Academic health centres: managing the transition from good to great
Editor – The article by Noble et al (Clin Med February 2010 pp 16–9) describes the high level strategies in four consistently high achieving healthcare organisations in the USA. While the American healthcare system has its flaws, the four organisations in Noble's article are outstanding.
Noble's observation that what unites academic health centres is greater than what divides them is important on this side of the Atlantic. We believe it extends even further: the factors that contribute to greatness apply to NHS acute trusts, where many district general hospitals are larger than academic institutions in the USA.
In contrast with the USA, where organisations such as John Hopkins are able to acquire a national reputation,1 in the UK we avoid talk of greatness. In Good to great, Jim Collins described great companies as organisations with a rigorous attachment to discipline and a relentless focus on key activities that make for success.2 Great organisations avoid Collins' definition of mediocrity: that is organisations that characteristically manifest ‘not reluctance to change but chronic inconsistency’. The NHS generally suffers from this problem of chronic inconsistency.
Understanding and implementing proven, relevant methodologies as well as having guiding principles and strategies and acting systematically on all fronts in a coordinated fashion is what is required to improve. Focusing on the how and applying it in the UK setting is the challenge.
The King's Fund Point of Care hospital programme, recognising the current state in NHS hospitals, aims to work with a handful of hospitals to test specific, system-wide methodologies designed to transform cultures and improve quality of care, ideally without additional cost.3 Vanderbilt, widely acknowledged in the USA as outstanding in delivering patient-centred care is one of the examples we will be working to emulate.4
We recognise that making a commitment to transform quality of care in these hard pressed times, is high risk. But unless we change our thinking and rigorously apply ourselves to working systematically towards the aim of reliable excellent quality of experiences, we will not break free from mediocrity.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: Clinicalmedicine{at}rcplondon.ac.uk
- © 2010 Royal College of Physicians
References
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- Berry L
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- Goodrich J
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- Shaller D
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