Improving Quality in Healthcare
Questioning the Work for Effective Change
- Murray Anderson-Wallace - London South Bank University, UK
- Nick Downham - Cressbrook Ltd
This book is for anyone who is interested in improving quality in healthcare. It will appeal to those who are traditionally responsible for quality matters, as well as practicing clinicians and leaders. Unusually, it will also be as relevant to those who have the keenest interest in the quality of care - interested citizens.
It is a deliberate antidote to the anti-intellectual, QI tool driven, mechanistic approach that still dominates much of healthcare quality improvement work. The authors - both of whom have extensive experience of working in and around quality issues in healthcare at a national, regional and local level - challenge such approaches, which they believe fail to take account of patient and organisational context and invite reductionism, cherry picking, atomisation of complex issues, leading ultimately to simplistic and unsustainable outcomes.
Key features of the book:
· An exploration of some of the often-overlooked and misunderstood core concepts of quality; their history and meaning in a contemporary context.
· A framework to “question the work" using four interconnected conceptual domains as a valuable framework to consider improving quality and reducing failure demand.
· Critical re-examination of the dominant approaches to change that are frequently adopted in “quality” work, many of which have been rooted in scientific management that have failed to live up to their promise – particularly transformational.
· Exploring how an inter-disciplinary perspective can reframe aspects of quality thinking.
True to form Murray & Nick invite a critical re-examination of the dominant approaches used in a great deal of improvement work in healthcare. Based on their extensive experience of working in the field over the last 25 years, they argue that many of the current approaches fail to take proper account of organisational and patient context; invite reductionism and the atomisation of complex issues, and ultimately create only an illusion of progress. They promote the use of a framework to "questioning the work”, and discuss four interconnected domains to help guide inquiry.
I was particularly drawn towards the chapters on “Cultures of Quality” and "Supporting the Human System at Work” in which they discuss a wide range of issues that impact on safety. They cite a lot of the great work done by Prof Mary Dixon-Woods (often referred to in this newsletter) and the Harmed Patient Alliance work on "compounded harm”. Although the book is unashamedly an academic text, it’s also pretty accessible, and offers a thoughtful analysis of how to understand some complex issues with case study examples to illustrate their points.
Of course, no one book could cover the hugely complex issues of healthcare. However, Anderson-Wallace and Downham make a valuable contribution and bring insights into areas where they are much needed. These insights cover both ‘hard’ and ’soft’ aspects. The ‘hard’ aspects include the vital topics of demand and capacity. The ’soft’ aspects include new insights into what the authors call ‘avoiding the specialist, generalist and citizen muddle’. Many healthcare professionals - practitioners and administrators - will gain from reading this book.
Do not be deceived by the modest cover and title, this book is overflowing with original ideas highly relevant to current primary and secondary care. The authors take you on a journey from what has happened so far to develop and improve care, to a compelling vision for the future. I’ve been working as Primary Care network Clinical Director for 5 years now, and have been a GP partner for 19 years. This book absolutely resonates with the direction I think we need to go. It offers evidence and tools, grounded both in research and their considerable shared experience of leading system change. It is challenging but pragmatic, and it demonstrates what is possible. It has filled me with confidence and optimism for future enhanced approach to supporting community-based care. Everyone who cares about care, and the future of healthcare needs to read this book, and engage in the debate and action that they invite.
Drawing from diverse sources of evidence, this book offers a comprehensive overview of critical issues in healthcare quality improvement. It covers topics such as quality cultures, demand drivers, and the concept of failure demand. Importantly, the book also explores how the social determinants of health influence individuals' health and healthcare needs. The authors have effectively tackled a complex subject, presenting it in a clear and thorough manner that encourages readers to re-examine their assumptions about healthcare. This approach provides valuable insights for improving the quality of healthcare services, especially in these challenging times.
As a practising GP, I loved reading this book because it gives a theoretical framework to the problems I see every day at work. Failure demand is a new concept to me, but makes perfect sense and provides a language to approach difficult topics like over medicalisation, risk aversion (e.g. due to medicolegal concerns) and fragmentation of care, whereby patients end up seeing multiple clinicians with nobody taking an overview or responsibility for overall care. The language is accessible and clear. In my opinion, it should be compulsory reading for all GPs, GP trainees, other primary care clinicians and especially for policymakers.
This book critically examines the underlying beliefs and practices that govern quality improvement and challenges conventional approaches. It is a must-read for clinicians and NHS leaders seeking to improve quality in healthcare.