Author Affiliation: Institute for Healthcare Improvement, Boston, Mass.
Students of improvement in complex, human systems have mixed feelings
about public report cards on performance. Here is the problem: On the one
hand, all improvement is change, and human systems resist change. Therefore,
improvement requires a source of tension, discomfort with the status quo, sufficient to overcome this inertia. Sometimes a charismatic
leader or a call upon ambition is enough, but usually not. In the commercial
world, conventional wisdom holds that "burning platforms" or "threats to survival"
are necessary to build will for improvement.
Berwick DM. Public Performance Reports and the Will for Change. JAMA. 2002;288(12):1523–1524. doi:10.1001/jama.288.12.1523
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