Leadership and culture are often blamed when underlying systems are the real problem.
July 12, 2024
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When efforts to improve health care fall short, the failures are often blamed on leadership and culture. But the main problem often is the underlying systems. To generate better outcomes, increase safety, and improve efficiency, health care organizations should shift their focus to designing systems that facilitate delivery of the highest-quality care.
Over the past three decades, many health systems have pursued improvements in care delivery to make it safer, more effective, and more efficient. Many banners have flown over this work: quality improvement, systems change, lean daily management, performance improvement, to name a few. When these activities fail to deliver on expected goals, two common and inter-related failure modes are usually cited: leadership and culture. Leadership because it has failed to create conditions that would lead to the improvement succeeding; and culture because it has failed to be the fertile soil in which the improvement could take root.
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Kedar S. Mate, MD, is president and chief executive officer of the Institute for Healthcare Improvement and a member of the faculty of Weill Cornell Medical College.
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Josh Clark is a vice president at the Institute of Healthcare Improvement. Prior to joining IHI, Josh served as the senior vice president of quality and safety operations at Jefferson Health, an 18-hospital system covering the greater Philadelphia region and southern New Jersey, and senior director of quality and safety at Carilion Clinic, a health system based in Roanoke, Virginia.
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Jeff Salvon-Harman, MD, is vice president of safety at the Institute for Healthcare Improvement.
