Sustainable change in healthcare: A cascading implementation model

Kasper Edwards, Thim Prætorius, Anders Paarup Nielsen

    Research output: Chapter in Book/Report/Conference proceedingConference abstract in proceedingsResearchpeer-review


    In 2013-2015 the heart centre at Rigshospitalet in Denmark went through a successful change process. Motivated by poor wellbeing at work survey results and management's belief that productivity could be improved a change project was launched. Management had requested that the project should be based on the principles of relational coordination and lean management to ensure that both wellbeing at work and productivity was addressed. The project was organised in three phases resembling diagnostics, development of interventions and implementation. Before and after implementation relational coordination and challenges related to the day-to-day operations in the heart centre was measured using a
    questionnaire. The challenges was formulated by the employees. The follow-up measurement showed that both relational coordination and challenges had been significantly improved and the project labelled a success. The purpose of this abstract is to analyse the project and develop theory and principles to explain the success so it may be replicated elsewhere.

    Material and Methods
    This is an action research project where Kasper Edwards participated as consultant. Group interviews were recorded and minutes from meetings as well as outcomes from workshops were collected. Three post project interviews were done with managers.

    We find that the project followed a transparent cascading structure where employees formulated problems and developed solutions. Management was not part of the process and only initiated the project stating the direction and desired outcome. This allowed employees to freely identify problems in their day to day work and propose solutions. Before developing solutions employees filled out a little black-book with notes describing challenges in their work. This was transcribed and emailed to all ensuring full transparency. Three workshops with a full surgical team were held to develop solutions to the described problems. The workshops used the A3 lean method which again ensured transparency. A3
    problem solving gathers problem, cause, solution and implementation plan in one piece of paper. These were then handed to all employees for comments. After all a series of meetings where employees commented and proposed improvements the changes were decided and implemented. 32 proposals were decided and all were implemented with success.
    Original languageEnglish
    Title of host publicationProceedings of The 12th NOVO symposium Care integration, systems reform and sustainability in health care
    PublisherNational Institute for Health and Welfare
    Publication date2018
    ISBN (Print)978-952-343-194-2
    Publication statusPublished - 2018
    Event12th NOVO Symposium: Care integration, systems reform and sustainability in health care - THL National Institute for Health and Welfare , Helsinki, Finland
    Duration: 15 Nov 201816 Nov 2018
    Conference number: 12


    Conference12th NOVO Symposium
    LocationTHL National Institute for Health and Welfare
    Internet address

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