title: Creating a fractal-based quality management infrastructure.
abstract: OBJECTIVE
  The purpose of this paper is to describe how a fractal-based quality management infrastructure could benefit quality improvement (QI) and patient safety efforts in health care.
  
  
  METHODS
  The premise for this infrastructure comes from the QI work with health care professionals and organizations. The authors used the fractal structure system in a health system initiative, a statewide collaborative, and several countrywide efforts to improve quality of care. It is responsive to coordination theory and this infrastructure is responsive to coordination theory and repeats specific characteristics at every level of an organization, with vertical and horizontal connections among these levels to establish system-wide interdependence.
  
  
  RESULTS
  The fractal system infrastructure helped a health system achieve 96 percent compliance on national core measures, and helped intensive care units across the USA, Spain, and England to reduce central line-associated bloodstream infections.
  
  
  CONCLUSIONS
  The fractal system approach organizes workers around common goals, links all hospital levels and, supports peer learning and accountability, grounds solutions in local wisdom, and effectively uses available resources.
  
  
  CONCLUSIONS
  The fractal structure helps health care organizations meet their social and ethical obligations as learning organizations to provide the highest possible quality of care and safety for patients using their services.
  
  
  CONCLUSIONS
  The concept of deliberately creating an infrastructure to manage QI and patient safety work and support organizational learning is new to health care. This paper clearly describes how to create a fractal infrastructure that can scale up or down to a department, hospital, health system, state, or country.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Jill A
authors.initials: JA
authors.lastname: Marsteller
mesh_terms: D055499:Catheter-Related Infections / Q000517:prevention & control; D017598:Efficiency, Organizational; D004739:England; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D013030:Spain; D014481:United States