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Consistently great care requires great systems to support people to be great

Consistently great care requires great systems to support people to be great

Over the past three decades, many health systems have sought to enhance care delivery. Despite various approaches such as quality improvement and lean management these efforts can fall short. Failures are often attributed to leaders and workers not doing the right things. This article argues that the real quality problems lie in the underlying systems staff work with. It says that human service organisations will be more successful if they focus on designing systems that support the delivery of high-quality care, rather than trying to fix the people working within them.

Historically, health care operated as a craft industry with individualised practices. With massive sector growth came the need for standardisation of processes. Influences from industries such as automotive manufacturing and commercial aviation introduced strategies like Lean/Six Sigma and High Reliability into healthcare.

While beneficial, the authors posit that manufacturing improvement methods have generally yielded only incremental improvements. They suggest that there are other industries with more relevant lessons for health and human services, such as Amazon and Ritz Carlton, who prioritise system optimisation over workforce demands. Successful quality service systems focus on redesigning operations to ease frontline workers' tasks and improve system outputs. This approach is critical for addressing health care's burnout crisis and workforce shortages.

Exemplars in health care, such as Jefferson Health and Prisma Health, have adopted dynamic operating systems to integrate various improvement initiatives into a cohesive, technology-enabled quality management system. This approach enhances patient care, re-engages clinicians, and fosters sustained improvements.

The article identifies key characteristics of these successful care operating systems as:

  1. Valuing people: Recognising and celebrating staff commitment and resilience.
  2. Supporting complexity: Creating systems that support complex, modern healthcare environments.
  3. Embedding improvement: Integrating improvement efforts into daily operations, rather than treating them as separate initiatives.
  4. Holistic management: Combining safety, equity, quality, and efficiency into a single operating system.
  5. System optimisation: Prioritising system improvement over workforce demands.
  6. Clear communication: Providing information in terms familiar to frontline staff.
  7. Transparency: Maintaining open communication with patients and staff about performance data and care outcomes.

The article urges healthcare leaders to adopt the principles of good practice and improvement from service industries, to support high-quality care and better address both consumer needs and workforce well-being.


All accessed 14/8/24:

Kedar S. Mate, Josh Clark, and Jeff Salvon-Harman.  To Improve Health Care, Focus on Fixing Systems — Not People.  HBR, July, 2024. https://hbr.org/2024/07/to-improve-health-care-focus-on-fixing-systems-not-people