Quality improvement as a primary approach to change in healthcare: a precarious, self-limiting choice?

Abstract

Argyris's contention above begs the question: Is quality improvement as a primary approach to change in healthcare potentially self-limiting? Our viewpoint is yes, particularly when fundamental underpinnings and mental models are not continually surfaced and challenged.1 2 We propose two imbalances underlie why quality improvement as a primary approach to change in healthcare can become self-limiting: prioritising performance (improving organisational-level quality measures) over participants' (improvement leaders, facilitators, team members) emotional experience, and privileging process-technical over sociobehavioural design elements.3 Contributing to these imbalances are performance-driven cultures (eg, zero-harm' goals4), pacesetting leadership styles,5 and environmental and organisational pressures for rapid, substantial improvement.