Transformational Change in Health Care Systems

An Organizational Model

In 2001, the Institute of Medicine (IOM) released the report Crossing the Quality Chasm: A New Health Care System for the 21st Century that recommended redesigning systems of health care at all organizational levels to achieve safer and higher-quality care for patients. This article offers a conceptual model for understanding how organizations can move from short-term performance enhancements to sustained, organization-wide patient care improvements. The researchers conducted comparative case studies based on interviews and document review in 12 health care systems over a 3.5-year period. Seven of the systems studies were funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and the other five had long-standing commitments to improving quality of care.

From the analysis of the 12 sites, the researchers found five critical elements to a health care organization's success in effecting sustained change. These five elements are: (1) impetus to transform; (2) leadership commitment to quality; (3) improvement initiatives that actively engage staff; (4) alignment of organizational goals with resource allocation and actions at all levels of the organization; and (5) integration of structures and processes across the organization. These case studies provide a model that will help other health care systems to transform their processes.