Redesigning Work Processes in Health Care: Lessons from the National Health Service

Initiatives designed to improve the quality of health services and to make these services more responsive to patients have a long history. In the British National Health Service (NHS), these initiatives have recently included total quality management, business process reengineering, and quality collaboratives. Drawing on experience outside the health sector, where quality improvement methods of this kind typically originate, NHS policymakers have focused particularly on changing work processes in their quest to improve performance. In so doing they have had to confront not only the inevitable challenges of managing organizational change ( Kotter 1996 ) but also some specific features of health care organizations that make change particularly problematic. This article analyzes and uses the NHS's experience to identify the lessons for future quality improvement initiatives. At the heart of this article is an account of one recent initiative, the national booked admissions program, which illustrates both the opportunities and the challenges in introducing and sustaining change.