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Improving Improvement

A toolkit for Engineering Better Care

 

Describing People

A people perspective uses knowledge of stakeholders’ abilities, experience, competence and culture to enable the design of systems that are fit for their intended purpose.

Contents

 

Introduction

The contribution of treatments, equipment, systems, processes and protocols are undeniably critical to health and care provision; however, it is people who ultimately affect the quality of that delivery. An appropriate awareness of people applies not only to the recipients of care, but also to the providers of care. It is important to acknowledge the diversity of the population and that health and care services should be accessible to, and usable by, as many people as reasonably possible, regardless of age or health condition. Equally, a chief executive can have a significant impact on an organisation, through their actions and behaviour, creating a culture that values the importance of the quality of relationships between employees and, most critically, the people in their care.

People are diverse in their size and capability, whether they are members of the public, patients or providers of care. Systems should be designed to be accessible to, and usable by, as many people as reasonably possible.

The success and effectiveness of a system are dependent on consideration of the people within the system, its context or place and the policy defining its operation. This can be represented as a series of iterative identify, locate and situate cycles where it is crucial to pay attention to provider/patient relationships as well as the relationships between health professionals, and how these can be enhanced by providing appropriate technologies, systems and policies to deliver a quality of care judged by the degree of warmth and reassurance shown to both colleagues and the people receiving care.

People are at the heart of an effective systems approach1, permeate all stages of the development and delivery of a system, and are rightfully central to the systems, design and risk perspectives.

A people perspective serves to involve patients, practitioners and the public to ensure that the systems created are truly fit for their intended purpose and reflect a deep understanding of how knowledge, competence and culture enables people, individually and corporately, to deliver and receive health and care within a complex socio-technical environment2.

Footnotes

  1. New care models: empowering patients and communities, a call to action for a directory of support. NHS England, Redditch, UK, 2005.
  2. Implementing human factors in healthcare, ‘taking further steps’. Clinical Human Factors Group, 2013.

Questions

Identify

Who will use the system?

The identify phase asks the question ‘Who will use the system?’ and leads to an understanding of the diversity of people involved and their needs, capabilities and behaviours, including reference to the means by which they will engage with the design of the system. It is likely to include a variety of activities to develop this understanding, for example:

  • Identify all the people who will use the system
  • Co-create the system with system users and change facilitators
  • Ensure accessibility for all systems users

Locate

Where is the system?

The locate phase asks the question ‘Where is the system?’ and leads to an understanding of the physical, organisational and cultural context of the system, including reference to organisation and culture, as well as the demographics and needs of the local population. It is likely to include a variety of activities to develop this understanding, for example:

  • Capture the needs of the local population
  • Identify related or adjacent systems of care
  • Understand the current culture relating to the delivery of care

Situate

What affects the system?

The situate phase asks the question ‘What affects the system?’ and leads to an understanding of the political and policy landscape within which the system is situated, including reference to policy opportunities and constraints, and the political landscape. It is likely to include a variety of activities to develop this understanding, for example:

  • Understand the local and national political landscape
  • Encourage a systems approach to the provision of care
  • Identify health and care policies that put patients first

Process

Tools

Literature

Coulter A (2005). What do patients and the public want from primary care? BMJ, 331(7526):1199—1201.

Clinical Human Factors Group (2013). Implementing human factors in healthcare, ‘taking further steps’. Clinical Human Factors Group.

CQC (2016). Better care in my hands: A review of how people are involved in their care. Care Quality Commission, Newcastle, UK.

Erwin K and Krishnan JA (2016). Redesigning healthcare to fit with people. BMJ, 354(i4536).

HRET (2016). Improving the patient experience through the health care physical environment. Health Research and Educational Trust, Chicago, IL.

Healthwatch England (2015). Safely home: What happens when people leave hospital and care settings? Healthwatch England Special Inquiry, London, UK.

Lucas B and Nacer H (2015). The habits of an improver Thinking about learning for improvement in health care. Health Foundation, London, UK.

NHS England (2015). New care models: empowering patients and communities, a call to action for a directory of support. NHS England, Redditch, UK.

NHS England (2016). People helping people: Year two of the pioneer programme. NHS England, Redd.itch, UK.

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