Lecture 3
Q&S
Cultures of quality and safety
Content
- What is the problem with cultures of quality?
- Definitions of culture – towards broadening the agenda
- Managerial and professional cultures?
o Governmentality, soft autonomy and organized professionalism
- Changing cultures
o Towards patient-centered healthcare?
Examples: shared decision-making, patient reported outcome
measures, experience-based co-design
Learning goals
- Explain the role of culture in q&s work
- Describe main components of culture in relation to q&s
- Describe some current examples of PCC and their consequences
- Get a grip on how to change cultures of q&s work
Quality challenges (bate et al.)
- Structural
- Educational
- Emotional
- Cultural
- Political
- Physical and technical
- “Giving quality a shared, collective meaning, value and significance within the
organization”
The cultural challenge
- How can we get to shared understandings of quality across disciplinary and
organizational boundaries
- But also
- How can we get to a more dynamic understanding of culture?
- Different understandings of quality (i.e. professions-managers-patients)
- Silo cultures
o Different professions or units ‘do’ care differently
o Hardly any coordination
- Defensive cultures
o No openness about mistakes
o No pro-active safety management
1
, Professional vs managerial cultures?
The problem with safety cultures
The problem with current definitions of culture
- Usually very static: denying
o Differences within cultures
o Dynamics of cultures
o Emergent properties
- Presuppose ‘one best culture’ (e.g. ladder), denying:
o Differences in traditions, organizational embedding, relation to wider context
(cf. country comparison)
o Relation to different types of problems (some problems might be better
tackled top down whereas others need bottom up approaches)
- Cultures often depicted as resistant to change
2
Q&S
Cultures of quality and safety
Content
- What is the problem with cultures of quality?
- Definitions of culture – towards broadening the agenda
- Managerial and professional cultures?
o Governmentality, soft autonomy and organized professionalism
- Changing cultures
o Towards patient-centered healthcare?
Examples: shared decision-making, patient reported outcome
measures, experience-based co-design
Learning goals
- Explain the role of culture in q&s work
- Describe main components of culture in relation to q&s
- Describe some current examples of PCC and their consequences
- Get a grip on how to change cultures of q&s work
Quality challenges (bate et al.)
- Structural
- Educational
- Emotional
- Cultural
- Political
- Physical and technical
- “Giving quality a shared, collective meaning, value and significance within the
organization”
The cultural challenge
- How can we get to shared understandings of quality across disciplinary and
organizational boundaries
- But also
- How can we get to a more dynamic understanding of culture?
- Different understandings of quality (i.e. professions-managers-patients)
- Silo cultures
o Different professions or units ‘do’ care differently
o Hardly any coordination
- Defensive cultures
o No openness about mistakes
o No pro-active safety management
1
, Professional vs managerial cultures?
The problem with safety cultures
The problem with current definitions of culture
- Usually very static: denying
o Differences within cultures
o Dynamics of cultures
o Emergent properties
- Presuppose ‘one best culture’ (e.g. ladder), denying:
o Differences in traditions, organizational embedding, relation to wider context
(cf. country comparison)
o Relation to different types of problems (some problems might be better
tackled top down whereas others need bottom up approaches)
- Cultures often depicted as resistant to change
2
