Managing quality in cancer services: why improvement isn't easy.

Optimising the quality of care is an imperative for health services worldwide, including in Australia. Recognition that poor quality often has its roots in system failures is beginning to shift strategies for improvement to the systems of care, although the tendency remains to focus on eliminating the practice variations of individual clinicians. In those instances where systems improvement is addressed, strategies tend to be generic and technical, and often unrelated to the context in which they are applied. This paper reports an interim evaluation of a quality management program in cancer services implemented in a Sydney metropolitan teaching hospital dispersed across multiple campuses. The paper aims to inform the debate on quality improvement by reporting not only on what was achieved, but why change seems to be so hard. We found that organisational and social factors that influence the quality of health services were not sufficiently addressed, compared with technical factors. We conclude that service quality needs to be repositioned as an organisational goal, and implemented via a structured process that addresses organisational and social factors, as well as technical factors.