When efforts to improve healthcare fall short, failures are often blamed on leadership and culture. Yet the primary problem is often the underlying systems. To produce better outcomes, increase safety, and improve efficiency, healthcare organizations must shift their focus to designing systems that foster the delivery of the highest quality healthcare.
Over the past 30 years, many health systems have striven to improve health care delivery to make it safer, more effective, and more efficient. This effort has been met with many slogans, including quality improvement, systems change, lean management, and performance improvement. When these efforts fail to achieve their expected goals, two common and interrelated failure modes are usually blamed: leadership and culture. Leadership failed to create the conditions for improvement to succeed, and culture failed to become the fertile soil for improvement to take root.