Redesigning work processes in health care: lessons from the National Health Service

Health I care reformers focus on changing work processes in order to improve performance. In the British national health service, a range of initiatives have been pursued, including total quality management, business process reengineering, and quality collaboratives. This article analyzes the impact of the national booked admissions program and its implications for the national health service and the current quality improvement programs. Although redesigning work processes can improve performance, the impact depends on local contexts for change and how the mechanisms,of,change are used. It is important to convince physicians that change will offer benefits to both them and their patients, and to modify cultures that resist new ways of working. It also is necessary to recognize the challenges involved in sustaining quality improvements, allow adequate time to change work processes, and establish long-term responsibility for quality programs.