Engineering quality through organization change: a study of patient care initiatives by teams

This report presents a summary and analysis of the continuous quality improvement and organizational change and redesign initiatives undertaken by the unit and service boards organized under the auspices of the HORIZONS Project. Board initiatives were identified and summarized by staff through interviews with the chairpersons and representatives of the boards and review of records. Forty-nine projects from the three pilot units were identified. Each project was classified according to outcome--positive, negative, mixed, and unknown. Sixty percent of initiatives had positive outcomes, and only three initiatives (6%) were negative. Case characteristics were summarized according to board identification, problem, outcome indicators, data baseline, proposed and selected solutions, implementation strategy, monitoring plan, results, change issues, and lessons learned. The study concludes that the board initiatives embody the HORIZONS Projects approach to improving patient care and improving quality of working life for staff and doing so in a budget-neutral manner. The HORIZONS boards process has moved the organization toward more open, collaborative forms of decision making than hitherto practiced.