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MAPPING INNOVATION IN HEALTH CARE
Friso den Hertog
MERIT/University Maastricht
Publin policy workshop
2 December 2005 Brussels
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
MappingWild & UnknownTerritoryEU network projects:Publin, Innoflex, Saltsa.Action research,Literature survey,In-depth interviews,Act as a soundingboard.
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.
5 minute INTRODUCTION IN SYSTEM THEORY
A SYSTEM IS:
• Set of elements
• Interrelations
• Function (=process)
• Feed back
LEARNING = FEED BACK
actie
measurement(deviation from the norm)
input otput
Blackbox
UNCLOSED CYCLE
action
measurement(deviation from the norm)
input output
Blackbox
??
OPENING THE BLACK BOX
The black box
input output
EFFECT HERE/ CAUSE OVERTHERE
Black box
input output
CAUSE
effect
WALLS & CEILINGS
Black box
input output
CAUSE
effect
HEALTH CARE AS A PROCESS
Discipline,function
innovation environmentsystem innovation
process innovationfunctional innovation
Firms, knowledge centers, advocacy organizations
1e carehospitalrevalidationhomecare
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
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
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
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
FEED BACK ON SERVICE LEVEL
action
measurement(deviation from the norm)
input output
homecare
MULTI-SERVICE FEED BACK
action
measurement
input output
homecare
hospitalcare
homecare
action action
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.
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
MULTI-LEVEL FEED BACK
Or: measuring theimpacts of system-levelchange on health care frontlines &vise versa
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)
HIGH ROAD
Radical reformof the primaryprocess in healthcare across disciplinesand services bycontinuous change.
NO DOUBT: MANAGEMENT OF
PROCESSES.
