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A conceptual model of health care, a theory of quality improvement in health care and the role of patient, physician and employee judgements as part of organisation‐wide improvement are introduced. The conceptual model of health care shows how the practitioner, the locus of care‐giving and the social context interact to meet the needs of patients and highlights potential sources of unwanted variation in outcomes. This theory of quality improvement stresses the continuous improvement of processes throughout the entire organisation to meet the needs and expectations of customers. Basic building blocks for continuous improvement ‐ knowledge of customers, knowledge of work as processes, and statistical and scientific thinking ‐ are discussed along with the need to transform the entire organisation. A method for gaining customer knowledge and for monitoring hospital quality, based on measuring quality from patients′, physicians′, and employees′ judgements of quality, is introduced. The method, called the Hospital Quality Trend (HQT) family of quality measures, is described and its uses to promote organisation‐wide quality improvement are illustrated. Health care work is complex and unique. Careful analysis of the way that work is done and knowledge of the customers in defining and improving quality is essential for achieving better quality and value from the health care system.

In 2002/3 the Health Foundation launched an ambitious five‐year Programme of investment in leadership development. This investment included resource for simultaneous evaluation (Lucas 2006). Against a background of unprecedented upheaval in healthcare systems in the UK, the Leadership Programme has evolved, encompassing initiatives aimed both at individuals and teams. The Programme has been refined to provide a more explicit focus on leadership for quality improvement. This article reviews what has been learnt from this investment to date, focusing on lessons both for practitioners and for academics.The focus of this paper is what has been learnt from running the Foundation's three individual leadership schemes over the past three years. The authors argue that to be effective talent spotting needs to develop rigorous mechanisms for identification of potential; that there needs to be a sustained focus on quality improvement outcomes if leadership programmes are to deliver more than personal development; that the most effective development is work rather than classroom‐based; and that organisational commitment for leadership development is critical if the full impact is to be realised. The authors draw on an extensive evidence base from the Programme evaluation, including some case studies.

This paper aims to compare and contrast quality improvement in the domain of health care disparities with quality improvement in other domains.

The author provides a descriptive essay and review to put forward the findings of their research.

In the USA, health care quality improvement systems have largely been accepted and institutionalized. Most if not all hospital and health care systems now have quality monitoring and improvement teams. In contrast, despite a plethora of stark reports in the literature showing that the US health care system has failed to deliver health care with equity when the care of Whites is compared with that of racial and ethnic minorities, there is not a parallel health care disparities improvement system in most health care settings.

Paralleling many steps that have been taken to improve quality in general, health care workers and health systems must take steps to improve structures and processes of care to reduce health care disparities.

Pinpoints some important distinctions between improving structures and processes of care related to health care disparities, and those related to other aspects of quality improvement. Doing so will save lives, and in the process improve overall quality.

Reviews the range of quality activity in a National Health Service hospital trust, using a staff questionnaire survey, self‐assessment against the Baldrige Quality Award criteria, and the application of the SERVQUAL approach to service quality assessment. Reviews the acute health care quality programme literature. Finds that there are needs for greater integration of quality effort, to engage with patients in a more meaningful manner, and to achieve greater commitment and involvement from clinicians and managers. Identifies lack of time and resources as a major barrier to greater application of quality programmes. Explores ways of developing a more holistic and integrated programme of quality improvement. Describes the creation and implementation of a model for continuous improvement in health care quality.

The quality approach, utilizing continuous improvement processes, is widely recognized as a vehicle for better outcomes in health care. In Mongolia, quality health systems have historically been poorly developed. Within the context of overall health reform, Mongolia has been emphasizing the development of quality systems to improve management, efficiency and clinical outcomes and processes. Mongolia has established a framework for quality assurance with the central Ministry of Health taking a lead role in developing and promulgating materials and organizing training. The focus has been on creating a governing system for quality in the health system with processes instituted at the hospital level and upwards in the health structure. In addition, the Mongolian framework has developed a range of indicators to guide the quality process. The commitment to quality is an integral part of comprehensive reform of the health sector in Mongolia and the principles of the quality approach – continuous improvement, customer focus, involvement of stakeholders, and among others – are currently being implemented across the health sector.

The importance of culture is often emphasized for continuous learning and quality improvement within health care organizations. Limited empirical evidence for cultivating a culture that supports continuous learning and quality improvement in health care settings is currently available.

The purpose of this report is to characterize the evolution of a large division of physical therapists and occupational therapists in a pediatric hospital setting from 2005 to 2018 to identify key facilitators and barriers for cultivating a culture empowered to engage in continuous learning and improvement.

An ethnographic methodology was used including participant observation, document review, and stakeholder interviews to acquire a deep understanding and develop a theoretical model to depict insights gained from the investigation.

A variety of individual, social, and structural enablers and motivators emerged as key influences toward a culture empowered to support continuous learning and improvement. Features of the system that helped create sustainable, positive momentum (e.g., systems thinking, leaders with grit, and mindful design) and factors that hindered momentum (e.g., system uncertainty, staff turnover, slow barrier resolution, and competing priorities) were also identified.

