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Fixing Health Care from the Inside

Fixing Health Care from the Inside

Fixing Health Care from the Inside

Response to Classmate

Hello, great post!! Your comparisons of the readings and the article are very insightful. It is true what you say that adopting a Just Culture provides a middle ground for a work environment that does not condone punitive actions or a blame-free one for that matter. You have also noted that the leadership in any HC facility needs to spearhead any changes and endorse strategies throughout the organization (Nash et al., 2012).  What happens when staff is resistant to change? What happens that despite a Just Culture being included in the hospital policies, is blatantly ignored by staff in an attempt to cover each other’s backs to avoid any job losses? Above initiating and endorsing strategies for change, leaders need to be team players that encourage open communication between them and the staff (Ulrich, 2017). Where leaders are perceived as part of the team by the staff, it becomes easier for openness to be embraced.  Staff will feel more at ease in disclosing any errors in their line of duty, and this would significantly improve service delivery within any given healthcare facility.

With open communication comes the freedom to share ideas, and this can greatly help in the eradication of ambiguities and propel a healthcare facility toward a lean model of service delivery. Even when experts from the outside are included in a change process as you have mentioned (Smith, 2019), when staff are encouraged to share ideas, the experts will use the ideas and add to them, their professional knowledge and expertise and the end result would be a system that is easily accepted by staff. An external evaluation that includes opinions and observations by staff would give a detailed picture of the situation at hand and resolutions made based on information gathered from staff as well as on the professionalism of the outsourced persons. All in all, communication is key and it is in my opinion, the main ingredient for change to occur within HC.


Nash, D.B., Clarke, J.L., Skoufalos, A., & Horowitz, M. (2012). Health care quality: the clinician’s primer. Tampa, FL: American College of Physician Executives

Smith, A. (2019). Beyond denial and defense. Physician Leadership Journal, (3), 20. Retrieved from

Ulrich, B. (2017). Just Culture and Its Impact on a Culture of Safety. Nephrology Nursing Journal44(3), 207–259. direct=true&db=aph&AN=123660932&site=ehost-live


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Fixing Health Care from the Inside

Hi, I would like to respond to my classmate’s response, below. Please see the text book readings and the article for the assignment   Harvard Business Review (2011). Harvard Business review on fixing the healthcare from the inside & out. Pages 1-29

Fixing Health Care from the Inside

Fixing Health Care from the Inside

Classmate’s Response

In Fixing Health Care From The Inside, Today (Spear, 2005/2011), it is stated that 98,000 people die each year due to medical errors (p.51). Facts like these must be the driving factors for quality improvement in U.S. health care. This article provides recommendations for remedying such errors to increase patient safety, including eradicating ambiguity, implementing small changes to produce big change, conducting simulations of problematic situations, and institutionalizing change through endorsement by upper management (Harvard Business Review, p. 52-53).

When comparing these recommendations to our class readings, it seems that there is much to be agreed upon. For example, when looking into how to apply Six Sigma for quality improvement and relating it to the Spear’s article’s suggestion of eradicating ambiguity in day-to-day hospital processes, Nash et al. (2012) states that when analyzing procedures, it is most useful to reduce variation in defined processes to ensure predictable performance and reduce waste (p. 285). In other words, standardization is key; how employees carry out certain tasks should be uniform no matter who is performing the duty to secure constant outcomes.

Conducting simulations of situations where errors may occur is a common and prudent strategy for improving quality. Nash et al. (2012) reinforces Spear’s recommendation of conducting simulations, stating that a team should be expected to “walk the process,” or experience it in the way a patient or customer would to better identify where the error originated from and determine where to focus improvement efforts (p. 290). This makes sense, because if employees are forced to experience dangerous or hazardous situations from both a professional standpoint and that of a patient, even though hypothetical, they will be able to cultivate empathy and sympathy, as well as learn what the proper steps are to take to avoid or remedy the potential error. This can help motivate employees to do what is right for both the organization and the person(s) they serve.

One area that Spear’s article does not address is work environment. Last week we explored just culture in health care organizations, and I feel it is relevant in this discussion. Again, a just culture environment finds the middle-ground between a blame-free culture and one that is overly punitive, and works to create a space where employees feel safe to report errors without fear of retribution (Morris, 2011). This is an important strategy for quality improvement, as it may assist health care organizations in identifying errors and why they arise in the first place. Errors must be properly identified before any change in processes can be effective.

Another useful tool to review systems and procedures and their effectiveness not included in the article’s recommendations is bringing in outside experts to perform a gap analysis (Smith, 2019). This would be useful because it offers an unbiased evaluation; it is fathomable that teams who develop quality improvement strategies within their organization may be too close to their ideas to evaluate them successfully, making them less open to new and more effective ways of doing things.

Across the board, it seems that to be agreed upon that leadership must fully buy-in and endorse strategies throughout the organizations; change starts at the top. Nash et. al (2012) states that to ensure processes and procedures are adopted by employees, the CEO must invest in generating enthusiasm throughout the organization. This is such an important fact to remember, especially for those who find themselves in upper management positions, as leading by example can help motivate employees. 1 Pete 5: 2-4: “…shepherd the flock of God that is among you, exercising oversight, not under compulsion, but willingly, as God would have you; not for shameful gain, but eagerly; not domineering over those in your charge, but being examples to the flock” (English Standard Version).


Morris, S. (2011). Focus: patient safety and the medical laboratory. just culture – changing the environment of healthcare delivery. Clinical Laboratory Science, Vol 24 (2).  Retrieved from

Nash, D.B., Clarke, J.L., Skoufalos, A., & Horowitz, M. (2012). Health care quality: the clinician’s primer. Tampa, FL: American College of Physician Executives

Smith, A. (2019). Beyond denial and defense. Physician Leadership Journal, (3), 20. Retrieved from

Spear, S.J. (2011). Fixing health care from the inside, today. Harvard Business Review: Fixing Health Care from Inside & Out. (pp. 49-90). Boston, MA: Harvard Business Review Press. (Original work published in 2005).

Thank you.

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