ABSTRACT
This chapter focuses on getting the best out of the system at each of the levels. Some factors are important at more than one level and individuals are part of the process at every level. The chapter describes with an example of quadruple-loop learning and a discussion of how the manifestations of such learning, together with behavioural changes in the people involved in healthcare, have the potential to produce a culture change and profoundly improve healthcare at every level. William Edwards Deming has described an instructive game, best played before an audience, which can be used to demonstrate the limitations of traditional approaches for improving quality. The chapter addresses the need for collecting information and assembling evidence. It discusses the major challenges for improving the system through regulation and accreditation – to set standards, monitor compliance and develop sanctions. The chapter also discusses the massive but futile disruptions associated with restructuring, produced in the hope of increasing efficiency.
