Building Systemwide Improvement Capability: Does an Organization's Strategy for Quality Improvement Matter?

OBJECTIVES: Health care organizations have used different strategies to implement quality improvement (QI) programs but with only mixed success in implementing and spreading QI organization-wide. This suggests that certain organizational strategies may be more successful than others in developing an organization's improvement capability. To investigate this, our study examined how the primary focus of grant-funded QI efforts relates to (1) key measures of grant success and (2) organization-level measures of success in QI and organizational learning. METHODS: Using a mixed-methods design, we conducted one-way analyses of variance to relate Veterans Affairs administrative survey data to data collected as part of a 3.5-year evaluation of 29 health care organization grant recipients. We then analyzed qualitative evidence from the evaluation to explain our results. RESULTS: We found that hospitals that focused on developing organizational infrastructure to support QI implementation compared with those that focused on training or conducting projects rated highest (at α = .05) on all 4 evaluation measures of grant success and all 3 systemwide survey measures of QI and organizational learning success. CONCLUSIONS: This study adds to the literature on developing organizational improvement capability and has practical implications for health care leaders. Focusing on either projects or staff training in isolation has limited value. Organizations are more likely to achieve systemwide transformation of improvement capability if their strategy emphasizes developing or strengthening organizational systems, structures, or processes to support direct improvement efforts.

Social responsibility, international development, and institutional commitment: lessons from the Boston University experience.

Boston University (BU) has a long history of a strong social mission and commitment to service. In August 2003, BU made an institutional commitment to work with the country of Lesotho to tackle the human capital implications of the HIV/AIDS epidemic. Surrounded by South Africa, and with a population of two million, Lesotho, a stable democracy, suffers the world's third-highest adult HIV prevalence rate of about 24%. The initiation of the program required a substantial initial institutional investment without any promise of payback. This allowed BU to begin work in Lesotho while searching for additional funds. The government of Lesotho and BU agreed to focus on preserving the lives of Lesotho's citizens, building the capacity of the country's workforce, and maximizing the efficiency of Lesotho's existing systems and resources. Initial activities were modest, beginning with workshops on problem solving, then the launch of a primary care clinic that offered HIV/AIDS treatment services at the nation's only teacher training college. With support from the W.K. Kellogg Foundation, the main focus is now on strengthening district-level primary care services, including the initiation of a family medicine residency training program in cooperation with the University of the Free State in Bloemfontein. The initial commitment has developed into a mutual partnership, with benefits to country and university alike. By combining the expertise from various schools and departments to focus on a single country, a university can significantly advance international development, strengthen its service mission, enrich teaching, and provide new opportunities for research.