A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting

Abstract

Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.

The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery

“…The data analyst and project manager provided a fresh outlook on the process and problem, as they did not work in the area, and did not have a bias when approaching the problem. This was congruent with the study site's approach to improvement, and its commitment to making LSS education and training accessible to team members from all disciplines and all levels of seniority [42].…”

Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19

“…The study site had a successful record of incremental and sustainable improvement using both Lean and Six Sigma methodologies supported by person-centred approaches. Improvement work routinely used the LSS define, measure, analyse, improve, control (DMAIC) framework to structure the improvement through process redesign [ 18 , 32 , 33 , 34 , 35 , 37 ]. The organisation had also used the LSS define, measure, analyse, design, validate (DMADV) framework [ 38 ] to co-design new processes.…”

“…Both Lean and person-centred methodologies have been shown to be synergistic approaches for process improvement [ 15 , 16 , 17 ]. The organisation had, in 2016, committed to a whole-system approach to process improvement with a focus on using person-centred, Lean, Six Sigma and Lean Six Sigma (LSS) methodologies [ 18 ].…”

“…Through understanding culture, system function, action triggers and sensemaking, the organisation had embarked on a process to devolve power and influence from the executive level and create a network of improvement specialists at all levels in the organisation [ 18 ].…”

Making a Sustainable Difference to People, Processes and Systems: Whole-Systems Approaches to Process Improvement in Health Systems

“…Each of these papers outlines how the project achieved its process improvement goals, while taking a person-centred and systems perspective. The key lessons from these projects are considered in a case study on whole-system change that is discussed below [ 11 ]. The quality and patient safety improvements reported in the papers include for example: using Lean and person-centred approaches to support the resumption of routine hospital activity following restrictions during the first wave of the COVID-19 pandemic [ 3 ]; a reduction of the length of stay for surgeries, leading to fewer healthcare-associated infections [ 4 ]; giving nursing and healthcare assistants time to care for patients [ 6 ]; an increase in capacity to deliver Basic Life Support across an organisation [ 8 ]; surgical notes transferred to electronic platforms to improve legibility and accessibility [ 9 ].…”