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Clinicians must be motivated to accept the changes necessary to achieve improvements in quality and performance
Quality improvements require change. Performance improvements require change. When a health system aspires to both over a sustained period there is a serious risk of “change fatigue”—key players getting tired of new initiatives and the way they are implemented—invariably the key players needed to make the changes work and bring in the improvements.
The National Health Service (NHS) in England has pursued improvements in performance and quality for almost 10 years, but particularly since the Labour government came to power in 1997.1,2 Significant extra funding has been made available by central government, and structures and systems have been established to ensure that the NHS “modernises” its practices. These programmes have achieved results: waiting times are down for elective procedures, access to care has improved, and more resources for staff and treatment are available to managers and clinicians. The improvements in performance have been achieved through the relentless application of targets via a managerial regime working “top down” in …