Books in the Elements of Improving Quality series

"Healthcare policy frequently invokes notions of cultural change as a means of achieving improvement and good-quality care. This Element unpacks what is meant by organisational culture and explores the evidence for linking culture to healthcare quality and performance. It considers the origins of interest in managing culture within healthcare, conceptual frameworks for understanding culture change, and approaches and tools for measuring the impact of culture on quality and performance. It considers potential facilitators of successful culture change and looks forward towards an emerging research agenda. As the evidence base to support culture change is rather thin, a more realistic assessment of the task of cultural transformation in healthcare is warranted. Simplistic attempts to manage or engineer culture change from above are unlikely to bear fruit; rather, efforts should be sensitive to the complexity and highly stratified nature of culture in an organisation as vast and diffuse as the NHS"--

"Positive deviance is an asset-based improvement approach. At its core is the belief that solutions to problems already exist within communities, and that identifying, understanding, and sharing these solutions enables improvements at scale. Originating in the field of international public health in the 1960s, positive deviance is now, with some adaptations, seeing growing application in healthcare. We present examples of how positive deviance has been used to support healthcare improvement. We draw on an emerging view of safety, known as Safety II, to explain why positive deviance has drawn the interest of researchers and improvers alike. In doing so, we identify a set of fundamental values associated with the positive deviance approach and consider how far they align with current use. Throughout, we consider the untapped potential of the approach, reflect on its limitations, and offer insights into the possible challenges of using it in practice"--

"Operational research is a collection of modelling techniques used to structure, analyse, and solve problems related to the design and operation of complex human systems. While many argue that operational research should play a key role in improving healthcare services, staff may be largely unaware of its potential applications. We explore operational research's wartime origins and introduce several approaches that operational researchers use to help healthcare organisations: address well-defined decision problems; account for multiple stakeholder perspectives; and describe how system performance may be impacted by changing the configuration or operation of services. We draw on examples that illustrate the valuable perspective that operational research brings to improvement initiatives and the challenges of implementing and scaling operational research solutions. We discuss how operational researchers are working to surmount these problems and suggest further research to help 6 operational researchers have greater beneficial impact in healthcare improvement"--