Collaboration for Leadership in Applied Health Research and Care East of England (CLAHRC EoE)

DEPARTMENTS OF PSYCHIATRY& ENGINEERING, DIVS F & C

Organisational Management Theory and the UK Patient Safety MovementNot enough time for change

Dr Jennifer Spencer Dual CCT MRCPsych, MB, BAO, BCh, BMedSci, BA; Dr Terry Dickerson, PhD; Ms. Amanda Goodger, PhD student; and CLAHRC East of England

BackgroundMost industries spend a lot of time and resources thinking about things before making changes. Time to market (TTM) is the length of time it takes from a product being conceived until its being available for sale. The average time to market for a prototype medical product, such as a medical device or a drug, is 5-16 years. A tacit assumption is that TTM and product quality are opposing attributes. Skipping steps of the development process compromises product quality.

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Figure 23: The Finalised MM Spreadsheet Model Navigation Interface

“Managers are not confronted with problems that are independent of each other, but with dynamic situations that consist of complex systems of changing problems that interact with each other… Managers do not solve problems, they manage messes.”

-- Russell Ackoff, Journal of Operational Research Society, 1979

The Sociotechnical system

A set of processes that embrace the actions of a number of individuals interacting with relevant technologies

Frontline staff were aware of interconnected nodes wherecommunication occurred between different teams. Theywere aware of safety concerns that were occurring andbeing addressed within the confines of the frontline staffcommunication network.

Managerial versus Frontline staff perceptions

What we learnedManagerial versus Frontline Staff Perceptions

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University of Cambridge

Department of Engineering

Engineering Design Centre

MPhil in Engineering Report

A SYSTEMS BASED APPROACH TO TRANSLATE

FROM ‘NEED’ TO STARTING POINT

31st July 2015

Amanda C Goodger

Supervisors: P John Clarkson, Nicholas H M Caldwell,

Industrial Supervisor: Adrian Davis

https ://commons.wikimedia.org

RTI Heal th Solutions: Market Access Planning Across the Product L ifecyc lewww.rtihs .org/s ervices/market-access -and-outcomes-strategy/market-access-heor-and-pric ing-strategies

Primary References

The Kano Model - Performance needs incrementally improve customer satisfaction. Basic needs must be met to prevent dissatisfaction, but can at best create indifference when met. Delighters are the result of innovation and are the most powerful driver of customer satisfaction. Over time, delighters become performance needs and eventually basic needs. Therefore, the innovation process can never stop.

What we agreed to do

The concerns managers came up with were compared with service staff concerns to see what the similarities and differences were.

Projec t Setup• Pro jec t Protocol• QA Tool Des ign

• CPFT Permiss ions• Peer Rev iews

• Eth ic a l Review

Routine Quali ty IndicatorsSet up | Collect ion and

M onit or ing à

QA In

terv

entio

n Ev

alua

tion

•Obj

ectiv

e 2

PHA

Eval

.•

Objec

tive

1

Pro jec t Reporting

• For m al • O bject ives 1,

2 and 3

PHA Arm• Consist s of a m anagem ent

wor kshops• Takes place ear ly in t his per iod

QA Arm -In terv ention• Cam br idgeshir e

Nor t h• Q A I nt er vent ion• O ut - of - Hour s

Ser vice• CRHT Ser vice

QA Arm - Control• Cam br idgeshir e

Sout h• No I nt er vent ion• O ut - of - Hour s

Ser vice• CRHT Ser vice

= M aPSaF

Tim ings ar e

indicat ive

Blinding ( as f ar as

pr act icable)

Blinding ( as f ar as

pr act icable)

2011 2012 2013O ct Nov Dec Jan Feb M ar Apr M ay – O ct Nov Dec Jan Feb M ar Apr M ay Jun July Aug

False Start• I nit ial

at t em pt t o r un t he

int er vent ion in Cam s Sout h

• Changed t o Cam s Nor t h

f or t he I nt er vent ion

• Revisit pr oject set up

act ivit ies

Methodology How do you identify what is missing from a Sociotechnical system?(Sometimes Systems Engineering really is Rocket Science)

A Patient-centred care cycle

Discussion• Are we making changes to the healthcare system too quickly Is

not enough time being spent on the design processes • Is the current healthcare reform process damaging to our

desired outcomes? • If we ensured healthcare change was appropriately paced,

would outcomes improve?

The Hourglass model

Defining the need that exists during a time of change