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September 25, 2002

Public Performance Reports and the Will for Change

Author Affiliations

Author Affiliation: Institute for Healthcare Improvement, Boston, Mass.

JAMA. 2002;288(12):1523-1524. doi:10.1001/jama.288.12.1523

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.