Promoting health through organizational change Harvey A. Skinner San Francisco: Benjamin Cummings; 2002 404 pp $75.95 ISBN 0-205-34159-4
Ecological health models guide our thinking about the complex relationships between individuals and the multiple dimensions of their environment. In Promoting Health Through Organizational Change, Harvey Skinner examines an important component of these models: the interaction between health care organizations and individuals, with a focus on creating capacity at the organizational level. Skinner, a leading academic authority in behavioural medicine and public health sciences, declares that the past few decades have seen “a transition from reacting to disease to preventing health problems through behaviour change and more recently organizational change.” He argues that “there is a compelling need to shift our approach to develop organizational resources for prevention and behavioural health care” as well as “a need to shift our approach to a population perspective that integrates individual, organization and community health.” I could not agree more. This is truly the direction of the many disciplines now attempting to improve the health of our population.
Skinner has chosen a challenging and timely topic. With the assistance of the 14 contributors who authored and coauthored 9 of the book's 19 chapters, he provides theoretically based and practical strategies for implementing organizational change to facilitate the development of effective health promotion and disease management programs. This unique body of work is a much-needed attempt to address both individual and population-level approaches for improving outcomes.
Skinner skillfully integrates the value of two parallel dimensions of health-behaviour change: the need for individual change, and the need for organizational change. The health care organization, he argues, has primary importance and serves as a precursor of effective outcomes in patient health behaviour change and physician behaviour practices. At the same time, Skinner appropriately embeds the rationale and strategies for behaviour change at the level of the individual patient and physician within the process of organizational change.
The content and engaging presentation of Promoting Health Through Organizational Change will appeal to a wide audience of health professionals. Indeed, it would serve very well as a generic, primary text for medical students, graduate and postgraduate health science students, health care professionals, and practitioners engaged in continuing education in this area. The book will resonate particularly with physicians who want to improve the effectiveness of their practices with respect to both patient- and population-level health outcomes.
The book is effectively presented in three major parts. Part I addresses the major challenges and forces driving health care and health promotion and clearly establishes the need to apply new approaches. To reinforce his points, Skinner presents examples and data from both Canada and the United States. Part II details a five-step model for improving health organizations through behaviour change. These steps are: building motivation for improvement; strengthening capacities; identifying strategic directions; conducting critical functions analysis (i.e., a series of linked activities or processes to accomplish a specific goal in behavioural health care); and making improvements using rapid-cycle change (i.e., testing a small series of changes). Although specific details and references are not provided, Skinner claims “the approaches and tools have undergone extensive trials over the past seven years” across a wide variety of North American settings. The model appears to be a worthwhile heuristic; it is premised on theoretical and evidence-based support, is intuitive, practical, adaptable to a broad range of settings, and has relevance across a wide array of programs. Part III provides useful information for implementing information technology as an important and rapidly emerging mode of health care delivery.
Skinner's work has a number of strengths in dealing with the complexities of behaviour change within organizations. He provides theoretical support for practical strategies with appropriate summaries of much of the key literature, along with case studies, practical applications and numerous user-friendly assessment and planning tools that appear to be intuitively sound.
The book can be used in various ways, e.g., in self-directed learning, courses, workshops, case studies and organizational auditing. Practitioners and managers will undoubtedly gravitate to the “how-to” of the second part. Readers will also find the various links to other resources and references beneficial.
For the busy practitioner not fully cognizant of the complexities of organizational behaviour change in health care settings, there are no magic bullets or overnight fixes to achieve effective and sustainable solutions. To this end, reading this text (or parts within) will certainly be worthwhile for gaining solid guidance.
Ronald C. Plotnikoff Associate Professor Centre for Health Promotion Studies University of Alberta Edmonton, Alta.