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MAPPING INNOVATION IN HEALTH CARE
Friso den Hertog
MERIT/University Maastricht
Publin policy workshop
2 December 2005 Brussels
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AGENDA
• Paradox of health care• Patient centered perspective • Diffusion & implementation: core problems• New map for identifying walls & ceilings• Systems perspective• Radical change: high & low road• Exploration
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MappingWild & UnknownTerritoryEU network projects:Publin, Innoflex, Saltsa.Action research,Literature survey,In-depth interviews,Act as a soundingboard.
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PARADOX OF HEALTH CARE
• Despite the impressive progress in the development of technological and professional competencies, commitment and involvement of the professionals:
Madness in the system: administrative and managerial powerlessness.
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5 minute INTRODUCTION IN SYSTEM THEORY
A SYSTEM IS:
• Set of elements
• Interrelations
• Function (=process)
• Feed back
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LEARNING = FEED BACK
actie
measurement(deviation from the norm)
input otput
Blackbox
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UNCLOSED CYCLE
action
measurement(deviation from the norm)
input output
Blackbox
??
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OPENING THE BLACK BOX
The black box
input output
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EFFECT HERE/ CAUSE OVERTHERE
Black box
input output
CAUSE
effect
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WALLS & CEILINGS
Black box
input output
CAUSE
effect
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HEALTH CARE AS A PROCESS
Discipline,function
innovation environmentsystem innovation
process innovationfunctional innovation
Firms, knowledge centers, advocacy organizations
1e carehospitalrevalidationhomecare
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NEW WORDS• Total quality management• (business-) reengineering• Continuous (clinical) improvement• Clinical pathways• Organizational learning• Focused factory• Case management• Care management• Value chain management• Evidence based medicine
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MEANING:• Total quality management• (business-) reengineering• Continuous (clinical) improvement• Clinical pathways• Organizational learning• Focused factory• Case management• Care management• Value chain management• Evidence based medicine
ProcessManagement
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Active submissionWhen a dog tucks his ears back and close to his head, hides his tail between his legs and crouches, he is probably in an active submission stance. This is a dog's message to an aggressor that he is not interested in fighting.
Courtesy "The Truth About Dogs," by Stephen Budiansky
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WALLS
innovation environmentsystem innovation
process innovationfunctional innovation
primary carehospitalrevalidationhomecare
Between primary care and hospitalcare
Betweendisciplines
Betweenservices
Betweenin- and
outpatient care
Discipline,function
Firms, knowledge centers, advocacy organizations
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FEED BACK ON SERVICE LEVEL
action
measurement(deviation from the norm)
input output
homecare
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MULTI-SERVICE FEED BACK
action
measurement
input output
homecare
hospitalcare
homecare
action action
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LEVEL 2Care functions
Regional platforms
LEVEL 4 care systems (policy)
ECHELONS
LEVEL 3Service mgt.
LEVEL 2Care functions
Communities of practice
LEVEL 1Care teams
LEVEL 1Care teams
LEVEL 3Service mgt.
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LEVEL 2Care functions
Regional platforms
LEVEL 4 care systems (policy)
CEILINGS
LEVEL 3Service mgt.
LEVEL 2Care functions
Communities of practice
LEVEL 1Care teams
LEVEL 1Care teams
LEVEL 3Service mgt.
Boardroomceiling
Care unitceiling
Front lineceiling
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MULTI-LEVEL FEED BACK
Or: measuring theimpacts of system-levelchange on health care frontlines &vise versa
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BETTER PRACTICE
• Management of processes: radical change
• Ownership of change
• Multi-level change: connecting system levels
• Integrated feed back systems: across levels, across functions (and services)
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HIGH ROAD
Radical reformof the primaryprocess in healthcare across disciplinesand services bycontinuous change.
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NO DOUBT: MANAGEMENT OF
PROCESSES.