RT Journal Article
SR Electronic
T1 Central versus Local Quality Efforts: The Need for Both
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 1038
OP 1041
DO 10.3122/jabfm.2021.05.210015
VO 34
IS 5
A1 Caron, Aleece
A1 Pronovost, Peter
YR 2021
UL http://www.jabfm.org/content/34/5/1038.abstract
AB Healthcare is in need of improvement. It harms too often, costs too much, learns and improves too slowly, and burns out its workforce. Large healthcare systems (HCS) have an important role in influencing the quality and value of care. Still, as systems that, in most cases, have grown and emerged rapidly in the last 20 years, few have organizational structures to support and foster the last aim, creating the conditions for the healthcare workforce to find joy and meaning in their work. HCS struggle to develop quality improvement (QI) because they are diverse and dynamic in composition, size, resources, culture and social structures, and needs. This diversity may drive forces for change or may undermine QI efforts. Clinical teams often rely on local QI efforts to improve care at the delivery site. At the same time, managers and executives focus on a centralized, system-wide approach, generally focused on externally reported metrics. We propose that a hybrid of the 2 most popular healthcare QI approaches, local QI and centralized QI, might be the best method for achieving and sustaining quality care across a wide variety of conditions.