Transformational change in healthcare: an examination of four case studies
Kate Charlesworth A B , Maggie Jamieson A , Rachel Davey A and Colin D. Butler AA Faculty of Health, University of Canberra, Locked Bag 1, ACT 2601, Australia. Email: Maggie.Jamieson@canberra.edu.au; Rachel.Davey@canberra.edu.au; Colin.Butler@canberra.edu.au
B Corresponding author. Email: u3112211@uni.canberra.edu.au
Australian Health Review 40(2) 163-167 https://doi.org/10.1071/AH15041
Submitted: 24 February 2015 Accepted: 26 May 2015 Published: 20 July 2015
Journal Compilation © AHHA 2016
Abstract
Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences.
Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form.
Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership.
Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare.
What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society.
What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies.
What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.
References
[1] Bevan H, Fairman S. The new era of thinking and practice in change and transformation: a call to action for leaders of health and care. United Kingdom NHS Improving Quality. Leeds: UK Government White Paper; 2014.[2] Sustainable Development Unit. Carbon footprint update for NHS in England 2012. Cambridge, United Kingdom Sustainable Development Unit; 2013.
[3] Hanlon P, Carlisle S, Hannah M, Lyon A. The future public health. Maidenhead, UK: Open University Press 2012.
[4] Hannah M. Humanising healthcare: patterns of hope for a system under strain. Axminster, UK: Triarchy Press; 2014.
[5] Schroeder K, Thompson T, Frith K, Pencheon D. Sustainable Healthcare. Chichester: Wiley-Blackwell, BMJ Books; 2012.
[6] Ratnanesan A, Howarth P. Future solutions in Australian healthcare. White paper: innovative ideas and strategies for sustainable healthcare. Sydney: Energesse; 2014.
[7] Corrigan P, Parish M. Going with change: allowing new models of healthcare to be provided for NHS patients. London: Reform Research Trust; 2014.
[8] Doebbeling BN, Flanagan ME. Emerging perspectives on transforming the healthcare system: redesign strategies and a call for needed research. Med Care 2011; 49 S59–64.
| Emerging perspectives on transforming the healthcare system: redesign strategies and a call for needed research.Crossref | GoogleScholarGoogle Scholar | 22095034PubMed |
[9] Ham C. Reforming the NHS from within: beyond hierarchy, inspection and markets. London: The King’s Fund; 2014.
[10] Van Deusen Lukas C, Holmes SK, Cohen AB, Restuccia J, Cramer IR, Shwartz M, Charns MP. Transformational change in health care systems: an organizational model. Health Care Manage Rev 2007; 32 309–20.
| Transformational change in health care systems: an organizational model.Crossref | GoogleScholarGoogle Scholar |
[11] Graves B. Lower costs and better outcomes: a system of care built on relationships. BMJ 2013; 347 f5301
| Lower costs and better outcomes: a system of care built on relationships.Crossref | GoogleScholarGoogle Scholar | 23996151PubMed |
[12] Yin RK. Enhancing the quality of case studies in health services research. Health Serv Res 1999; 34 1209–24.
| 1:STN:280:DC%2BD3c%2FlslagtQ%3D%3D&md5=8480f1261c24dca77f1983661bbc83afCAS | 10591280PubMed |
[13] Ritchie J. Not everything can be reduced to numbers. In Berglund CA, editor. Health research. Melbourne: Oxford University Press; 2001. pp. 149–73.
[14] Driscoll DL, Hiratsuka V, Johnston JM, Norman S, Reilly KM, Shaw J, Smith J, Szafran QN, Dillard D. Process and outcomes of patient-centered medical care with Alaska Native people at Southcentral Foundation. Ann Fam Med 2013; 11 S41–9.
| Process and outcomes of patient-centered medical care with Alaska Native people at Southcentral Foundation.Crossref | GoogleScholarGoogle Scholar | 23690385PubMed |
[15] United Kingdom NHS Fife and International Futures Forum. Shining a different light: a report on the visit of Southcentral Foundation to NHS Fife. 2010. Available at: http://www.internationalfuturesforum.com/publications [verified 17 June 2015].
