Measurable improvements in the American Healthcare System have been elusive. To understand why, a survey measuring improvement capabilities in a health system was developed from a 2002 tool that measured an outdated quality improvement methodology. That survey was tested for content validity and achieved an overall representativeness content validity index of 87.5%. From the responses and discussions with the subject matter experts, 3 reasons emerged as to why a lack of improvement occurs in key metrics on a balanced scorecard. These 3 were the decentralization of improvement efforts, waning leadership attention, and presenting information rather than insights.
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