Can innovation be led by clinicians and professionals in local healthcare services?
Can these innovations drive improved services for patients?
It seems possible – at least in a recent learning report produced by the Health Foundation, who sponsored 32 Shine projects designed to do just this. They summarised internal lessons learned across 4 project categories; using IT to improve services, changing the way services are organised, improving access to information and by training staff. Despite emphasising the need for these projects to demonstrate cost benefits, many could not. In part this may be due to difficulties with data collection, project design and outcome measurement.
However, some interesting lessons have been reported about the way to design improvement projects, that could be a useful adjunct to what is known about implementing change in healthcare organisations. 4 success factors have been highlighted.
- Local clinical leadership is crucial to identify where the local improvement is needed, generate local ownership of the project, manage upwards through their organisations and facilitate the promotion of new ideas
- Project managers are key to ensure successful logistics for the implementation and measurement of the proposed change
- Detailed early planning with all key players is necessary to generate comprehensive implementation plans
- Effective communication, using regular meetings and wide dissemination of important information, is necessary to engage staff and key stakeholders
While many of these projects were focussed on improving work flow efficiencies, it is important to build up the research evidence for key processes behind these success factors, that can show improvement, and for ways in which they can be measured.
We should separate out 2 types of change, to understand how to measure both;
- the ‘actual’ change in how patients are treated; usually described as a clinical intervention and measured by an objective clinical outcome
- the change in HOW the practice is implemented ; these conditions for improvement usually refer to key processes in the surrounding environment, or context, which can be monitored and measured
On the one hand, if we only report final outcomes, we know that variation in outcome measurements can be caused by differences in the type of patient, measurement tools, chance and actual differences in the quality of care. However, process measures are more sensitive that outcomes measures to quality differences, and they are easier to interpret. Process measures usually describe some aspect of the context, or conditions for improvement. Therefore, if we can show associations between key processes and meaningful clinical outcomes, it will be much easier to generate future improvements in the quality of health care.