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This conceptual model helps to understand how organizations move from short-term performance improvements to sustained, organization-wide patient care improvements. The model has five critical elements or drivers of change:

  • Impetus to transform,
  • Leadership commitment to quality,
  • Improvement initiatives that actively engage staff in meaningful problem solving,
  • Alignment to achieve consistency of organizational goals with resource allocation and actions at all levels of the organization, and
  • Integration to bridge traditional intra-organizational boundaries among individual components. 

These elements drive change by affecting the components of the complex healthcare organization in which they operate: 1) Mission, vision, and strategies that set its direction and priorities; 2) Culture that reflects its informal values and norms; 3) Operational functions and processes that embody the work done in patient care; and 4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization.

The elements identified as critical to successful transformation have been studied before. The model’s contribution lies in bringing them together to show how they behave and interact in healthcare systems striving for perfection.

The five critical elements of the model do not operate in isolation.  Rather, they occur in and through the context of complex and dynamic healthcare organizations.  Substantial systemic change requires interaction of the key elements with one another and with the rest of the organization.  To achieve transformation, the five elements not only interact with each other but also drive change through the organization’s mission, culture, infrastructure, and operations. 

Transformation of healthcare systems is a complex and difficult undertaking.  Each model element offers direct practice implications for system managers seeking to change their systems to improve patient care.  No single element is sufficient to achieve organizational transformation.  For example, successful improvement projects can contribute importantly to improved quality, but improvement projects alone do not ensure sustainability of the improvements, including the spread of core values and expectations, the engagement of staff in delivering near-perfect care, and the skills and methods for achieving it.  Managers should recognize that all model elements need to be part of organizational transformation, and that the challenge is to maximize the likelihood that the elements and the organization will interact in complementary ways to maintain urgency to change and to move the organization forward.  Full transformation may be attained only when multiple improvements are spread across the system and sustained over time.

Successful transformation takes time.  Transformation (and the attainment of near-perfect care) most likely unfolds over a decade or more.  Transformation can be thought of as a continuing journey with no fixed endpoint.  Changes and adaptations always are needed to stay abreast of the volatile healthcare environment and the discovery of new areas for improvement.