Er QI en selvbegrænsende tilgang til forandring i sundhedsvæsenet?

En ny artikel, der sætter forbedringstankegangen til debat, er både fascinerende og udfordrende. Presset for hurtige forbedringer og stræben mod resultatindikatorer har tendens til at overse emotionelle, adfærdsmæssige og sociale faktorer, foreslår forfatterne.

Af Simon Tulloch, psykolog, Dansk Selskab for Patientsikkerhed

An article by Keith Mandel and Steven Cady on the potential ‘self-limiting’ nature of quality improvement as an approach to change healthcare is both fascinating and challenging. The authors present an argument that performance driven cultures, which overly focus on performance indicators and process-technical design elements over participants emotional experience and socio-behavioural design elements, underpin the self-limiting nature. The authors also suggest that these elements are often compounded by inappropriate leadership styles and organisational pressures for rapid and substantial improvement.

The authors state the aim of writing such an article is to catalyse dialogue on quality improvement as an approach, to reinforce aspects of the human systems during change activity, and to help drive successful, enduring change and improvement. As such, in their conclusion, the authors recast the oft cited quote from Langley et al (2009) as: “All improvement requires change, and all change requires a balanced approach that improves performance and participants’ emotional experience”. Not quite as catchy, but perhaps more appropriate.

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