Clinical systems improvement: it’s all about the project boundaries

Abstract

The National Health Service (NHS) in England is facing significant challenges ahead as a result of the government’s plans to reduce national debt. The challenge for infection control practitioners will be to continue to support the development and delivery of high quality clinical services without the level of funding previously experienced over the last decade. In order to achieve this all healthcare professionals will be required to embrace improvement strategies. The purpose of this paper is therefore to report on a review of a clinical reporting and root cause analysis (CRRCA) process coordinated by a community-based infection prevention and control team. The paper outlines the issues surrounding the current CRRCA process and analyses the process using lean concepts. A series of change options are put forward in order to illustrate how a failure to effectively scope improvement project boundaries can constrain change thereby limiting the potential for productivity and quality improvement.