Individual-level, social-level, and structural-level elements all influenced the culture that emerged over a 12-year period. Several cultural catalysts and deterrents emerged as factors that supported and hindered progress and sustainability of the emergent culture.

Cultivating a culture of continuous learning and improvement is possible. Purposeful consideration of the proposed model and identified factors from this report may yield important insights to advance understanding of how to cultivate a culture that facilitates continuous learning and improvement within a health care setting.

The various quality improvement (QI) frameworks and maturity models described in the health services literature consider some aspects of QI while excluding others. This paper aims to present a concerted attempt to create a quality improvement maturity model (QIMM) derived from holistic principles underlying the successful implementation of system-wide QI programmes.

A hybrid methodology involving a systematic review (Phase 1) of over 270 empirical research articles and books developed the basis for the proposed QIMM. It was followed by expert interviews to refine the core constructs and ground the proposed QIMM in contemporary QI practice (Phase 2). The experts included academics in two academic conferences and 59 QI managers from the New Zealand health-care system. In-depth interviews were conducted with QI managers to ascertain their views on the QIMM and its applicability in their respective health organisations (HOs).

The QIMM consists of four dimensions of organisational maturity, namely, strategic, process, supply chain and philosophical maturity. These dimensions progress through six stages, namely, identification, ad-hoc, formal, process-driven, optimised enterprise and finally a way of life. The application of the QIMM by the QI managers revealed that the scope of QI and the breadth of the principles adopted by the QI managers and their HOs in New Zealand is limited.

The importance of QI in health systems cannot be overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality.

This paper contributes new knowledge by presenting a maturity model with an integrated set of quality principles for HOs and their extended supply networks.

This study seeks to investigate empirically the impact of organizational culture (bureaucratic, innovative, and supportive) and quality improvement practices.

Data used in this study were obtained through a questionnaire by random sampling, which took place in four large public hospitals, located in Irbid Governorate, Jordan, involving 271 managers, physicians, and nurses.

Quality improvement practices were measured by 16 statements on a five‐point rating scale. Each of the three types of organizational culture was measured using five items on a five‐point rating scale.

The three types of culture have a significantly positive influence on quality improvement practices, and account for 62 per cent of the variation of quality improvement practices. Compared with bureaucratic and supportive cultures, innovative culture appears to play a stronger role in quality improvement practices. Contrary to expectations, the analysis shows that bureaucratic actions enhance rather than hinder quality improvement practices. Respondents with a bachelor or a higher degree and participating in a training course related to quality reported higher prevalence of each culture and a higher level of quality improvement practices.

Innovative culture has a crucial role in quality improvement practices compared with bureaucratic and supportive cultures.

The purpose of this study is to benchmark the use of process improvement techniques among US health care organizations that won the Malcolm Baldrige National Quality Award.

The applications from 13 Baldrige award winning health care organizations were researched to determine which process improvement techniques were used most frequently to guide their operations.

The results from this study identify several best practices in process improvement techniques. Furthermore, the study pinpoints in which aspect of performance that a process improvement technique is most likely to be used.

Only applications from organizations winning the Baldrige award have been studied. The identity and application for organizations that do not win the award are not released to the public. Statistical analysis of the data is limited to the relatively small number (13) of award winners.

The results clearly show that there are certain process improvement techniques used by a majority of the Baldrige winners. It is not possible to guarantee that the use of these same techniques by other health care organizations will result in performance improvement, only that the winners used the techniques and have achieved a high level of performance. The results identify processes for further benchmarking studies.

The process improvement techniques identified in this study have been used by successful health care organizations. This information may be useful to other health care organizations when deciding on which process improvement techniques to pursue in order to improve their own performance. While the Baldrige award process has driven benchmarking efforts, this study uses the Baldrige process to identify benchmarking opportunities for process improvement in health care organizations.

The purpose of this paper is to examine how the design and implementation of learning models for performance management can foster continuous learning and quality improvement within a publicly funded, multi-site community hospital organization.

Niagara Health’s patient flow performance management system, a learning model, was studied over a 20-month period. A descriptive case study design guided the analysis of qualitative observational data and its synthesis with organizational learning theory literature. Emerging from this analysis were four propositions to inform the implementation of learning models and future research.

This performance management system was observed to enable: ongoing performance-related knowledge exchange by creating opportunities for routine social interaction; collective recognition and understanding of practice and performance patterns; relationship building, learning for improvement, and “higher order” learning through dialogue facilitated using humble inquiry; and, alignment of quality improvement efforts to organizational strategic objectives through a multi-level feedback/feed-forward communication structure.

The single organization and descriptive study design may limit the generalizability of the findings and introduce confirmation bias. Future research should more comprehensively evaluate the impact of learning models on organizational learning processes and performance outcomes.

This study offers novel insight which may inform the design and implementation of learning models for performance management within and beyond the study site.

Few studies have examined the mechanics of performance management systems in relation to organizational learning theory and research. Broader adoption of learning models may be key to the development of continuously learning and improving health systems.