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Leadership Commitment & Support

Leadership commitment to quality and change – beginning at the top of the organization but including all levels – is a critical element for organizational transformation.  Leadership is shown in the upper left corner of the model to reflect the importance of senior leadership promoting change down through the organization.

Senior leadership drives change in two ways:

  • First, senior leaders steer change through the organization’s structures and processes to maintain urgency, set a consistent direction, reinforce expectations, and provide resources and accountability to support change.  They set the path for other model elements and for the interactions among those elements in the larger organization.
  • Second, in order to create the climate and momentum for dramatic improvement in patient care, leaders need to demonstrate authentic passion for and commitment to quality.  Many expend significant personal capital to inspire and motivate staff, often leading by example through personal involvement in QI efforts.

Leadership involves more than the CEO.  Engagement of the larger senior leadership team provides important linkages and facilitated cultural change throughout the organization.  While leadership strategies began at the top of the organization, improvement is greater when middle and front-line managers are also committed to quality, being actively involved in supporting process redesign and wholly aligned around the importance of quality improvement.


At Site D the CEO spoke of engendering an “edgy, impatient culture” around patient care quality.  Although QI operations were led by a highly effective physician leader, the CEO remained personally involved, both as a champion for a clinical improvement team (despite not being a clinician) and as a member of the quality integrating committee.  The CEO also worked actively behind the scenes to clarify expectations and to resolve problems.


At Site F, the full senior leadership team (including the CEO) began each day with patient rounding in which team members asked patients and frontline staff  specific questions about their experiences and then engaged in a debriefing session to resolve identified issues.  Senior leaders also were required to serve as champions for improvement projects, with responsibility for linking the team to other senior managers who could help to resolve barriers.