The application of a person-centred approach to process improvement in ophthalmology services in the North East of the Republic of Ireland

Background: Ophthalmology in the Republic of Ireland has one of the longest waiting lists in healthcare, with around 44,000 people awaiting a first outpatient appointment. In the north-east region, 12,500 people are waiting. The North-Eastern Region Integrated Eye Care Service (NERIECS) was established in 2021 to improve patient care and access to services. A key driver for the team was to understand ‘how we work together’ to enable a shared vision of change within regional services. Aim: To support hospital and community ophthalmology services, which comprise eight organisations in the region, to prepare for the development of system-level integration of eyecare services. Methods: We integrated a popular process-improvement methodology, Lean Six Sigma, with a person-centred approach to support staff to develop a shared vision of change and to deliver improvements for ophthalmology services. Findings: The integrated approach enabled staff to work in ways that supported the development of good quality, person-centred care that takes account of the outcomes for and experiences of ophthalmology patients and their families, and of staff. Conclusions: Our work builds on a recent study that identified coherence in the underlying philosophy, intention, method and outcomes of Lean Six Sigma and person-centred approaches to healthcare improvement, highlighting the added value of an integrated approach in enabling improvement that positively impacts patient outcomes and healthcare culture. Implications for practice: The application of an integrated approach to process improvement in healthcare is shown to be effective beyond a single study site, having a positive impact across geographic and organisational boundaries, and across levels of care (primary, secondary, tertiary and post-acute) The integrated approach puts the focus on synergies between both methodological approaches and avoids improvement work being reduced to the use of a decontextualised toolkit