MSc Healthcare Leadership

Module Title: Contextualising Leadership Practice

Topic 9: Service Improvement & Leading Change

Learning Objectives

By the end of this session, students will be able to:

• Appreciate the importance of change and innovation for healthcare
quality improvement.

• Discuss some concepts, tools, and models relevant to leading

improvement and change in healthcare.

• Demonstrate a critical understanding and analysis of the challenges of

leading change and improvement across complex systems within health
and care.
Principles and Models to be explored

This session will cover the following models and/or principles:

• Experience-based co-design

• Model for improvement

• Plan-Do-Study-Act (PDSA) cycle

• Lean

• Six Sigma

• ISO9001
What is Change?

Change… has to do with individuals (employees), teams,

and organizations making modifications to how work is
done in order to deliver better services for patients and
their care, and/or for efficient operation within
organizations.
Why Change and Improvement in Healthcare?

Improve patient Save cost and reduce Implement

Improve quality care feedbacks/learning
outcome waste

Health workforce Employee/stakeholders The globalisation of

challenges satisfaction healthcare Population dynamics

Evolving Technological changes

knowledge/evidence and advances
Contexts

The NHS is facing significant pressures, with services struggling to

maintain the required standards of care.

This challenge is significant and in some parts of the NHS, quality is

deteriorating rather than improving:
• Waiting times are increasing.
• The numbers of people waiting to leave hospital are at record
levels.
• Budget cuts and staff shortages.
• waiting times are increasing

• the numbers waiting times are increasing

• the numbers of people waiting to leave hospital are at record levels

• budget cuts and staff shortages

• of people waiting to leave hospital are at record levels

• budget cuts and staff shortages

Contexts cont.

It is on record that between 5.7 and 8.4 million deaths are attributed to poor
quality care each year in low- and middle-income countries (LMICs), which
represents up to 15% of overall deaths in these countries

60 percent of these deaths in LMICs are from conditions requiring health

care attention due to poor quality care

Globally, the essential structures for achieving quality care are inadequate:
one in 8 health care facilities have no water supply, 1 in 5 has no sanitation
service, and 1 in 6 have no hand hygiene facilities at the points of care

Source: https://www.who.int/news-room/fact-sheets/detail/quality-health-
services
Contexts cont.

Now, more than ever, local, national and global

health leaders need to focus on improving quality
and delivering better-value care.

The potential benefit is even greater if

quality improvement techniques and tools
are applied consistently and systematically
across organisations and systems
Quality Improvements

Quality improvement – Involves the use of methods and tools to

continuously improve quality of care and outcomes for patients (Kings
Fund, 2017).

According to (Batalden & Davidoff, 2017, p.1) quality improvement is the

combined and unceasing efforts of everyone to make the changes that
will lead to better patient outcomes (health), better system performance
(care) and better professional development (learning)’.
Quality Improvement Models

• Experience-based co-design

• Model for improvement

• Plan-Do-Study-Act (PDSA) cycle

• Lean

• Six Sigma

• SO9001
Plan-Do-Study-Act (PDSA) Cycle

PDSA cycle is a tool which can be used to test out changes

on a small scale, building on the learning from these test
cycles in a structured way before implementing it on a larger
scale.

The purpose of the PDSA method lies in learning as quickly

as possible whether an intervention works in a particular
setting and to adjusting accordingly to increase the chances
of delivering and sustaining the desired improvement.
Plan-Do-Study-Act (PDSA) Cycle

The four stages of the PDSA cycle are:

Plan – the change to be tested or
implemented
Do – carry out the test or change
Study – based on the measurable outcomes
agreed before starting out, evaluate the
impact of the change and reflect what was
learned
Act – plan the next change cycle or full
implementation.

Source: National Institute for Health and Clinical Excellence (Grande-Bretagne), 2007
Sequential and Simultaneous PDSA Cycles

Source: Royal college of Physicians, 2019

Lean
This model seeks to eliminate waste and ensure efficiency in the process of
service delivery. It focuses on being able to do more with lean resources.

Five principles of lean thinking

Source: https://theleanway.net/The-Five-Principles-of-Lean
Lean – cont’d
Seven Types of waste:

• Correction
• Inventory
• Motion
• Overproduction
• Waiting
• Transportation
• Over processing
Change Management

Change management and quality improvement are often

used interchangeably as they both describe
transformational changes to a way of doing work.

Quality improvement can only be effective if it is adopted

by the stakeholders, and this is has become a major
challenge for change management.

Change management is thus an effective primer for

quality improvement as it is essential to achieving and
sustaining it.
Change Management Explained
1 minute Bing Video

https://www.youtube.com/watch?v=gmoDpj1jtyA
Change Management Models

Lewin’s Galbraith Star Kotter’s

Change Model Model Change Model

The Prosci
McKinsey 7S NHS Change
ADKAR®
Model Model
Change Model

7-step
RAPSIES
Model
Kotter’s Change Model

Establishing a sense of urgency

Creating the guiding coalition

Developing a vision and strategy

Communicating the change vision

Empowering employees for broad-based action

Generating short-term wins

Consolidating gains and producing more change

Anchoring new approaches in the culture

Lewin’s Change Model
Management of Change vs Change Management
Bing Video

https://www.youtube.com/watch?v=3hJxmWiBQjI
Summary

The delivery of healthcare services is currently faced with unprecedented

challenges.

This demands a continuous examination of ways to improve the current state of

health service delivery.

To foster these improvements, there is the need to adopt evidence-based quality

improvement and change management theories and tools, all of which can be
useful in addressing the challenges.

There is no clear indication that one tool is better than the other. Rather, it’s the
process of adopting a systematic and consistent approach to quality improvement,
while taking into consideration the local situational factors, that matters.
Any questions
References
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