title: Building Systemwide Improvement Capability: Does an Organization's Strategy for Quality Improvement Matter?
abstract: OBJECTIVE
  Health care organizations have used different strategies to implement quality improvement (QI) programs but with only mixed success in implementing and spreading QI organization-wide. This suggests that certain organizational strategies may be more successful than others in developing an organization's improvement capability. To investigate this, our study examined how the primary focus of grant-funded QI efforts relates to (1) key measures of grant success and (2) organization-level measures of success in QI and organizational learning.
  
  
  METHODS
  Using a mixed-methods design, we conducted one-way analyses of variance to relate Veterans Affairs administrative survey data to data collected as part of a 3.5-year evaluation of 29 health care organization grant recipients. We then analyzed qualitative evidence from the evaluation to explain our results.
  
  
  RESULTS
  We found that hospitals that focused on developing organizational infrastructure to support QI implementation compared with those that focused on training or conducting projects rated highest (at α = .05) on all 4 evaluation measures of grant success and all 3 systemwide survey measures of QI and organizational learning success.
  
  
  CONCLUSIONS
  This study adds to the literature on developing organizational improvement capability and has practical implications for health care leaders. Focusing on either projects or staff training in isolation has limited value. Organizations are more likely to achieve systemwide transformation of improvement capability if their strategy emphasizes developing or strengthening organizational systems, structures, or processes to support direct improvement efforts.
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts (Drs Babich, Charns, McIntosh, Lerner, Burgess, and VanDeusen Lukas and Ms Stolzmann); and Departments of Family Medicine (Dr Babich) and Health Law, Policy, and Management (Drs Charns, Burgess, and VanDeusen Lukas), Boston University, Boston, Massachusetts.
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Babich
authors.forename: Martin P
authors.initials: MP
authors.lastname: Charns
authors.forename: Nathalie
authors.initials: N
authors.lastname: McIntosh
authors.forename: Barbara
authors.initials: B
authors.lastname: Lerner
authors.forename: James F
authors.initials: JF
authors.lastname: Burgess
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stolzmann
authors.forename: Carol
authors.initials: C
authors.lastname: VanDeusen Lukas
mesh_terms: D057191:Capacity Building / Q000458:organization & administration*; D006298:Health Services Administration; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D009936:Organizational Innovation; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012109:Research Support as Topic / Q000706:statistics & numerical data