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Improvement, trust, and the healthcare workforce
  1. D M Berwick
  1. Correspondence to:
 D M Berwick
 Institute for Healthcare Improvement, 375 Longwood Avenue, 4th Floor, Boston, MA 02215, USA;


Although major defects in the performance of healthcare systems are well documented, progress toward remedy remains slow. Accelerating improvement will require large shifts in attitudes toward and strategies for developing the healthcare workforce. At present, prevailing strategies rely largely on outmoded theories of control and standardisation of work. More modern, and much more effective, theories of production seek to harness the imagination and participation of the workforce in reinventing the system. This requires a workforce capable of setting bold aims, measuring progress, finding alternative designs for the work itself, and testing changes rapidly and informatively. It also requires a high degree of trust in many forms, a bias toward teamwork, and a predilection toward shouldering the burden of improvement, rather than blaming external factors. A new healthcare workforce strategy, founded on these principles, will yield much faster improvement than at present.

  • trust
  • improvement
  • workforce
  • Taylorism

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  • * This paper is a reprint from the Nuffield Working Differently QSHC supplement: DM Berwick. Improve-ment, trust, and the healthcare workforce. Qual Saf Health Care2003;(Suppl i):–6.