The Integration of Improvement Knowledge with Professional Knowledge

Improvement and change of healthcare organisations and systems Since the late 1980s and early 90s there has been an increased interest in quality and quality improvement in healthcare. The concepts of quality have become commonplace in health services and organisations to different degrees and are built into the structure of various provider units. For example the United Kingdom has made quality improvement an integral part of the healthcare system. The website of the Department of Health in the UK http://www.doh.gov.uk/ gives examples of initiatives taken in this country. Berwick’s leading article on improvement of systems outlined a number of principles on improvement and change derived from what the author authoritatively called ‘the central law of improvement’. He stressed on the ‘indissoluble bond between improvement and change’ and explained that ‘not all change is improvement, but all improvement is change’. Every system is perfectly designed to achieve the results it achieves and reframes performance from a matter of effort to a matter of design. Better or worse performance cannot be obtained from a system of work (any set of activities with a common aim) merely on demand. The results of health care are themselves properties of the system of care in analogy to the length of an athlete’s maximum long jump being inherent in the nature of his body. Although mere effort can achieve some improvement, this improvement is not fundamental and does not often represent a new level of capability. While different players in the health care system want to bring about change, the results everyone wants to change (performance) are properties inherent in the system and new results can only be expected through the creation of new systems. The author emphasised on change of a system, not change within a system. Stressing the current Towards a Framework for the Continual Improvement of Healthcare