Den 11-13 September träffades de fyra utvalda Vinnvård Improvement Science Fellows, Johan Thor, Andreas Hellström, Karin Pukk Härenstam och Ulrica von Thiele Schwarz, för att påbörja arbetet.
Professor Paul Batalden och professor Bill Lucas leder arbetet tillsammans med Staffan Arvidsson.
Vill du läsa mer om Vinnvård Fellows, klicka HÄR.
Nedan är Paul Bataldens tal från mötet.
"Thank you for taking your time to think together about the future ability to improve the quality, safety and value of health care in Sweden.
About 40-50 years ago, it became clear that manufacturing systems and organizations could improve the production of goods in some dramatic ways when they focused the whole organization on never-ending improvement. This effort required leaders who could identify and keep the focus on improvement. It required the creation of shared knowledge of the processes and systems of production. It flourished when internal organizational cultures of testing and redesign invited the curiosity and creativity of the workforce. People learned to use measurement for learning. Many sectors of our lives changed as a result of these insights and their application.
Some of us in health care became curious about these ways of work and began to wonder if there were lessons that might be learned that could be used in health and human services provision. We knew we had an enormous capacity for the development of new scientific knowledge about the biologic basis of disease, but we also knew we had real challenges in applying those insights in equitable and reliable ways for whole populations of people.
Our methods for developing biologic knowledge about disease were not adequate for the social task of changing practices, habits and relationships. Our organizations of professionals-at-work were very different than manufacturing settings. We had a long tradition of preparing doctors and nurses as professional soloists. Our abilities to intervene in the natural course of disease had become much more powerful and our work had become less safe for both patients and workers.
As we began to try some of the manufacturing lessons, namely to understand health care as process and system, we learned a lot. We realized professionals were not “soloists-in-fact” as they worked interdependently with one another to solve a particular patient’s problem. We began to measure this cooperative work performance over time and learned about the unwanted variation that seemed to be everywhere. As we thought about our work as a system, we began to look very differently at patients and their families. We now could see that those who benefitted from the services—patients, families and communities—actually worked together with professionals to “co-produce” health and health care.
We realize today that we must become 1)better at moving scientific evidence into practice, 2)better at prototyping new designs of care-giving, 3)better at using information / telecommunication technology, 4)better at creating cultures of work that truly facilitate the co-production of care and health, and 5)better at creating reliable and resilient systems of safe practice.
As we tried to change these systems, we began to know much more about them. We soon realized that we needed multiple disciplines, multiple ways of knowing to address the challenges of achieving real change. In addition to biologists and chemists, it became clear that Medicine and Nursing could benefit from the insights of Sociologists, Psychologists, Political Scientists, Economists, Statisticians, Organizational Behaviorists, Engineers, Design Scientists, Communication and Evaluation specialists and on and on.
These realizations led us to begin to formally explore the different ways of developing and using knowledge from these diverse disciplines. We had to learn to listen across disciplines. We had to learn to build bridges that would cross these gaps. It was more than “knowing differently”...it was “knowing differently and taking action differently” that was needed. The Vinnvård “Bridging the Gaps” program is a nice example of an early recognition of the benefits needed.
We began to realize that this work of working across knowledge-system disciplines and the work of putting diverse coalitions together to design and redesign care might benefit from some leaders who could energize and catalyze this type of work. We realized that this could not be done just as a “service delivery” project, because at the end of the day, we needed professionals who could work in these new ways and so we needed to address the pedagogical implications of all this if we were to include the initial and life-long development and formation of the health professionals we depend upon. Further, we realized that all of these actions would require public policies that offered support and encouragement as well as meaningful accountability.
This led the Health Foundation in the UK to create a fellowship program to advance the systematic efforts at developing the new science, art, pedagogies and practices necessary to improve the quality, safety and value of health care in ways that go beyond our current efforts. The idea was to nurture a few of the people that were needed to help lead this cross-discipline, cross-knowledge system work. Soon the Health Foundation will seek the third cohort of these UK Improvement Science Fellows. Bill Lucas and I have the privilege of leading this program for the Health Foundation.
These efforts in the UK were noticed by the leadership of Vinnvård. At their request, Professor Martin Marshall of the Health Foundation and I came to discuss what this deep fellowship program was all about. After further consideration the leadership of Vinnvård came to the conclusion that they should explore such a program for Sweden. The Health Foundation in the UK offered to make its lessons and designs transparent and freely available to Vinnvård in an effort to shorten the time and minimize the costs of starting. We are here this week to formally launch this program, having found four exceptionally well-qualified persons to occupy this first cohort of Swedish Improvement Fellows.
More could be said, but I think it best to have more words in the form of conversation and in response to the questions you have. We’ll work in Swedish and English. Bill and I work best in English, but many can help us understand what you say, if Swedish works better for you.