Abstract
Achieving lasting performance improvement in health care is a demanding challenge. Service delivery processes are frequently fragmented with many symptoms of poor behaviour observable. Competing vested interests within the National Health Service (NHS) and experiences of muddled and muddied top-down government exhortation suggest the need for a balanced perspective in which the expectations of patients, staff, management and government can be considered, agreed and enabled. Our conclusion is that effective innovation is best achieved by establishing a 'Train-Do-Train-Do' cycle in which all 'players' in the system must be actively involved. The particular methodology of 'managing by projects' for effective bottom-up step-by-step innovation in NHS practice is described. It takes a holistic and systematic view of health-care delivery as a service business process to be optimized via a five-step procedure. The core tool element of this methodology is the multidiscipline natural-group task force used to execute the change process in an enterprise. When properly constituted, motivated and driven, it is very capable of transforming a 'mess' into an effective health-care delivery process.
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