The purpose of this chapter is to provide context for the existing definitions, methods, and strategies to develop organizations and manage change in the healthcare industry. The authors have compiled some of the more commonly used methods and presented the ideas as closely as possible to the original author's intent for the methodology. Where practical, the more recent discussion in the literature is also represented. With this context, the last section of the chapter discusses the scope of the scalability of methods to support a multinational conversation of electronic health records interoperability.
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Plan Do Study Act (PDSA), also known as the Shewhart cycle, was attributed to W. Edward Deming and has been a long-standing method of managing change in healthcare (Deming & Orsini, 2013; Wong et al., 2023). While it is appropriate for maintaining continuous improvement within a culture of action research, it is not the best option for digital transformation or other highly complex changes involving multiple departments or with an urgent implementation deadline. Restructuring is possible using the tool and has been successfully applied as Plan Do Check Act (PDCA) during response to COVID-19 in Brazil (Morais et al., 2022). While it is designed as a continuous improvement tool to manage quality outcomes, the iterative nature of the tool operates much like the action research methods that have proven highly successful in other studies (Parkin, 2009; Burke, 2024).
Six Sigma is also a method used in healthcare to manage costs and reduce waste (Kuiper et al., 2022; Niñerola, 2020). A study of the Dutch use of Lean Six Sigma practices addresses the potential benefits and drawbacks of the method (Kuiper et al., 2022). The findings show that while lean methods are appropriate for cost reduction, it is possible to push an organization to operate so “lean” that the organization is not prepared to respond to a global pandemic. Studies of the literature related to the use of Six Sigma methods in the healthcare setting have shown that not all approaches to lean in healthcare have been effective (Anthony et al., 2019; Niñerola, 2020). Watkins, Mohr, and Kelly (2011) offer a case study discussing Six Sigma from the Appreciative Inquiry perspective that may also shed light on how organizations practice problem-solving.
Parkin (2009) discusses the history of traditional methods of research in healthcare and how action research became a strategy for implementing change. He specifically discussed socio-technical theory relating to the methods of managing change using action research to create a culture of continuous improvement in the healthcare setting. This strategy of managing change with a participative approach allows the change recipients to be part of the process (Cawsey et al., 2016; Knightbridge et al., 2006). Benefits to using this strategy include robust needs assessment with involvement of those who will use the new system, reduced resistance to the change in technology, and better use of the new measurements and metrics resulting in a more sustainable outcome.
Action Research and Appreciative Inquiry are a helpful strategy to begin to manage the complexity in healthcare. Jane Magruder Watkins and Jacqueline M. Stavros’ work concerning Appreciative Inquiry place it in the context of helping all Organizational Development models be applied in world-wide change initiatives (Watkins & Stavros, 2010). Watkins and Stavros provide the proper context of the origins of Appreciative Inquiry by discussing the connection of the term to David Cooperrider’s work appreciating Kurt Lewin’s Action Research Model. Watkins, Mohr, and Kelly (2011) used the case study of Newark Beth Israel Medical Center to illustrate the role of Appreciative Inquiry in complex adaptive systems. Watkins et al. (2011) illustrated the process of Appreciative Inquiry used in NBIMC’s emergency department (ED) needs assessment showing a cyclical model as seen in Figure 1.
Figure 1. Appreciative inquiry 5-D cycle for ED redesign