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Financial Increasing demand Bureaucracy Institutional inertia GP engagement as well as other

stakeholders Barriers to change Amongst others:

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Incremental improvements in current practice

Corrects only one error No long lasting changes

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Obstetric department of Hospital A examines care of patients through clinical audit.

Gaps are identified between current practice and established standards (ie. Guidelines)

Meetings are held to discuss guidelines, with changes made to working practice. And reporting and feedback on practice

Changes made increase the proportion of patients receiving good care for that area.

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When organisations try to rethink their basic goals, norms and paradigms

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Obstetric department of hospital B. In examining its quality of care decides to

interview some patients. It emerges that the issues which are

bothering women are to do with continuity of care, communication skills, access to information.

Obstetric care is reconfigured but the guidelines are not abandoned but woven into the new pattern of interaction and values.

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Learning to learn Increasing our capacity for learning

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Obstetric care at hospital B was a useful experience.

The experience itself was analysed Through its structure and culture the

organisation encourages the transfer of these valuable lessons.

Other hospital services share the lessons about learning to reconfigure

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Systems thinking Improving individual capabilities Team learning Mental Models Shared Vision

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Learning organisation Curriculum planning Outcomes based and situational analysis Appraisal Skill shares Communicate, communicate, communicate!

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Communicate and engage at early stages Ownership by all involved – including

managers Develop outcomes that look into the future Ways of evaluating and reviewing process

as it occurs feeding in to the change

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Initial stages◦ Masterclass◦ Newsletters and surveys◦ Structure with forums to involve all including managers

Learning organisation Induction process Appraisal processes Review of outcomes and changes in delivery of service

accordingly Moodle System of working and process related to our outcomes

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1. Doctors, managers and the battle for quality 2. Managing Change in Primary Care The chains of education,

experience, and culture David Metcalfe3. Spencer J (2001) Educational outcomes and leadership to

meet the needs of modern health care Qual Health Care 2001;10:ii38-ii45 doi:10.1136/qhc.0100038

4. Future of primary healthcare education: current problems and potential solutions J Lord Postgrad Med J 2003;79:553–560

5. Developing learning organisations in the new NHS Davie et al BMJ 320 : 998 doi: 10.1136/bmj.320.7240.998

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