CHALMERS

Bo Bergman SKF Professor

IMPROVEMENT SCIENCE –

REVOLUTIONIZING HEALTHCARE?

Bo Bergman

SKF Professor Quality Sciences

Divison of Quality Sciences

Centre for Healthcare Improvement (ESQH/EHFF)

Department of Technology Management and Economics

Chalmers University of Technology

SE-412 96 Gothenburg, Sweden

Phone: +46 31 772 8180

E-mail: bo.bergman@chalmers.se

Guest professor, Meiji University, Tokyo

1 Ouality Sciences

CHALMERS

Bo Bergman SKF Professor

The Well Known Challenges

• Aging Population – multi-sick elders

• Patient Safety

• Accessibility

• Increased possibilities

• Increased Demands

• Changed power relations

• Healthcare Financial System

• ...

2

CHALMERS

Bo Bergman SKF Professor

The Positive Trends ...? • The changing role of the patient as an active

resource and co-producer as well as co-creator in the health care processes,

• An earlier unseen openness in healthcare about results, good results as well as improvement possibilities,

• Integrative approaches to bridge gaps between specialist islands including an emphasis on the value creating processes,

• An increasing emphasis on cross disciplinary teams, • An emphasis on leader­ship and co-leadership

(medarbetarskap in Swedish), • etc. 3

CHALMERS

Bo Bergman SKF Professor

The Positive Trends ... A Swedish Perspective

• The changing role of the patient as an active resource and co-producer as well as co-creator in the health care processes,

• An earlier unseen openness in healthcare about results, good results as well as improvement possibilities,

• Integrative approaches to bridge gaps between specialist islands including an emphasis on the value creating processes,

• An increasing emphasis on cross disciplinary teams, • An emphasis on leader­ship and co-leadership

(medarbetarskap in Swedish), • etc. 4

CHALMERS

Bo Bergman SKF Professor

The customer

Decisive competence

Market Industrialism

Production

Source Customer basis

Relations

Co-creator Co-producer

Reconfigure the value creating system

Organizing Value creation

From Richard Normann (2002)

First, a general trend on how we change how we look upon our customers

CHALMERS

Bo Bergman SKF Professor

Co-production and Co-creation

• Rheumatic patients

• Diabetes Patients

• Neo-natal care (parents)

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CHALMERS

Bo Bergman SKF Professor

The Positive Trends ...? • The changing role of the patient as an active

resource and co-producer as well as co-creator in the health care processes,

• An earlier unseen openness in healthcare about results, good results as well as improvement possibilities,

• Integrative approaches to bridge gaps between specialist islands including an emphasis on the value creating processes,

• An increasing emphasis on cross disciplinary teams, • An emphasis on leader­ship and co-leadership

(medarbetarskap in Swedish), • etc. 7

CHALMERS

Bo Bergman SKF Professor

Openness

• Quality Registers

• Open Comparisons

8

CHALMERS

Bo Bergman SKF Professor

The Positive Trends ...? • The changing role of the patient as an active

resource and co-producer as well as co-creator in the health care processes,

• An earlier unseen openness in healthcare about results, good results as well as improvement possibilities,

• Integrative approaches to bridge gaps between specialist islands including an emphasis on the value creating processes,

• An increasing emphasis on cross disciplinary teams, • An emphasis on leader­ship and co-leadership

(medarbetarskap in Swedish), • etc. 9

CHALMERS

Bo Bergman SKF Professor

Specialisation Integration

• A General observation:

– Specialisation increases productivity and Quality

– But only to a certain limit

– Then integration of specialist work become increasingly important for the increase in Productivity and Quality

• In healthcare

– the specialist functions are wonderful – very advanced

– How about integration?

