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: [email protected]
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)
6
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
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