Transferring Breakthrough Series to Finland – drift, adaptation, or an entirely new model?

Abstract The description of BTS presented by IHI does not explicitly state its theoretical background but emphasises the Model for Improvement and series of PDSA cycles. The philosophical roots of the PDSA-cycle are in the pragmatist ideas of reflective inquiry and learning. These were applied by Walter Steward and Edward Deming who started the movement for quality management and continuous improvement in the 1920s. In the 1950s, the PDSA cycle was adopted into Lean philosophy in which it was used, against Deming's original idea, to emphasise checking and controlling instead of open spiral enabling learning and innovation. In 1999, the original BTS inspired the development of a conceptual model for improved access to primary health care in Sweden. The BTS was not adopted fully as the purpose and function were different. Instead, the pedagogical structure was transferred to Sweden and from there adopted to Finland through several projects (2010-2023). In 2022, the Finnish model was adapted for two entirely new purposes. Today, it can be argued that the two national versions of BTS, used to design new practices in Finland, combine two theoretically and epistemologically different approaches. They are 1) industrial management and Lean-thinking aiming to efficiency and leaning on standardization and control and 2) employee-driven development work emphasizing learning and innovation by empowering employees to initiate solutions to problems at their work. At this stage, the adaptations had significantly changed the original aim of BTS to implement evidence-based practices designed by experts on the subject matter. Thus, it can be questioned whether the coaching model is anymore an adaptation of BTS, a drifted version or an entirely new model. Similar to the original BTS is the pedagogical structure and Model for Improvement. Our two empirical studies try to find out how the elaborated versions with partly incompatible theoretical roots involved, function and succeed with their aims.