Editorial

Citation

Jackson, S. (2004), "Editorial", International Journal of Health Care Quality Assurance, Vol. 17 No. 2. https://doi.org/10.1108/ijhcqa.2004.06217baa.001

Editorial

The other day I was explaining to a friend of mine some of the recent changes in healthcare. I happened to mention nurse prescribing and nurse-led clinics, which to me are totally sensible developments. However, my friend had concerns about the competency of practitioners, other than doctors taking on traditionally medically oriented roles. I instantly defended both initiatives explaining that the training and policy surrounding such changes are so stringent that effective risk management is the norm. Nevertheless it did start me thinking about public and professional perceptions regarding the evolution of healthcare. For instance, what should the evolution of healthcare look like and should it mirror the “product life cycle”, a concept that is so well known and applied in industry?

According to Kotler (1991) the product life cycle portrays four distinct stages in the sales history of a product. These stages are knows as:

1. 1.

   introduction (a period of slow sales growth as the product is introduced into the market place);

2. 2.

   growth (a period of rapid market acceptance);

3. 3.

   maturity (a period of a slowdown in sales growth because the product has achieved acceptance); and

4. 4.

   decline (a period when sales show a downward trend).

Recognising that a product travels through a cycle means that people recognise that products have a limited life, they raise different issues as they travel through the life cycle, and that they require different management techniques in order to ensure that delivering quality services and working towards continuous improvement remains the day-to-day endeavour of every organisation.

In terms of medical developments the life cycle may look something like this:

1. 1.

   Introduction – an eminent medical practitioner undertakes some pioneering work and only he/she is able to perform the procedure, a new drug is launched and patients have to undergo many tests and screening procedures before they are able to take it, furthermore only a few experts in the field are able to prescribe it.

2. 2.

   Growth – expertise and training takes place in conjunction with the development of national and local policies so that more and more medics are able to undertake the procedure or prescribe the new drug.

3. 3.

   Maturity – the practice becomes common place and the procedure or new drug is described in text books and is part of the normal curriculum within medical and professionals allied to medicine training schools.

4. 4.

   Decline – the procedure or drug is so well ingrained into everyday practice that it no longer requires a medic to undertake or prescribe it, so devolvement to the relative speciality can begin to occur. In some cases this new procedure or drug may have been superseded by a fresh development.

I can think of a number of areas where this type of cycle has probably taken place already. Examples would include suturing, resuscitation, forceps deliveries, prescribing, taking blood, fitting intra-uterine contraceptive devices, administering thrombolysis and intravenous administration. No doubt you can think of many more. However, what may not have taken place is the recognition that the aforementioned procedures should have been following this normal course of events rather than being seen as special initiatives undertaken by a few leading edge centres initially before becoming integrated into mainstream healthcare services. A process that takes many years if not decades.

Being aware of and working within the parameters of a “healthcare initiative life cycle” may enable healthcare organisations and personnel to become more efficient and effective within a shorter time frame than is currently the case. For instance, instead of a few innovative people working very hard and expending a lot of time and effort to change people’s mindsets around which a professional group should undertake a certain procedure or administer a certain drug, time and effort could be eased if innovations were expected to follow the previously described course of events. This would be because systems and procedures would be in place to enable devolvement to allied health professionals rather than hinder it. Furthermore practitioners working in healthcare would expect devolvement to take place rather than be wary of it and challenge it whenever they felt threatened. Not having to overcome resistance to change would no doubt make life easier for many healthcare professionals who thrive on leading the way and would probably make access to certain healthcare procedures much easier for patients.

It would also facilitate the application of “activity-based management” a technique that enables organisations to accomplish their outcomes at a lower total cost. There are two levels of activity-based management (ABM); operational ABM where the organisation and the individuals do things right and strategic ABM where the organisation and the individuals do the right things. Recognising the existence of a “healthcare initiative life cycle” would help strategists to identify the right things and help practitioners working in the field to be better at anticipating change. Moreover, publicising this concept in popular healthcare texts and common public reading material would equip the public to recognise and expect devolvement of healthcare procedures to take place. That way the general public would not be surprised when a practitioner, other than a doctor, prescribes them a certain drug or carries out a certain procedure. They may even lobby for it knowing that access to such treatments will become more commonplace and more readily available.

Because this thought of the “healthcare initiative life cycle” has just occurred to me, I wonder if it has crossed any of your minds and if you know of any such work that would support my argument for change. If you do, please let the readers of the journal and I know. You may like to write a follow up editorial about it or alternatively write an article where this type of thinking is being developed. I welcome your contribution.

Sue Jackson