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Bridging the Quality Chasm or Falling Into it?

I know I am at a stimulating talk when I feel my passion rising. So it was last Friday when I attended a talk given by Professor Marc Berg from Erasmus University Rotterdam at a NHS Faculty of Health Informatics Masterclass in London.

Professor Berg argues that quality improvement and health informatics must be combined if healthcare it to be improved and healthcare IT projects to succeed. At the core of his proposal is standardisation: of practice using Integrated Care Pathways (ICP), of semantics (using common health languages-like SNOMED CT) and of IT.

His approach is pragmatic, concentrating on changes that will make the biggest difference and on using the right expertise at the right stages of care. As you would expect in a method based on quality management, clinicians monitor outcomes and adjust processes as needed. So far, so good.

What Professor Berg did not adequately explain is how such changes are to be brought about. How are organisational politics and resistance to change to be prevented from bringing such major changes to a shuddering halt?

My scepticism comes from experience: I was part of a team implementing an almost identical system to Professor Berg's more than 9 years ago at a hospital in England (see my article “Making NP Fit” ).

Further, such quality management systems are excellent at normalising and standardising care-but what about innovation? Professor Berg argues routinely monitoring outcomes and changing processes where needed will bring about innovation.

I say resistance to change and the pressure to maintain business as usual will cause such feedback loops to normalise processes and thereby inhibit radical change. A similar argument to this is presented by Clayton M. Christensen in the “Innovator's Dilemma”.

Pleased as I am to see such ideas gain acceptance, hard experience has taught me their implementation often falters in the machinations of the real world. Focusing on technology (including IT) to the exclusion of human factors may lead to failure. But, the integration of technology into healthcare does bring about major change--consider, for example, the changes brought about by surgery, asepsis, anaesthetics, minimally invasive surgery.

So here the Professor and I differ. Changing attitudes, practice and IT simultaneously it just too difficult, no matter how attractive it seems in theory. A more pragmatic way to similar ends is to allow IT to be the focus and to encourage clinicians to exploit it to create better care.


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The seminar was inspiring and educating. I am in support of the integrated care pathway mooted by Prof. Berg.

Also, his idea that IT implementation should merged with Quality Improvement in Health is innovative but we need to be aware of the enormosity of doing this because the NHS clinical Governance is focused on patient outcomes, therefore implementing IT projects will need a lot of inputs from patients in NHS.

Furthermore, I suggested that for the IT implementation to be sustainable, curriclar change is needed in the training of future health care professionals.

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