Intended for healthcare professionals

CCBYNC Open access
Analysis Quality Improvement

Can we import improvements from industry to healthcare?

BMJ 2019; 364 doi: (Published 21 March 2019) Cite this as: BMJ 2019;364:l1039

Re: Can we import improvements from industry to healthcare?

The article highlights that routine procedures in healthcare are not always underpinned by standardised and stable processes. One common cause of instability arises from the use of bespoke workarounds that individual staff develop to enable processes to operate within the context of their wider, overlapping and often conflicting work responsibilities. These workarounds are seldom discussed, rarely endorsed and can sometimes even be kept from view. They not are therefore subject to proper review or risk assessment, although they do form part of the unofficial ‘real-world’ SOP. Those overseeing such a system may be partially or completely unaware of these custom modifications and so rarely take them into account when planning upgrades and improvements. The system is seen to work but does so in a fashion that differs from the way understood or intended. Without a stable and defined process to underpin routine procedures, process improvements methods are less effective and can more often have unexpected, unintended and unwanted consequences. Understanding workarounds is key to effective process improvement.

Competing interests: No competing interests

29 March 2019
Mark Davies
Consultant in anaesthesia & perioperative medicine
Royal Liverpool & Broadgreen University Hospitals NHS Trust
Liverpool L7 8XP