• Margaret C Wang, Jenny K Hyun, Michael Harrison, Stephen M Shortell, and Irene Fraser.
• The RAND Corporation, Santa Monica, California, USA. mcywang@rand.org
• Jt Comm J Qual Patient Saf. 2006 Nov 1;32(11):599-611.

BackgroundIt has been five years since the Institute of Medicine (IOM) report, Crossing the Quality Chasm, proposed systemwide changes to transform our health care system. What progress has been made? What lessons have been learned? How should we move forward?MethodsSemistructured telephone interviews were conducted with 16 health care providers and researchers at organizations involved in system redesign. The findings were supplemented with a focused literature review and discussions from a national expert meeting.ResultsMany promising and innovative examples of redesign were identified. However, even delivery systems that are redesigning care in pursuit of the six IOM aims face daunting challenges, reflecting the need to align system changes across multiple levels and to integrate redesign efforts with ongoing system features. Four success factors were reported by providers as crucial in overcoming redesign barriers: (1) directly involving top and middle-level leaders, (2) strategically aligning and integrating improvement efforts with organizational priorities, (3) systematically establishing infrastructure, process, and performance appraisal systems for continuous improvement, and (4) actively developing champions, teams, and staff. A framework that integrates these success factors to facilitate a systems approach to redesigning health care organizations and delivery systems for improved performance is provided.ConclusionsSuccessful system redesign requires coordinating and managing a complex set of changes across multiple levels rather than isolated projects.

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