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A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting

Author

Listed:
  • Marie E. Ward

    (Centre for Innovative Human Systems, School of Psychology, Trinity College, The University of Dublin, D02 PN40 Dublin, Ireland)

  • Ailish Daly

    (Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland)

  • Martin McNamara

    (UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, D04 V1W8 Dublin, Ireland)

  • Suzanne Garvey

    (Beacon Hospital, Sandyford, D18 AK68 Dublin, Ireland)

  • Sean Paul Teeling

    (UCD Centre for Interdisciplinary Research, Education & Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, UCD Health Sciences Centre, University College Dublin, D04 V1W8 Dublin, Ireland
    Centre for Person-Centred Practice Research Division of Nursing, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, UK)

Abstract

Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.

Suggested Citation

  • Marie E. Ward & Ailish Daly & Martin McNamara & Suzanne Garvey & Sean Paul Teeling, 2022. "A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting," IJERPH, MDPI, vol. 19(3), pages 1-22, January.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:3:p:1246-:d:731200
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    References listed on IDEAS

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    1. Rachel Flynn & Stephanie P. Brooks & Denise Thomson & Gabrielle L. Zimmermann & David Johnson & Tracy Wasylak, 2021. "An Implementation Science Laboratory as One Approach to Whole System Improvement: A Canadian Healthcare Perspective," IJERPH, MDPI, vol. 18(23), pages 1-14, December.
    2. Ailish Daly & Seán Paul Teeling & Marie Ward & Martin McNamara & Ciara Robinson, 2021. "The Use of Lean Six Sigma for Improving Availability of and Access to Emergency Department Data to Facilitate Patient Flow," IJERPH, MDPI, vol. 18(21), pages 1-15, October.
    3. Nicola Wolfe & Seán Paul Teeling & Marie Ward & Martin McNamara & Liby Koshy, 2021. "Operation Note Transformation: The Application of Lean Six Sigma to Improve the Process of Documenting the Operation Note in a Private Hospital Setting," IJERPH, MDPI, vol. 18(22), pages 1-16, November.
    4. Ailish Daly & Nicola Wolfe & Seán Paul Teeling & Marie Ward & Martin McNamara, 2021. "Redesigning the Process for Scheduling Elective Orthopaedic Surgery: A Combined Lean Six Sigma and Person-Centred Approach," IJERPH, MDPI, vol. 18(22), pages 1-15, November.
    5. Seán Paul Teeling & Jan Dewing & Deborah Baldie, 2021. "A Realist Inquiry to Identify the Contribution of Lean Six Sigma to Person-Centred Care and Cultures," IJERPH, MDPI, vol. 18(19), pages 1-21, October.
    6. D’Andreamatteo, Antonio & Ianni, Luca & Lega, Federico & Sargiacomo, Massimo, 2015. "Lean in healthcare: A comprehensive review," Health Policy, Elsevier, vol. 119(9), pages 1197-1209.
    7. Anne Dempsey & Ciara Robinson & Niamh Moffatt & Therese Hennessy & Annmarie Bradshaw & Sean Paul Teeling & Marie Ward & Martin McNamara, 2021. "Lean Six Sigma Redesign of a Process for Healthcare Mandatory Education in Basic Life Support—A Pilot Study," IJERPH, MDPI, vol. 18(21), pages 1-18, November.
    8. Nick McDonald & Lucy McKenna & Rebecca Vining & Brian Doyle & Junli Liang & Marie E. Ward & Pernilla Ulfvengren & Una Geary & John Guilfoyle & Arwa Shuhaiber & Julio Hernandez & Mary Fogarty & Una Hea, 2021. "Evaluation of an Access-Risk-Knowledge (ARK) Platform for Governance of Risk and Change in Complex Socio-Technical Systems," IJERPH, MDPI, vol. 18(23), pages 1-33, November.
    9. Lisa O’Mahony & Kerrie McCarthy & Josephine O’Donoghue & Seán Paul Teeling & Marie Ward & Martin McNamara, 2021. "Using Lean Six Sigma to Redesign the Supply Chain to the Operating Room Department of a Private Hospital to Reduce Associated Costs and Release Nursing Time to Care," IJERPH, MDPI, vol. 18(21), pages 1-14, October.
    10. Patricia Egan & Anthony Pierce & Audrey Flynn & Sean Paul Teeling & Marie Ward & Martin McNamara, 2021. "Releasing Operating Room Nursing Time to Care through the Reduction of Surgical Case Preparation Time: A Lean Six Sigma Pilot Study," IJERPH, MDPI, vol. 18(22), pages 1-15, November.
    11. Michael Gibbert & Winfried Ruigrok & Barbara Wicki, 2008. "What passes as a rigorous case study?," Strategic Management Journal, Wiley Blackwell, vol. 29(13), pages 1465-1474, December.
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    Cited by:

    1. Elaine Shelford Mead & Seán Paul Teeling & Martin McNamara, 2024. "A Realist Review Protocol into the Contexts and Mechanisms That Enable the Inclusion of Environmental Sustainability Outcomes in the Design of Lean Healthcare Improvement Interventions," IJERPH, MDPI, vol. 21(7), pages 1-16, July.
    2. Ailish Daly & Sean Paul Teeling & Suzanne Garvey & Marie Ward & Martin McNamara, 2022. "Using a Combined Lean and Person-Centred Approach to Support the Resumption of Routine Hospital Activity following the First Wave of COVID-19," IJERPH, MDPI, vol. 19(5), pages 1-20, February.
    3. Sinead Moffatt & Catherine Garry & Hannah McCann & Sean Paul Teeling & Marie Ward & Martin McNamara, 2022. "The Use of Lean Six Sigma Methodology in the Reduction of Patient Length of Stay Following Anterior Cruciate Ligament Reconstruction Surgery," IJERPH, MDPI, vol. 19(3), pages 1-18, January.
    4. Martin McNamara & Marie Ward & Seán Paul Teeling, 2023. "Making a Sustainable Difference to People, Processes and Systems: Whole-Systems Approaches to Process Improvement in Health Systems," IJERPH, MDPI, vol. 20(7), pages 1-5, March.

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