Reengineering the Lithuanian healthcare system: a hospital quality improvement initiative

A tertiary-level academic hospital in Kaunas, Lithuania, adopted a continuous quality improvement (CQI) management paradigm from June 1996 through July 1997 in response to new political, economic, and social environments. This article presents an overview of the hospital's strategy, initial steps, and main accomplishments, as well as mitigating factors that arose in its quest to manage its own resources. Because historical influences are key to understanding the Lithuanian healthcare system, this discussion includes pre- and post-independence dynamics that caused a multidisciplinary hospital management team to choose a CQI approach that targets organizational and professional structures for change. In addition, it identifies environmental factors, internal and external to the hospital organization, that influence the continued development and sustainability of these healthcare management reform efforts.