title: Large-scale improvement initiatives in healthcare: a scan of the literature.
abstract: BACKGROUND
  The goal of this article is to provide a succinct scan of the literature as it relates to the current thinking and practice in large-scale improvement initiatives in healthcare.
  
  
  METHODS
  We employed a scan of the literature using a modified Delphi technique. A standard review form was used. The scan was limited to large-scale spread efforts in hospitals and healthcare systems. Each of the main factors that emerged during the scan was linked to secondary factors and organized using a driver diagram.
  
  
  RESULTS
  Four primary drivers (factors) emerged during our scan that inform large-scale change initiatives in healthcare: Planning and Infrastructure; Individual, Group, Organizational, and System Factors; The Process of Change; and Performance Measures and Evaluation.
  
  
  CONCLUSIONS
  Our scan identified a tremendous amount of work being done around the world to improve healthcare. In general, our findings suggest these initiatives tend to be fragmented from an implementation standpoint. We identified primary and secondary drivers (factors) that can be used by those responsible for implementing large-scale improvement initiatives both at a strategy level and in their daily work. These drivers could serve as a "checklist" of ideas to consider in different testing and implementation situations.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, USA. Rocco.Perla2@umassmemorial.org
authors.forename: Rocco J
authors.initials: RJ
authors.lastname: Perla
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bradbury
authors.forename: Christina
authors.initials: C
authors.lastname: Gunther-Murphy
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D003697:Delphi Technique; D004496:Education, Continuing / Q000379:methods / Q000639:trends; D017598:Efficiency, Organizational; D014943:Global Health; D006282:Health Personnel / Q000193:education*; D006295:Health Resources / Q000592:standards* / Q000639:trends; D006801:Humans; D015279:Organizational Culture; D009936:Organizational Innovation; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D060756:Social Networking