Towards sustained organisational learning and innovation in health service: In-depth longitudinal studies of the Memeologue Improvement Approach (MIA)
Our vision is a Swedish health service guided by a true health-orientation, implying a shift in perspectives towards holistic views of people’s health problems all in order to improve the quality of care for the whole population.
The project is intended to work as a foundation for the creation of a dynamic network and a platform for research, cooperation and spread of knowledge in northern Sweden concerning organisational development and quality improvement within health service organisations.
The overall objective of the principal project is to clarify how organisations acting within health service can simultaneously handle demands for efficiency, safety and availability AND demands for flexibility, context dependent problem solving and learning in organisational systems which are today characterized by hierarchical and centralistic structures. What we aim to achieve is to improve the understanding of how quality assured knowledge can become workplace practice and also how locally established best practice can become widespread and recognized knowledge in complex health service organisations.
The principal project involves four main research areas and a comparative investigation with in-depth longitudinal analyses of four empirical cases. Within each case four perspectives are represented: the Memeologen approach, the organisational perspective, the clinical and unit perspective, and the stakeholder perspective.
Memeologen is a development unit within Västerbottens Läns Landsting (VLL) which for several years has been developing and implementing a change approach in line with concepts of organisational learning, quality management and system theory. Memeologen works with change teams of nurses, doctors, medical secretaries and other staff at specific units and clinics. In addition to this organisational and managerial support structures for planning, communication, decision-making, measurement and feed¬back have been developed. The change approach has so far been successfully spread from local pilot units to some larger parts of the health care system. In September 2006 a county-wide implementation of the change approach commenced in primary care. The start for widespread implementation in specialist care is set for January 2008.
The principal project encompasses an examination of how the Memeologen approach manages in its attempt to develop the health service organization. Effects of special interest include: patient and staff satisfaction, the spread of knowledge and learning and results on organisational economy.
A central question to be examined is if the change approach effectively addresses needs for development of innovative working organisations and increased exploitation of evidence-based knowledge. The approach is evolving and has now reached a level of organisational support that makes it possible to study some of the more complex issues outlined in this application. VLL provides full and unique access to the ongoing transformation of primary care and the up-coming transformation of specialist care. Research is also applicable to projects involving cooperation between VLL and other regions and municipalities. Furthermore, this extensive network creates an excellent opportunity to test theories and new praxis directly in health care units.
The first part of the project includes examining effects of the Memeologen work on contemporary management systems regarding aspects of innovation and learning, including a gap analysis between theoretical requirements and states of the observed systems. This will be supplemented by examinations of attitudes and behaviour within the targeted organisations and in their context. The second part of the project includes analysis and transformation of results from the empirical studies into principles for management systems and methodologies for organisational innovation/learning.
The research project has a strong practical orientation, aiming at evaluating and reflecting on organisational development with an ambition to improve health service. The studies will be carried out in the form of action research seeking both to take action and to create knowledge or theory about that action. Our contention is that for real change and sustained organisational improvement a tailored research methodology is indispensable. It is also essential that researchers from different faculties and disciplines collaborate in this complex field.
It could be argued that the Swedish health service system has a strong potential to successfully meet its challenges by applying new ideas on leadership, learning, working methods and system development. However, the necessary knowledge foundation is still largely lacking. Our application departs from a number of major health challenges where the problems are quite apparent. Corresponding organisational solutions are in different stages of development, but the steps from knowledge to widespread implementation still remain to be taken.
The project is intended to work as a foundation for the creation of a dynamic network and a platform for research, cooperation and spread of knowledge in northern Sweden concerning organisational development and quality improvement within health service organisations. These vehicles for improvement of understanding, knowledge transfer and learning in a wide perspective will involve representatives from several organisations, organisational departments and units, managerial levels, developers, patient groups and researchers from the universities in Umeå and Luleå. Through specialized forums for discussions, innovations, projects and the creation of new ideas will be enhanced. Management and operational development are today well established fields of research at Umeå University and Luleå University of Technology. Through the creation of this research platform these research fields will become much stronger links to the medical and health science faculties in Umeå.
There can be little doubt that the fundamental problem of effectively transforming evidence based and formalised knowledge into established practice within health service organisations merits further investigation. More evidence and understanding is required and this principal project maintains the importance of learning about change in the real world of health care and the fundamental determinants of successful improvements.