[16] Gottlieb K. The Nuka system of care: improving health through ownership and relationships. Int J Circumpolar Health 2013; 72 21118
[17] Eby D. Dr Doug Eby on integrated healthcare design. Online Vimeo. 2013. Available at: https://vimeo.com/58727522 [verified 17 June 2015].
[18] Our People, Our Strength. Southcentral Foundation 30-year report. Anchorage: Southcentral Foundation; 2012.
[19] Gottlieb K, Sylvester I, Eby D. Transforming your practice: what matters most. Fam Pract Manag 2008; 15 32–8.
| 18277759PubMed |
[20] Plummer D, Irwin L. Grassroots activities, national initiatives and HIV prevention: clues to explain Australia’s dramatic early success in controlling the HIV epidemic. Int J STD AIDS 2006; 17 787–93.
| Grassroots activities, national initiatives and HIV prevention: clues to explain Australia’s dramatic early success in controlling the HIV epidemic.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2s%2Fhslejsg%3D%3D&md5=7cd5b8296c4ae525c91c5f82b58abaf1CAS | 17212850PubMed |
[21] Hulse GK. Australia’s public health response to HIV and HCV: a role for ‘affected’ communities. Drug Alcohol Rev 1997; 16 171–6.
| Australia’s public health response to HIV and HCV: a role for ‘affected’ communities.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MrivV2ltg%3D%3D&md5=6894f2d2b17bf251c22c9b89a71be638CAS | 16203423PubMed |
[22] Bowtell W. Australia’s response to HIV/AIDS 1982–2005. Sydney: Lowy Institute for International Policy; 2005.
[23] Blewett N. World AIDS Day memorial service speech. 2013. Available at: https://www.youtube.com/watch?v=REv6oC1jYUE [verified 17 June 2015].
[24] Gilburt H, Peck E, Ashton B, Edwards N, Naylor C. Service transformation: lessons from mental health. London: The King’s Fund; 2014.
[25] Vize C, Humphries S, Brandling J, Mistral W. New ways of working: time to get off the fence. Psychiatr Bull 2008; 32 44–5.
| New ways of working: time to get off the fence.Crossref | GoogleScholarGoogle Scholar |
[26] Fooks C, Decter M. The transformation experience of the Veterans Health Administration and its relevance to Canada. Healthc Pap 2005; 5 60–4.
| The transformation experience of the Veterans Health Administration and its relevance to Canada.Crossref | GoogleScholarGoogle Scholar | 16088312PubMed |
[27] Kizer KW, Dudley RA. Extreme makeover: transformation of the Veterans health care system. Annu Rev Public Health 2009; 30 313–39.
| Extreme makeover: transformation of the Veterans health care system.Crossref | GoogleScholarGoogle Scholar | 19296778PubMed |
[28] Perlin JB. Transformation of the US Veterans Health Administration. Health Econ Policy Law 2006; 1 99–105.
| 18634684PubMed |
[29] Anderson M. Lessons learned from the Veterans Health Administration. Healthc Pap 2005; 5 30–7.
| Lessons learned from the Veterans Health Administration.Crossref | GoogleScholarGoogle Scholar | 16088307PubMed |
[30] Payne D. Culture change matters more than technological change, US healthcare expert tells integrated care summit. BMJ 2012; 344 e3178
| Culture change matters more than technological change, US healthcare expert tells integrated care summit.Crossref | GoogleScholarGoogle Scholar | 22556054PubMed |
[31] Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the Veterans Affairs health care system on the quality of care. N Engl J Med 2003; 348 2218–27.
| Effect of the transformation of the Veterans Affairs health care system on the quality of care.Crossref | GoogleScholarGoogle Scholar | 12773650PubMed |
[32] Kizer KW, Pane GA. The ‘new VA’: delivering health care value through integrated service networks. Ann Emerg Med 1997; 30 804–7.
| The ‘new VA’: delivering health care value through integrated service networks.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FmtFShtw%3D%3D&md5=7bc80543a4743facf85386443e8e4c03CAS | 9398778PubMed |