Better Health Care: How do we learn about improvement?

Andrew Murphy

Healthcare Improvement Fellow, University Research Co., LLC

About | Founded in 1947, Salzburg Global is a global hub tackling the world’s most pressing issues from education, to health, environment, economics, government, peace-building and more. Salzburg Global connects global leaders at the Salzburg Global Seminar. This year, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) project’s Director will lead a key session entitled, entitled “Better Health Care: How do we learn about improvement?”

The purpose of the Salzburg Global Seminar Session 565, entitled, “Better Health Care: How do we learn about improvement?” is to have a deep discussion about how we are evaluating improvement interventions and if there are better ways that we could be evaluating them. 

There is a consensus among many leading implementers and researches in the field of healthcare improvement that the adaptive nature, inherently found within improvement, requires a different way of thinking when it comes to how we evaluate. As practitioners and researchers in the field of healthcare, most of us have taken Epidemiology 101 or a similar course in which we learned about different experimental approaches by which we can prove that something has happened. In this class we usually move though different study design methods to demonstrate different levels of causality. Students start by learning about cohort studies or something similarly broad and lead up to the “gold-standard” of experimental approaches, the Randomized Control Trial (RCT).

This teaching sticks with us and so does the way we speak about RCTs. As they are the gold standard, all roads must lead to an RCT and the faster we can reach this goal, the faster and easier we can disseminate the “best” way to do something. This scientific process might be perfect for figuring out if a certain chemical compound can increase one’s red-blood cell count; however it might not be the best way to demonstrate the effectiveness of our improvement interventions.

Improvement happens in complex systems. 

Improvement happens when you change processes of care, when you address system bottlenecks and when you change the hearts and minds of relevant stakeholders. Improvement is not always due to a single change or adjustment and therefore the evaluation of these interventions is not always straight forward. Common convention says to isolate in order to prove, beyond a doubt, that X was the reason that outcomes improved. However, often, isolation can alter the intervention, nullifying any effect that may have occurred. 

We are convening in Salzburg to find a better way, or likely better ways, to evaluate the improvement interventions that are occurring around the world. The goal is to bring together 60 of the brightest minds in this field to develop a framework that can be used by researchers and implementers alike, to better design improvement interventions and their evaluations to answer questions about attribution and generalizability.

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