Healthcare is in need of improvement. It harms too often, costs too much, learns and improves too slowly, and burns out its workforce. Large healthcare systems (HCS) have an important role in influencing the quality and value of care. Still, as systems that, in most cases, have grown and emerged rapidly in the last 20 years, few have organizational structures to support and foster the last aim, creating the conditions for the healthcare workforce to find joy and meaning in their work. HCS struggle to develop quality improvement (QI) because they are diverse and dynamic in composition, size, resources, culture and social structures, and needs. This diversity may drive forces for change or may undermine QI efforts. Clinical teams often rely on local QI efforts to improve care at the delivery site. At the same time, managers and executives focus on a centralized, system-wide approach, generally focused on externally reported metrics. We propose that a hybrid of the 2 most popular healthcare QI approaches, local QI and centralized QI, might be the best method for achieving and sustaining quality care across a wide variety of conditions.

中文翻译：

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中央与地方质量努力：两者都需要

医疗保健需要改进。它伤害太频繁，成本太高，学习和改进太慢，并且耗尽了它的劳动力。大型医疗保健系统 (HCS) 在影响护理质量和价值方面发挥着重要作用。尽管如此，作为在大多数情况下在过去 20 年中迅速发展和兴起的系统，很少有组织结构来支持和促进最后一个目标，为医疗保健人员创造条件，在他们的工作中找到乐趣和意义。HCS 努力发展质量改进 (QI)，因为它们在组成、规模、资源、文化和社会结构以及需求方面具有多样性和动态性。这种多样性可能会推动变革或破坏 QI 的努力。临床团队通常依靠当地 QI 的努力来改善交付地点的护理。同时，管理人员和高管关注集中的、全系统的方法，通常关注外部报告的指标。我们建议混合两种最流行的医疗保健 QI 方法，即本地 QI 和集中式 QI，可能是在各种条件下实现和维持优质护理的最佳方法。