Qual Saf Health Care 13:62-66 doi:10.1136/qshc.2003.006965

The next phase of healthcare improvement: what can we learn from social movements?

  1. P Bate1,
  2. G Robert1,
  3. H Bevan2
  1. 1Centre for Health Informatics and Multiprofessional Education, University College London, London, UK
  2. 2NHS Modernisation Agency, London, UK
  1. Correspondence to:
 Professor P Bate
 Chair of Health Services Management, CHIME, Royal Free and University College Medical School, University College London, The Archway Campus, London N19 3UA, UK;


    To date, improvement in health care has relied mainly on a “top down” programme by programme approach to service change and development. This has spawned a multitude of different and often impressive improvement schemes and activities. We question whether what has been happening will be sufficient to achieve the desired scale of change within the time scales set. Is it a case of “more of the same” or are there new and different approaches that might now be usefully implemented? Evidence from the social sciences suggests that other perspectives may help to recast large scale organisational change efforts in a new light and offer a different, though complementary, approach to improvement thinking and practice. Particularly prominent is the recognition that such large scale change in organisations relies not only on the “external drivers” but on the ability to connect with and mobilise people’s own “internal” energies and drivers for change, thus creating a “bottom up” locally led “grass roots” movement for improvement and change.

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