Cultural change as a driver for outcomes

Ten Key Factors, Healthcare Improvement Scotland, Quality Improvement Hub, Spread and Sustainability, Quality Improvement, Cultural Change, Opencity Inc.,

Cultural change is one driver for ensuring sustainability for quality health improvement. In this continuing series of posts, we explore the excellent work by Healthcare Improvement Scotland.

Their excellent resource titled The Spread and Sustainability of Quality Improvement in Healthcare explores 10 key factors underpinning spread and sustainability. We highly commend their work and hope it receives wider international recognition.

“Spreading and sustaining change is recognized as a significant challenge in healthcare systems around the world.”

The work of Healthcare Improvement Scotland identified the needs to:

  1. Develop an accessible resource to help healthcare practitioners understand the key factors that impact on the successful spread and sustainability of improvement.
  2. Understand in practice which factors are already being addressed well and which are presenting particular challenges.
  3. Develop and test approaches to support staff to overcome the challenges.

10 Key Factors

The 10 Key Factors explored by Healthcare Improvement Scotland are:

  • Innovation
  • Measurement
  • Human factors
  • Culture
  • Change management
  • Leadership
  • Knowledge into action
  • Engagement
  • Evaluation
  • Empowerment

In the resource document each is explaining;

  • What is important?
  • Key to success
  • Key messages
  • Reading

The 10 factors are summarized in Figure 2 of the resource document as a table that healthcare providers can print, display and share with colleagues.

Practical Insights

As a followup to the resource document, Healthcare Improvement Scotland published a 2015 supplementary document; A practical insight into spreading and sustaining change in an acute care setting. 

The aim of understanding, in practice, the factors which are being addressed and those which are presenting challenges are captured in this second document. This QI Hub research revealed that the areas below significantly impact the successful spread of the original 10 key factors.

  • Focus on the why the change will improve patient outcomes
  • Impact measurement on patient outcomes
  • Planning for spread with local adaption
  • Workforce capacity to engage with improvement work
  • Senior management leadership and communication

Diligent illustration

One tremendous illustration of the sustained cultural change in healthcare is the Diligent Consulting program applied to Safe Patient Handling in the US. Musculoskeletal injury is common to nurses with many US healthcare providers spending hundreds of thousands of dollars in Workers’ Compensation payments. This affects the quality of life of the nurse, patient care and financial sustainability of the providers.

In essence, through Diligent, healthcare system providers are mentored through a 3-year cultural change program delivering measurable healthcare improvement outcomes and strong financial returns. Much of the success of the approach lies in the sustainability achieved through a detailed focus on ensuring best practice becomes everyday practice.

Hacking Health Waterloo

MedTech companies can successfully help mentor healthcare system providers through outcome partnership programs leading to healthcare improvement in preventable healthcare-acquired conditions.

We articulated the following critical success factors:

  • The strategic initiative must be owned by the executive leadership of the healthcare system customer;
  • The customer executive leadership recognise that their current approach requires revision in order to improve outcomes and willing to change;
  • The role of the Med Tech company is to mentor the customer through the process;
  • Health indicator process metrics and health outcome measurement data integrity is paramount;
  • A longer-term horizon of cultural change is essential to build sustainability;
  • The Med Tech company must carefully segment to select the right customers based on analysis.


I will be presenting core messages from this Health Outcome Models white paper at the Hacking Health Waterloo café in April.

What Matters Most

Our last post explored ICHOM’s excellent document What Matters Most.

To summarise, we encourage you to access and digest these excellent Healthcare Improvement Scotland resource documents and follow their ongoing work on the spread and sustainability of healthcare quality improvement.


Image of 10 Key Factors reproduced with kind permission of Healthcare Improvement Scotland

Diligent is a registered trademark of ArjoHuntleigh, part of the Getinge Group of companies