PubMed Health⌕ Search

Biomedical subjects

Paul Walley

Publications and source records attributed to Paul Walley.

5 recordsLinked to original sources
PubMed2006

Health-care process improvement decisions: a systems perspective.

PURPOSE: The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes. DESIGN/METHODOLOGY/APPROACH: A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted. FINDINGS: The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations. PRACTICAL IMPLICATIONS: Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline. ORIGINALITY/VALUE: Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.

Decision Making, Organizational↗
PubMed2006

Knowledge and behaviour for a sustainable improvement culture.

Wait limits have improved UK healthcare access, and Ontario's Wait Time Strategy bears a remarkable resemblance. There appears to be an implicit assumption that capacity and efficiency factors are the main causes of waits. The improvement mechanism is driven by performance measurement that reports wait time outcomes. Our experience makes us conclude that Ontario's plans contain risks. Superficially, the UK approach has been successful with dramatic wait time reductions but has incurred tremendous financial cost and patients not always benefiting. Reasons for partial success are not understanding the cause of waiting, with inappropriate"improvements"; and often encouraging unintended behaviours, with poor stakeholder management. Those sustaining their approach have significantly better performance and timely service without excess cost, but their approach has not seen a wide enough audience for acceptance and adoption. At the top, there is almost bewilderment about why others struggle with wait time targets. For an effective program it is essential to understand the system and have consistency between the measurement system and engendered behaviour, the root causes of waits and solutions, the management style and improvement culture, the reward system and good clinical practice.

Government↗
PubMed2004

Completing the circle: from PD to PDSA.

Problem-solving teams, involving front-line staff, are widely used to achieve continuous process improvement. Approaches such as "plan-do-study-act" (PDSA) cycles, are now a core element of many health-care improvement initiatives. This paper evaluates the use of PDSA improvement cycles within the UK National Health Service, using emergency care improvement activity as a source of research evidence. It was found that, despite an abundance of information on how to implement this type of change, many senior professionals still misinterpret how this should work. This has implications for how such methodologies are implemented. There is a long way to go in allowing greater employee involvement, moving much further away from the "management committee" style of change. Care has to be taken to ensure that empowered employees are working to consistent and appropriate objectives. It is important that senior personnel develop process understanding alongside the workforce, rather than simply providing distant support.

Emergency Service, Hospital↗
PubMedDate not supplied

Managing variation in demand: lessons from the UK National Health Service.

Managers within the U.S. healthcare system are becoming more aware of the impact of variation in demand on healthcare processes. The UK National Health Service provides a prime example of a system that has experienced the consequences when the issue is not dealt with satisfactorily, having suffered from excessive queues for a prolonged period. These delays are mostly caused by a lack of attention to variation and inappropriate responses to the queues, rather than a capacity shortage. A number of collaborative programs recently have come to grips with many of the causes of the queues in both elective care and emergency care. Although there are still areas that need large-scale improvement, good progress has been made, especially within emergency care. The authors of this article have acted as technical advisors to a number of these improvement programs and have been able to document many of the practices that have helped to reduce or eliminate unnecessary queues and delays across the 200 sites in England that have 24-hour emergency care facilities. Local program managers at these sites continuously reported progress for a period of 18 months. A number of important lessons for both the design and control of healthcare processes have emerged from the collaborative work. These lessons focus on understanding and measurement of demand, capacity planning, reduction of introduced variation, segmentation and streaming of work, process design, capacity yield management, and measurement of variation.

Cooperative Behavior↗