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Background  Although care pathways are a response to the calls for a major change in health system redesign initiatives, very few articles have proposed an implementation method. Indeed, no method exi...

Sustained improvement to primary care radiology referral quality and value is achievable at scale using a multifaceted intervention. The transferability of this outcome is likely to be connected to su...

This article summarises the background and benefits of community HealthPathways, and offers tips on using this tool.

In this paper, we make a distinction between spreading and scaling innovations and spreading and scaling good practices for improvement, as many healthcare change practitioners often feel there is a “...

Background Staff in health systems everywhere have exhibited flexibility and a capacity for improvisations during, and in response to, the COVID-19 pandemic. Looking to other examples of such resilient behaviours outside of those induced by the pandemic is instructive for those involved with researching or understanding change, or making health systems improvements. Methods Here, we synthesise and then assess the value of eight case studies of in situ resilient performance from Canada, Sweden, Japan, Belgium, the United Kingdom, Norway, the United States and Brazil. The cases are divided into four categories: responsiveness to a crisis; adaptiveness over time; local adoption in accommodating to a top down, national policy change; and the consequential outcomes of an intervention. Results The cases illuminate the resourcefulness of translational and social researchers in examining such behaviours and practices. More than that, they also foreground the ingenuity and adaptive capacity of staff on-the-ground who continually anticipate, respond and adapt to make systems work and provide continuous care in the face of many challenges, including resource deficiencies, policy misalignments, and new technologies, policies and procedures that need to be integrated into local workflows. Front line clinicians make care systems work, pre-empting issues and sorting out problems before they occur or as they arise. Conclusions A key lesson amongst a range of findings is that, rather than focusing on shiny new tools of change (checklists, frameworks, policy mandates), it is much more insightful and satisfying to deeply apprehend care at the sharp end, where clinicians deliver care to patients, understanding how everyday work is executed. This, rather than the Health Ministry, the Boardroom, or the Management Consultant’s office, is where and how change is being enabled, and where street level actors solve problems, thwart issues in advance, and constantly avoid pitfalls.

Governments worldwide owe an unprecedented $91 trillion, an amount almost equal to the size of the global economy and one that will ultimately exact a heavy toll on their populations.12 The UK is among the countries that seemingly have no more money. Figures released for August 2024 highlighted that UK government borrowing hit 100% of GDP, levels not seen since the turbulent times of the 1960s.3 Our prospects for raising more money in the short term are limited. Economic productivity is low and the palatability of raising taxes for the general population is also low given how many UK residents are already struggling to make ends meet. The solutions of higher taxes on real estate, as well as introducing fairer and more balanced wealth and inheritance taxes, have been proposed. But the ability of the current Labour government to implement these in the short term is questionable. Overlaid onto this are two further challenges. The first is that the real …