Wednesday, July 26, 2006

Lessons from developing nations on improving health care -

Lessons from developing nations on improving health care : " Notwithstanding the barriers, nothing in my two decades of work on healthcare improvement has inspired and amazed me quite so much as these early days of systemic improvement in the developing world. Time after time, in setting after setting, I find exactly the combination of intensity, cleverness, hard work, and optimism that we all need for this tough job of change to go well. Here are a few of the lessons I am starting to learn from the people whose form of wealth is so different from mine.

Simplify everything—The core of improvement need not be complex. Set aims, track results, find great ideas, and change something every day to find the better ways. Involve everyone you can, and do not assume that the rules of today must be the rules of tomorrow. I find elegance in the simplicity of approach that people who have little to waste have a knack for. Complexity is waste.

Take teams seriously—Improvement is about cooperation, and no one should trump the team. Uncooperativeness is waste.

Be pragmatic about measurement—Information technology is nice but not the point at all. Use the least measuring that helps, not the most that you can think of. Too much counting is waste.

Strip the support system for improvement to a minimum—Flatten the organisation. Consultants should make it their job to become unnecessary as fast as they can. Dependency is a form of waste.

Manage the political interface wisely—It is wiser to use it than to change it. Naivety is waste.

Help patients become advocates for change—Their stake is the highest, and their voices count the most. Keeping patients silent is waste.

Go quickly. Start now—Delay is waste.

Make spread a system—Find the latent structures, the channels along which change can flow, and use them from the start. Go, as Tver, from 5 to 50 to all, then to the neighbours, and then to their neighbours. Isolation is waste.

And finally, don't complain—I have visited settings in Rwanda, Mozambique, Peru, and Palestine where every person I met had 100 times more reasons to complain than I do. And none did. Complaint is waste."

This is an inspiring paper - please read it !

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