The quality of healthcare in the UK and the USA: looking back, moving forward

Vollständiger Abstract

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This paper updates an implementation framework we first proposed 25 years ago for improving the quality of healthcare in the UK and USA, based on a multilevel approach to change involving the four core properties of: distributed leadership, a learning-oriented culture, team-based care and information technology applications. We now add a fifth, relational coordination. We assess subsequent developments to improve healthcare quality in both countries. While each has made some progress, they fall short of what is needed to address the evolving challenges of ageing populations, growing inequities in care and incorporating advances in cell, gene, informational and related technologies and therapies. We examine the macro policy contexts in the two countries that influenced past efforts to improve the quality of care, review the current state of quality initiatives, consider specific examples each country implemented and suggest what is needed in moving forward.