The last month has been pretty busy for me as the ISQua conference took place in Cape Town. This affords me the opportunity to reflect on the key lessons that came out of the conference that may apply to the Irish Healthcare system. There is more than enough for more than one article so I probably will use the concepts over a few, writes Dr. Pater Lachman.
Throughout the programme, we had a theme of Coproduction. This was highlighted by the leading thinker in the field, Dr Paul Batalden. Paul is well known for the introduction of microsystem theory while he led the way in Dartmouth and many of us use this theory as we come to recognise the importance of systems theory – pure extrapolation from Deming. In Ireland, we teach Microsystem theory and I think it is the foundation of the improvement work we undertake.
Every Hospital Manager needs to understand how systems work and interact. An understanding of Microsystem theory can help in achieving better results as we navigate the complex adaptive system that is healthcare. There are examples from Dartmouth http://clinicalmicrosystem.org/ and the successful transference of the theory to Sheffield where there have been great results in the application of the theory. https://www.sheffieldmca.org.uk/
However, Batalden has progressed to the next level of understanding what it takes to improve healthcare. He is now the key advocate of Coproduction of Health This is a new way of looking at healthcare from the eyes of the user and really acknowledging that we do not have the answers to solving the challenges we have. It is about thinking differently and undergoing a true transformation rather than making token improvements.
THE BAR IS NOW SET FOR THE NEXT QUALITY JOURNEY- FROM IMPROVING WHAT IS NOT WORKING TO CODESIGNING WHAT WILL WORK.
In this paper and at the conference he makes the point that unless we really share our decision making at the system level and clinical level with people whom we call patients, we will not achieve the outcomes we want to achieve. “Clinicians need to learn in ways that encompass all of the forms of knowledge …. including eliciting a patient’s immediate and long term aims. On an individual level, this can be described as shared decision making. On a system level, this way of thinking and practising may enable us to transform healthcare to improve health for our patients and populations”
- and https://qualitysafety.bmj.com/content/qhc/25/7/509.full.pdf
People are the missing ingredients in all our planning. We consult focus groups, patient groups and the wider population. But is this real consultation and does it lead to the co-production of Health and the delivery of Healthcare. Every member of the HMI needs to ask this question when they plan healthcare provision – who has is the real expert and have we taken their view into account? An examination of what it takes to coproduce means that we share power and design appropriate healthcare.
The real challenge is to meet the need for coordinated integrated care that is infused with dignity and compassion. The bar is now set for the next quality journey- from improving what is not working to codesigning what will work.