This course focuses on understanding how health care organizations and broader health systems create and implement strategies to improve care. The course builds upon the quality knowledge, skills, and methods provided in the Leadership and Managing Change course, the Concepts and Strategies in Patient Safety course and Fundamentals course. In this course we shift focus from an emphasis on quality improvement and patient safety at a team or microsystem level to emphasize the key elements of organizations and broader health care systems needed to implement, spread, and sustain improvements in turbulent health care environments. What knowledge do leaders need to support improvement? What is the role of governing boards? What benefit and how can we include patients in the design of care processes and systems? How do electronic health records help to promote quality improvement and patient safety? Case studies, guest lectures, readings, discussions, and exercises will be use to identify key issues facing health care systems, strategies for addressing these issues and the factors that influence successful implantation of organizational and system-wide improvement efforts.

Objectives: 1) Analyze the critical skills and knowledge that leaders need to lead change in health care organizations. 2) Assess the strategies leaders use to create effective quality and patient safety strategies in organizations and broader systems. 3) Understand how organizations need to assess risk and deal with organizational failures. 4) Identify the strategies needed for effective governance of quality and patient safety and appraise their implementation in various settings. 5) Explain the impact that engaging patients can have on improvement strategies and assess the approaches used to engage patients in these efforts. 6) Appraise the role of electronic health records in large scale improvement. 7) Assess the role of quality councils, Ministries of Health and other support groups in monitoring and guiding system change. 8) Identify the characteristics of high performing health care systems and judge the effectiveness of current systems in adopting and implementing these strategies.