The authors describe the evolution of a pediatric quality management program in a large community hospital that has rapidly grown in size and complexity to be a tertiary care center. Positive changes in senior leadership expectations, physician involvement, and training in performance improvement methodologies contributed to the development of a more comprehensive program. The authors from several specialty areas of the pediatric service illustrate three quality and performance improvement projects that they used in coping with the challenges of fast growth and higher acuity.
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