Redesigning health systems for quality: Lessons from emerging practices

Margaret C. Wang, Jenny K. Hyun, Michael I. Harrison, Stephen M. Shortell, Irene Fraser

Research output: Contribution to journalArticlepeer-review

68 Scopus citations

Abstract

Background: It has been five years since the Institute of Medicine (IOM) report, Crossing the Quality Chasm, proposed systemwide changes to transform our health care system. What progress has been made? What lessons have been learned? How should we move forward? Methods: Semistructured telephone interviews were conducted with 16 health care providers and researchers at organizations involved in system redesign. The findings were supplemented with a focused literature review and discussions from a national expert meeting. Results: Many promising and innovative examples of redesign were identified. However, even delivery systems that are redesigning care in pursuit of the six IOM aims face daunting challenges, reflecting the need to align system changes across multiple levels and to integrate redesign efforts with ongoing system features. Four success factors were reported by providers as crucial in overcoming redesign barriers: (1) directly involving top and middle-level leaders, (2) strategically aligning and integrating improvement efforts with organizational priorities, (3) systematically establishing infrastructure, process, and performance appraisal systems for continuous improvement, and (4) actively developing champions, teams, and staff. A framework that integrates these success factors to facilitate a systems approach to redesigning health care organizations and delivery systems for improved performance is provided. Conclusions: Successful system redesign requires coordinating and managing a complex set of changes across multiple levels rather than isolated projects.

Original languageEnglish
Pages (from-to)599-611
Number of pages13
JournalJoint Commission Journal on Quality and Patient Safety
Volume32
Issue number11
DOIs
StatePublished - Nov 2006
Externally publishedYes

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