Improving Quality in Healthcare

True to form Murray & Nick invite a critical re-examination of the dominant approaches used in a great deal of improvement work in healthcare. Based on their extensive experience of working in the field over the last 25 years, they argue that many of the current approaches fail to take proper account of organisational and patient context; invite reductionism and the atomisation of complex issues, and ultimately create only an illusion of progress. They promote the use of a framework to “questioning the work”, and discuss four interconnected domains to help guide inquiry.

I was particularly drawn towards the chapters on “Cultures of Quality” and “Supporting the Human System at Work” in which they discuss a wide range of issues that impact on safety. They cite a lot of the great work done by Prof Mary Dixon-Woods (often referred to in this newsletter) and the Harmed Patient Alliance work on “compounded harm”. Although the book is unashamedly an academic text, it’s also pretty accessible, and offers a thoughtful analysis of how to understand some complex issues with case study examples to illustrate their points.

– James Titcome OBE

Of course, no one book could cover the hugely complex issues of healthcare. However, Anderson-Wallace and Downham make a valuable contribution and bring insights into areas where they are much needed. These insights cover both ‘hard’ and ’soft’ aspects. The ‘hard’ aspects include the vital topics of demand and capacity. The ’soft’ aspects include new insights into what the authors call ‘avoiding the specialist, generalist and citizen muddle’. Many healthcare professionals - practitioners and administrators - will gain from reading this book.

– John Bicheno

Do not be deceived by the modest cover and title, this book is overflowing with original ideas highly relevant to current primary and secondary care. The authors take you on a journey from what has happened so far to develop and improve care, to a compelling vision for the future. I’ve been working as Primary Care network Clinical Director for 5 years now, and have been a GP partner for 19 years. This book absolutely resonates with the direction I think we need to go. It offers evidence and tools, grounded both in research and their considerable shared experience of leading system change. It is challenging but pragmatic, and it demonstrates what is possible. It has filled me with confidence and optimism for future enhanced approach to supporting community-based care. Everyone who cares about care, and the future of healthcare needs to read this book, and engage in the debate and action that they invite.

– Dr Ollie Hart

Drawing from diverse sources of evidence, this book offers a comprehensive overview of critical issues in healthcare quality improvement. It covers topics such as quality cultures, demand drivers, and the concept of failure demand. Importantly, the book also explores how the social determinants of health influence individuals′ health and healthcare needs. The authors have effectively tackled a complex subject, presenting it in a clear and thorough manner that encourages readers to re-examine their assumptions about healthcare. This approach provides valuable insights for improving the quality of healthcare services, especially in these challenging times.

– Dr Ana Llamas, Public Health Consultant

As a practising GP, I loved reading this book because it gives a theoretical framework to the problems I see every day at work. Failure demand is a new concept to me, but makes perfect sense and provides a language to approach difficult topics like over medicalisation, risk aversion (e.g. due to medicolegal concerns) and fragmentation of care, whereby patients end up seeing multiple clinicians with nobody taking an overview or responsibility for overall care. The language is accessible and clear. In my opinion, it should be compulsory reading for all GPs, GP trainees, other primary care clinicians and especially for policymakers.

– Dr Rupal ShahImproving Quality in Healthcare is one of the most interesting and credible books on healthcare that I have read. The authors combine a comprehensive knowledge of the literature on healthcare quality and safety with their own extensive experience of organisational change. Reading this book feels like that inspiring conversation that you have with a colleague. It invites the reader to ‘question the work’ and think through the implications of power, moral purpose and the human and relational dimensions of giving and receiving care. I recommend it for anyone interested in healthcare improvement but particularly healthcare leaders and executives looking for clear and helpful analysis. – Dr Lorelei Jones

As someone who has worked in health and care improvement for more than 30 years (and who has lived through the ups and downs of successful and less successful improvement initiatives), I loved reading “Improving Quality in Healthcare: Questioning the Work for Effective Change”. This is a book with a heart. It is driven by the mission of making a bigger difference for people who use services. It challenges improvement orthodoxy in a compelling way. I particularly like the focus on failure demand - demand created within the system, not as a result of delivering care of value to people, but due to failings within the system. Failure demand is a massive problem in the NHS and other health systems. It means we create extra demand and extra work because we organise and deliver care in ways that doesn′t meet people′s needs. Here′s how to tackle it. I recommend this book highly to anyone who thinks there must be a different, better way to go about improvement (whilst building on the strengths of prevailing approaches).

– Helen Bevan

If traditional quality-improvement methods feel dry and ineffective, this book is for you. I discovered it during a healthcare-leadership fellowship and have seen nothing better since. Clear, engaging chapters challenge the managerial mind-set that still dominates much of healthcare. By questioning how we define “value” and measure change, the authors invite true systemic thinking—exactly what frontline clinicians need to drive meaningful, sustainable improvement in day-to-day care.

Operational leaders will find it practical, but its real power lies in sparking clinicians’ critical curiosity: Why do we work this way? What if we didn’t? Read it early in your improvement journey: its insights will keep paying off.

– Dr Cristina Sorlini

Murray has a clinical background in mental health services and psychological therapy and is trained in systemic approaches to counselling, consultation and supervision. He is a qualified groupwork practitioner, registered with the Institute of Group Analysis. Murray has an enduring interest in the social dynamics of organising and has spent much of his career tackling complex socio-cultural and ethical issues, including leading several large-scale independent reviews of care. Murray has provided strategic support to a wide range of national quality programmes and networks in the UK and abroad. He has taught at postgraduate level internationally and is a visiting professor at the Health Systems Innovation Lab at London South Bank University. Murray’s practice also includes work as an independent editor, writer and broadcaster, producing media to stimulate debate about complex professional and ethical issues in healthcare. He is co-author of Networks in Healthcare: Managing Complex Relationships (Emerald) with Professor Becky Malby.

Nick is a healthcare quality, systems thinking and organisational development specialist. He is committed to helping clinicians, other professionals and communities be their most impactful in helping people live good lives. He has a quality and industrial engineering background and has spent most of his career working in health and social care. Nick has shaped, and continues to shape, some of the largest and most enduring quality improvement programs in the NHS. He is visiting teaching faculty at the Health Systems Innovation Lab at London South Bank University and works with front line teams, and their leaders at all levels, in healthcare services across primary and secondary care domestically and internationally.