The health care sector shows a disjunction between the well-understood necessity for change and the capacity to realize it. Conventional management strategies and traditional means of influencing professionals often fail to deliver projected outcomes. We address this issue from a different angle. An organization's capacity for change is determined by the combination of power distribution, value system and change readiness, which should be analyzed not as formal qualities but as aspects of the organization as a social system, disclosing a reality beneath the surface of mission statements, quality policy and management models. We describe a method to analyse the identity of an organization as a social system with respect to its innovation potential. This identity shows in the rules of discourse determining what is valid communication and which are the sources of impact of arguments in a communicative interaction leading to decisions. We present two case studies in which groups of physicians argue in favor of respectively against the availability of physician-assisted death (PAD) for terminal patients.

Within health care projects for change and innovation, professionals should ambitiously cooperate in order to yield a creative multidisciplinary mindset for guaranteed innovative output. Failure of innovation projects is amongst others due to deterioration and insufficient focus on relational aspects. Aim; an innovative management tool for facilitating process innovation is launched. Methods; Systemic innovation (SI) is a social network management model, subsidiary to actual management models for quality improvement and innovation. The SI management model yields essential tools for stimulation of communication in multidisciplinary teams in order to shape alternative mindsets. Results; The key domains of SI representing socio-dynamics, value of arguments and flexibility for change concern topics for assessment of behavior with regard to psychosocial and organizational characteristics. The key domains yield a format enabling a critical appraisal concerning improvement of socio-technologic aspects in case of process innovation. Conclusion; SI yields a format for stimulation of social awareness with regard to self-assessment, interoperability and mindset generation in multidisciplinary teams of professionals.

Within health care projects for change and innovation, professionals should ambitiously cooperate in order to yield a creative multidisciplinary mindset for guaranteed innovative output. Failure of innovation projects is amongst others due to deterioration and insufficient focus on relational aspects. Aim; an innovative management tool for facilitating process innovation is launched. Methods; Systemic innovation (SI) is a social network management model, subsidiary to actual management models for quality improvement and innovation. The SI management model yields essential tools for stimulation of communication in multidisciplinary teams in order to shape alternative mindsets. Results; The key domains of SI representing socio-dynamics, value of arguments and flexibility for change concern topics for assessment of behavior with regard to psychosocial and organizational characteristics. The key domains yield a format enabling a critical appraisal concerning improvement of socio-technologic aspects in case of process innovation. Conclusion; SI yields a format for stimulation of social awareness with regard to self-assessment, interoperability and mindset generation in multidisciplinary teams of professionals.

In the third era of quality assurance in health care, innovation is no longer the exclusive focus area of the individual medical professional dedicated to optimizing patient care nor is it achieved by design thinking by the health delivery organization aiming for economic sustainability. Change platform in the third era is the community of professionals, committed to providing the best possible care within the limits of organizational logic. We aim to clarify the conditions for sustainable quality improvement in health delivery organizations and in doing so to provide a means of improving initial feasibility assessment by identifying critical factors in the cooperation between different parties. We designed a model representing the sources of influence on the process of decision making regarding the selection of innovations and choosing the most effective implementation strategy. These sources are: aspects of legitimacy, core values and change readiness. We tested this model on a project, aimed at improving the efficiency of the OR in a Dutch University Clinic. The example project failed to deliver the projected outcome because of non-disclosed conflicting interpretations of core values and an implicit controversial status shift between medical professionals and OR management. This confirms the explaining power of our model. Successful implementation of quality innovation in health care depends (among other things) on addressing the challenges of differing concepts of legitimacy, conflicting core values and varying change readiness between social systems in complex organizations. Installing a QIC as such does not meet these challenges.