Improving the effectiveness and efficiency of healthcare systems through change programs: A comparison of initiatives in Australia and England

The demand for healthcare services has risen due to ageing populations, changing lifestyles, increased expectations and advances in medicine. Throughout the world, there has been a steady increase in expenditure on healthcare. However, since the economic crisis in 2008, there has been pressure from governments to comply with budgetary constraints. Healthcare systems are complex adaptive systems with many different stakeholders. They are sociotechnical systems in which it is important to jointly optimise the technical, social and organisational aspects of the system. Implementing change needs to take into account organisational vision, people and processes over the long term. Many healthcare organisations have embarked on transformational change initiatives based upon Lean principles, which have sought to increase their efficiency and effectiveness. This paper used multiple case studies to compare and contrast the approaches adopted in the North East of England and the State of Victoria in Australia. The differences in healthcare system made little difference to the transformational change approaches adopted. In both countries the importance of a vision and people was recognised and process improvement was achieved through the application of a very similar approach.