How to Make Systems Changes
for Improved Care

Changes at Various Levels

In addition to efforts to improve patients and/or provider outcomes, change can be brought about at the community level, with groups of providers, or with individual providers.

Community Changes: Community campaigns and partnerships involve organizations in coordinated activities to share knowledge about desired practices and to carry out improvement work. The partners could line up intellectual and perhaps financial resources to address a common topic of interest, and agree to execute a single, unified set of activities to address that topic. For example, they might agree to develop infrastructure to nurture health-promoting behavior and community initiatives on active lifestyles. For more information on developing community partnerships, click here.

Group Changes: Groups of interested medical providers or organizations may agree to conduct quality improvement projects. Leaders will need to organize the effort and seek expertise as needed about conducting a project. Instruction might be needed on training in the use of self-measurement tools, best practices, process change tools, and rapid cycle improvement. The groups could join a functioning collaborative in which members work on similar processes (e.g. increasing rates of eye, feet, and kidney examinations for persons with diabetes) and share their experience with the other members of the collaborative to accelerate the rate of improvement.

Collaborative improvement is based on the following premises:12

1. A substantial gap exists between knowledge and practice in diabetes care.
2. Broad variation is pervasive in clinical practice.
3. Examples of improved practices and outcomes exist, but they need to be described and disseminated to other potential users.
4. Collaboration between professionals working toward clear aims enables improvement.
5. Health care outcomes are the result of processes rather than individual efforts.
6. Understanding the methods of rapid cycle improvement can accelerate demonstrable improvement.

Individual Changes: Individual practices or healthcare organizations may choose to work on their own improvement projects. As in the group model, training in self-measurement tools, best practices, process change tools, and rapid cycle improvement is needed for the success of these projects. Support for these activities may be available through local Quality Improvement Organizations, internal quality improvement professionals or purchasers of health care plans.

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