Is the role of an organisational champion effective?

The label "champion" is a complex one to wear and one which I've been a bit cautious about recommending anyone use.  In the UK, it's been common to identify that enthusiastic doctor or nurse, label them the champion for the work and then expect them to get on and lead the changes.  Sometimes this works, and sometimes it doesn't.

There's a really interesting paper published (by Hendy & Barlow, Imperial College, London) which examines the role of the champion and their effectiveness in one program in the UK. I like this research because it is lengthy (three years is a long time) and ethnographic. Their bottom line, it seems, is that it's good to be a champion in your own patch, but as soon as you're expected to deliver your champion role outside your regular context, then the effectiveness drops off. This is instinctively logical but all the same it's good to see some research on the topic.

Soc Sci Med. 2012 Feb;74(3):348-55. Epub 2011 Mar 1.
The role of the organizational champion in achieving health system change.

How does organisational context impact spread and adoption

Those who know me, know I am critical of the continued use of Roger's Diffusion Curve as a means of telling people how and how to plan for the spread and adoption of good practice. If you read Roger's work in depth you will understand its limitations.

One of these is the lack of attention to context. It's fairly obvious to anyone involved in spread and adoption of good practice that leadership, organisational culture and readiness to change etc. are all important in the process. The problem is, although many models and frameworks are drawn up to show how context is important - which is an excellent first step - there is a shortage of published work on the topic.

A key problem is that those who publish ignore the contextual factors.  A recent review paper by Emmens, Weiner & Fernandez looks at this issue.


Health Educ Behav. 2012 Feb;39(1):87-105. Epub 2011 Jul 1.
Systems antecedents for dissemination and implementation: a review and analysis of measures 

WHO Patient Safety Curriculum Guide

More great resources from the World Health Organisation.  To be frank - this curriculum guide is the most comprehensive set of teaching resources on patient safety that I've come across in a decade.  It has been developed by multi-professional groups so avoids the biases that so often occur when courses are developed by a single organisation.  Whilst it's aimed at integrating patient safety into educational curricula, there's no reason why you can't use this within your own organisational setting.

You can access the multi-professional guide here. If you would like the teaching slides for each of the 11 topics then you can download them here, where you will also find background and evaluation information.

And unless I'n missing something - these are free to use - so no there is no excuse in wasting time creating, developing, designing, discussing how to educate and train staff in patient safety. Nor should you be paying anyone to do the creating, designing, developing etc.

Well done WHO!

International Profiles of Healthcare Systems

A fascinating comparison of healthcare systems is available for The Common Wealth Fund.

Some highlights:

• Healthcare system financing and coverage: there's a table that shows how 14 countries finance healthcare (I thought the NHS was complicated in England, but I see it really is quite simple when it comes to financing it.)
• Selective system indicators: this is where you get to see how funding, population, numbers of physicians etc link to chronic care management, avoidable deaths etc. It's all riveting reading but I'm impressed by England's capacity for quality in Primary Care.
• There is a chapter on each of the fourteen countries: Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, Norway, Sweden, Switzerland and the USA

There's nothing like a bit of comparison to place both positive and negative aspects of our healthcare systems in context.  I thoroughly recommend at least browsing the tables, if not reading the whole report.

Why one to many is not a large scale change strategy

Large scale change is about the numbers.  If part fo your strategy for large scale change is to develop or use networks to communicate your message then you need to understand the mathematics of networks.

If you don't know about Sarnoff's Law, Metcalfe's Law and Reed's law - then watch this video, which if nothing else, explains why broadcasting messages is low impact. It's 10 minutes long but hang in there - it's the best explanation I've heard for a long time.





The numbers:
Sarnoff: 1 message to 20 people: network score of 20

Metcalfe: Email and telephones connect humans and help small groups form: because everyone can connect to everyone, the potential is 20 x 20, meaning a network score of 400.

Reed: the value of the network is exponential in social networking, going beyond the establishing communities.. So it's 2 to the power of 20 which is 1,000,000.

Reed's Law is about scale.
Social networking matters.