Intended for healthcare professionals


Improving health care through redesign

BMJ 2006; 332 doi: (Published 01 June 2006) Cite this as: BMJ 2006;332:1286
  1. Derek Bell (, professor in acute medicine and national clinical lead, unscheduled care collaborative programme,
  2. Nicki McNaney, programme manager unscheduled care,
  3. Mike Jones, deputy medical director and national clinical lead, unscheduled care collaborative programme
  1. Dept of Medicine and Therapeutics, Chelsea and Westminster Hospital, London SW10 9NH
  2. Scottish Executive Health Department, Edinburgh EH1 3DG
  3. Single Delivery Unit, NHS Tayside, Ninewells Hospital, Dundee DD1 9SY

    It's time to shift from small projects to whole systems

    The belief that increasing demand for health care will be solved only by increasing capacity remains common in health communities. Yet other industries have developed a greater understanding of demand and capacity and delivered increased productivity while increasing quality. This occurs within an environment that drives cost efficiency by focusing on what customers want and by applying a rigorous approach to systematic business process re-engineering.1 The improvement methods used in different healthcare systems are often similar yet the drivers, approach, and emphasis differ. Initially the focus of improvement programmes in the United Kingdom has been to achieve targets for patients' waiting times and access to services, while in the United States, through the Institute for Healthcare Improvement (IHI), the focus has been on quality with a recent increased emphasis on patient safety.24 The Institute's latest campaign, to prevent 100 000 deaths in US hospitals over 18 months, reaches its first milestone in mid-June, and is described in this issue (p 1328).5 It exemplifies the merging of …

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