A simple framework for complex system improvement

Abstract

The need to rapidly improve health care value is unquestioned, but the means to accomplish this task is unknown. Improving performance at the level of the health care organization frequently involves multiple interventions, which must be coordinated and sequenced to fit the specific context. Those responsible for achieving large-scale improvements are challenged by the lack of a framework to describe and organize improvement strategies. Drawing from the fields of health services, industrial engineering, and organizational behavior, a simple framework was developed and has been used to guide and evaluate improvement initiatives at an academic health center. The authors anticipate that this framework will be helpful for health system leaders responsible for improving health care quality.

Keywords: academic medical center; quality improvement; quality management framework.

Figure 1. Variation in colorectal cancer screening performance in 2007 between UW Health primary care clinics and physicians practicing at those clinics

Black bubbles indicate average clinic performance for colorectal cancer screening (denominator is the population of patients who are included in the WCHQ denominator definition for this test and are included on the panel for a primary care physician practicing at that clinic). White bubbles indicate individual physician performance related to colorectal cancer screening for those patients on the physician’s panel and included in the WCHQ denominator definition. The size of the white bubble corresponds to the number of patients on the physician’s panel who are eligible for colorectal cancer screening. Providers with fewer than 30 patients in the denominator were excluded from these analyses. Abbreviations: WCHQ, Wisconsin Collaborative for Healthcare Quality

Figure 2. 2007 colorectal cancer screening rates among WCHQ provider groups: Black bubble indicates UW Health performance

White bubbles are the other provider groups reporting to WCHQ. Size of the bubbles corresponds to the size of the denominator (number of patients eligible for screening at each organization). These data were measured from January 1, 2007 to December 31, 2007. Abbreviations: WCHQ, Wisconsin Collaborative for Healthcare Quality.

Figure 3. Variation between UW Health and other provider groups reporting to the Wisconsin Collaborative for Healthcare Quality in colorectal cancer screening

Bubble size corresponds to the size of the denominator (the number of patients at each organization who are eligible for this screening). Black bubbles indicate UW Health performance. White bubbles indicate other providing groups reporting to the WCHQ. UW Health eligible patient population by year: 2008, n = 3,647; 2009, n = 39,454; 2010, n = 38,848; 2011, n = 40,129; 2012, n = 41,857. Abbreviations: UW, University of Wisconsin; WCHQ, Wisconsin Collaborative for Healthcare Quality