The Modern Quality System Organizes the Drive for Outcomes

Legislative changes, cost and quality forces, publicly reported quality data, and changing consumer demand are converging on healthcare quality management systems. With all of this attention, there is evidently no shortage of advice regarding what needs to improve. But the real question, as we see it, is how do hospitals and healthcare providers build momentum for change using latent capacity and available resources? We’re optimisitc about taking up this question. We hope you stick around and share your insights.

With over 20 years of leadership practice in a variety of healthcare settings, we’ve learned a good deal about what works. What’s striking to us these days is the intense industry focus on improvement styles. Since there is scant evidence of a superior healthcare improvement model, and since models, in general, are not culturally transportable from one organization to another, the ongoing emphasis is remarkable.

Perhaps even more interesting to us is the seemingly bland interest in quality management fundamentals. We wonder, when did leadership, infrastructure, and core operating systems take a back seat? Some may reason that when QI models are deployed properly, these challenges are confronted. We disagree. Style almost never prevails over substance. If the foundation is weak, the building will eventually fall regardless of how clever the framework. Evidently, this is why we have yet to see one improvement model rise above all the others. We think the enthusiasm for an elite improvement framework is misguided. We have nothing against these models and we’ve employed many of them in our own practice – generally with good success. But in our view, the improvement style is far less important than the infrastructure and culture with which you plan to implement it. This makes us freethinkers when it comes to Six Sigma or FADE or PDSA or DMAIC, or AI, etc.; they are all sensible choices in our view.

In short, we’re systems thinkers and QMS operations geeks. We believe that good system design is fundamental to organizational success. Because healthcare delivery is a dynamic endeavor, adaptability and balance are the new organizational competences. We see the modern QMS as an integral part of the value solution.

In keeping with these principles, Fieldnotes focuses on strategies for achieving a whole-system approach to cost and quality improvement. This includes: leadership techniques, infrastructure reform, advanced system design, cultural transformation, and the relentless correlation of process and outcome. We believe these concepts have relevance to hospitals and healthcare providers of all shapes and sizes. We hope to inspire our fellow colleagues to challenge the status quo and to think differently about quality management. We’ll know that we’re making progress when our readers share their own tactics and success stories for pushing the modern QMS forward. We foresee and eagerly anticipate the chance to grow our knowledge and learn with you.

I sincerely hope you join in!

Kind regards,

Kimberley Kresevic RN, BSN, MBA


Kim is currently President and CEO of Opt2Lead, a healthcare consultancy based in Cleveland, Ohio. She earned her BSN from Kent State University and her MBA from Tiffin University. She is certified in Appreciative Inquiry for Positive Organizational Change from Case Western Reserve University Cleveland, Ohio.