The purpose of this research is to critically evaluate the quality improvement (QI) phenomenon in healthcare providing organisations (clinics, hospitals, etc.) and propose an agenda for system-wide continuous improvement for their care delivery processes, using New Zealand’s healthcare sector as a case study.
A systematic literature review (SLR) highlighted multiple gaps regarding quality improvement methodologies and the scope of their implementation in healthcare providing organisations across the world. Based on the SLR, a quality improvement maturity model was developed and used to analyse the use of QI methodologies and their scope of implementation within the District Health Boards (DHBs) operating in the New Zealand.
In-depth interviews with quality improvement managers from 15 DHBs were conducted. In addition to the interviews, internal documents and operational data detailing the quality improvement activities and initiatives undertaken by DHBs were analysed using qualitative methods. This provided basis for a sector-wide analysis of QI implementation in New Zealand DHBs.
While healthcare providing organisations strongly portray inclination towards different quality improvement methodologies, their overall understanding and use of quality tools is very similar to each other. This inclination towards different QI methodologies is primarily based on the personal preferences of quality improvement managers, who are assigned with leading, supporting and managing quality improvement activities. Similarly, the majority of the proposed benefits and criticisms of different methodologies are based on their origin from outside of the healthcare sector. Second, the quality improvement managers and their teams are rarely given the appropriate authority and resources to fully offer change, i.e., manpower, power, influence and commitment from staff and senior leadership towards quality improvement. Finally, the scope of quality improvement in healthcare tends to be narrow and siloed—within singular value-streams or wards—and the concept and benefit of linking internal and external supply chains with quality improvement activities is missing in the care delivery processes.
This research is located within the New Zealand healthcare system. While, the healthcare delivery processes are largely similar to Australia and the UK, there can still be many inbuilt cultural and policy-related features that may limit the research findings to the New Zealand’s healthcare context.
This research findings highlight a need to move forward from obtuse discussions about seeking the best quality improvement methods in healthcare sector. Selection of a specific QI methodology does not guarantee success or failure of QI initiatives. Instead, healthcare providing organisations need to realise the true meaning of QI, its principles, and implement them in their wider supply networks, to remove operational waste and increase value for the end-users – the patients, each and every one of us.
QI phenomenon in the healthcare sector is less mature compared to the manufacturing industries. Partly because, the institutional logics of healthcare environment are not aligned with the institutional logics associated with quality improvement. This mismatch arises from multiple factors, ranging from simple misunderstandings regarding quality improvement methods to the use of inappropriate jargon and complications in conducting QI work, which has created resistance in the healthcare workforce. However, pressure from government and public, healthcare organisations and their employees perform quality improvement initiatives that are narrow in scope and the implementation of quality tools and techniques. This narrow focus was observed not only in singular interviews, but also in the maturity analysis of participating District Health Boards.||