Abstract
AbstractFragmented, people‐intensive processes and entrenched cultural issues are among the thorny realities of cost and quality improvement in healthcare settings. The unconventional hybrid approach of Shriners Hospitals for Children goes to the heart of the problem and also entailed a “middle‐out” deployment that tackled the politics of change. The author describes the strategy for building buy‐in and participation among clinicians and other staff and for demonstrating the program's potential benefits in order to eventually win board‐level endorsement. The program, which integrates a portfolio of improvement methodologies, project management training and tools, and change agents and change leaders from across the organization, is already producing measurable gains for the health system. © 2009 Wiley Periodicals, Inc.
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