MAPPING INNOVATION IN HEALTH CARE

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MAPPING INNOVATION IN HEALTH CARE

• Friso den Hertog
• MERIT/University Maastricht
• Publin policy workshop
• 2 December 2005 Brussels

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AGENDA

• Paradox of health care
• Patient centered perspective
• Diffusion implementation core problems
• New map for identifying walls ceilings
• Systems perspective
• Radical change high low road
• Exploration

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Mapping Wild Unknown Territory EU network
projects Publin, Innoflex, Saltsa. Action
research, Literature survey, In-depth
interviews, Act as a sounding board.
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PARADOX OF HEALTH CARE

• Despite the impressive progress in the
  development of technological and professional
  competencies, commitment and involvement of the
  professionals
• Madness in the system administrative and
  managerial powerlessness.

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5 minute INTRODUCTION IN SYSTEM THEORY

• A SYSTEM IS
• Set of elements
• Interrelations
• Function (process)
• Feed back

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LEARNING FEED BACK
measurement (deviation from the norm)
actie
Black box
input
otput
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UNCLOSED CYCLE
measurement (deviation from the norm)
action
?
Black box
input
output
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OPENING THE BLACK BOX
The black box
input
output
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EFFECT HERE/ CAUSE OVERTHERE
CAUSE
effect
Black box
output
input
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WALLS CEILINGS
CAUSE
effect
Black box
input
output
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HEALTH CARE AS A PROCESS

innovation environment system innovation process
innovation
Firms, knowledge centers, advocacy organizations
Discipline, function
functional innovation
1e care?hospital?revalidation?homecare
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NEW WORDS

• Total quality management
• (business-) reengineering
• Continuous (clinical) improvement
• Clinical pathways
• Organizational learning
• Focused factory
• Case management
• Care management
• Value chain management
• Evidence based medicine

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MEANING

• Total quality management
• (business-) reengineering
• Continuous (clinical) improvement
• Clinical pathways
• Organizational learning
• Focused factory
• Case management
• Care management
• Value chain management
• Evidence based medicine

Process Management
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WALLS
Between disciplines
Between services
Between primary care and hospital care
Between in- and outpatient care

innovation environment system innovation process
innovation
Firms, knowledge centers, advocacy organizations
Discipline, function
functional innovation
primary care?hospital?revalidation?homecare
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FEED BACK ON SERVICE LEVEL
measurement (deviation from the norm)
action
home care
input
output
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MULTI-SERVICE FEED BACK
measurement
action
action
action
home care
hospital care
home care
input
output
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ECHELONS
LEVEL 4 care systems (policy)
LEVEL 3 Service mgt.
LEVEL 3 Service mgt.
Regional

platforms
LEVEL 2 Care functions
LEVEL 2 Care functions
Communities of practice
LEVEL 1 Care teams
LEVEL 1 Care teams


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CEILINGS
Boardroom ceiling
LEVEL 4 care systems (policy)
LEVEL 3 Service mgt.
LEVEL 3 Service mgt.
Regional

platforms
Care unit ceiling
LEVEL 2 Care functions
LEVEL 2 Care functions
Communities of practice
LEVEL 1 Care teams
LEVEL 1 Care teams


Front line ceiling
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MULTI-LEVEL FEED BACK
Or measuring the impacts of system-level change
on health care frontlines vise versa
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BETTER PRACTICE

• Management of processes radical change
• Ownership of change
• Multi-level change connecting system levels
• Integrated feed back systems across levels,
  across functions (and services)

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HIGH ROAD
Radical reform of the primary process in
health care across disciplines and services
by continuous change.
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NO DOUBT MANAGEMENT OF PROCESSES.