Removing Obstacles to Quality Improvement for Academic Health Centers

In 2001, RWJF authorized $20.9 million for a national program, Pursuing Perfection®: Raising the Bar for Health Care Performance, to help hospitals and physician organizations improve patient outcomes throughout the continuum of health care.

However, during the course of the 2001 grant competition, RWJF staff became concerned that it appeared that many leading academic health centers did not apply to the program and, among those that did, few were successful in receiving grants.

In November 2002, RWJF provided a seven-month grant to the General Hospital Corporation – Massachusetts General Hospital to examine why academic health centers seemed to fare poorly in the grant competition and to make recommendations on how they can improve quality of care at their institutions.

Key Findings

Findings in a report prepared for RWJF, Promoting Quality Improvement at Academic Health Centers: Building on Pursuing Perfection, include:

  • Quality improvement work is "orders of magnitude" harder in academic systems than in other health care settings.
  • The most important barriers to improvement in academic health centers include:
    • Complex missions of research, teaching and patient care.
    • Academic culture.
    • Large organizational size.
    • Weaknesses of governance process.
    • Underdeveloped strategic and operational planning and development.
    • Lack of reward and accountability for performance improvement.
  • There is strong resistance within academic health centers to rhetoric suggesting that quality improvement is a "movement"; such rhetoric creates the perception that improvement is a management fad at best or cult-like activity at worst.
  • Many academic health centers demonstrate commitment to improvement.
  • Unsuccessful academic health center applicants to the Pursuing Perfection process expressed considerable frustration over the lack of feedback concerning the reasons that their applications were rejected.
  • The following factors were most often cited as important to people reviewing the Pursuing Perfection applications:
    • Degree or quality of leadership commitment to the proposed improvement initiatives.
    • Principal investigator time availability and competing responsibilities.
    • Overall institutional commitment to improvement and change.
    • Sufficiency of resources committed to the project.
    • Likelihood that the institution needed and would benefit from the grant.