10

CHALMERS

Bo Bergman SKF Professor

Illustrations

• Pulmonary medicine clinic, Linköping

• Most sick elders in Västra Skaraborg (Västra Götaland Region, VGR)

• Cancer processes in VGR (8 Hospital Groups)

– Process owners (25 different diagnoses, 30 process owners)

– Improvement teams

11

CHALMERS

Bo Bergman SKF Professor

The Positive Trends ...? • The changing role of the patient as an active

resource and co-producer as well as co-creator in the health care processes,

• An earlier unseen openness in healthcare about results, good results as well as improvement possibilities,

• Integrative approaches to bridge gaps between specialist islands including an emphasis on the value creating processes,

• An increasing emphasis on cross disciplinary teams, • An emphasis on leader­ship and co-leadership

(medarbetarskap in Swedish), • etc. 12

CHALMERS

Bo Bergman SKF Professor

HU at Linköping University

• Entrance tests

• Some common courses (medicine and nursing)

• Team focus

Also, for example, the National platform for Improvement

Knowledge

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CHALMERS

Bo Bergman SKF Professor

The Positive Trends ...? • The changing role of the patient as an active

resource and co-producer as well as co-creator in the health care processes,

• An earlier unseen openness in healthcare about results, good results as well as improvement possibilities,

• Integrative approaches to bridge gaps between specialist islands including an emphasis on the value creating processes,

• An increasing emphasis on cross disciplinary teams, • An emphasis on leader­ship and co-leadership

(medarbetarskap in Swedish), • etc. 14

CHALMERS

Bo Bergman SKF Professor

Doctors in their Specialist Training (ST)

• Improvement projects compulsory for all ST students

• Sahlgrenska University Hospital

– ST in leadership

– Five week course in Improvement Science including an improvement project in their respective organisation.

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CHALMERS

Bo Bergman SKF Professor

The Positive Trends ...

• The changing role of the patient as an active resource and co-producer as well as co-creator in the health care processes,

• An earlier unseen openness in healthcare about results, good results as well as improvement possibilities,

• Integrative approaches to bridge gaps between specialist islands including an emphasis on the value creating processes,

• An increasing emphasis on cross disciplinary teams, • An emphasis on leader­ship and co-leadership

(medarbetarskap in Swedish), • etc. 16

CHALMERS

Bo Bergman SKF Professor

Theoretical underpinning:

Improvement Science (Deming’s Profound Knowledge)

• System understanding

• Understanding variation

• Psychology

• Knowledge Theory

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CHALMERS

Bo Bergman SKF Professor

Improvement Science . Its further development .

• System understanding – Cybernetic Systems Complexity and responsive adaptive

processes (Stacey, 2004, Latour (2005)...

• Variation – Not only reduction and handling – Evolutionary processes, Creativity, ...

• Psychology – Motivation, Self Determination Theory, Positive Psychology,

social psychology – Sociology (on the borderline between System understanding

and Psychology)

• Knowledge Theory – Deepened understanding of knowledge creation and spread – Epistemology

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CHALMERS

Bo Bergman SKF Professor

Swedish National Platform for Improvement

Science

• Professional Societies in healthcare has joined to find a common (Swedish) version of Improvement science to be taught in professional healthcare educations – medicine, nursing, physiotherapists, work therapists, nutritionists, ...

• Already today: Improvement projects compulsory for doctors in specialist training

• Suggestion from medical society: Improvement science to be taught for all medical students – improvement projects compulsory

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CHALMERS

Bo Bergman SKF Professor 20

Even better

care

Even better professional education

Even better

system

All

Adapted from Batalden & Davidoff (2007)

National platform for

Improvement Science

CHALMERS

Bo Bergman SKF Professor

Positive trends – Improvement Science

Which is first: The Hen or the Egg?

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CHALMERS

Bo Bergman SKF Professor

A Reversed Knowledge Flow?

• How about Industry? – A lot of improvement initiatives!

– A lot of lessons learned!

• However: – what about Improvement Science (or Deming’s

Profound Knowledge)?

– and utilisation its utilisation?

• In the future – perhaps industry should go to healthcare to learn more?

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CHALMERS

Bo Bergman SKF Professor 23

THE ROAD TO WISDOM? Well, it's plain and simple to express. Err and err and err again, but less and less and less. Piet Hein

CHALMERS

Bo Bergman SKF Professor 24