eligible for the orthodontic benefitOrthodontic CoverageA treatment that aligns a person’s teeth, which may include the use of braces. [6] with this plan.