Organizations differ considerably in their rate of performance improvement. Since any improvement trajectory is the fruit of a series of improvement projects, the proximate cause of this variation among organizations lies in the varied ways these projects are managed. The success of these projects depends, however, not only on the goals and the efforts of the project team, but also on the context within which the projects are undertaken—and, more specifically, on the competencies on which the projects can draw. It is variation in these competencies—the organization's underlying "performance improvement capability" (PIC)—that explains the substantial and sustained differences in rates of improvement across organizations. This article describes the efforts of several hospitals to strengthen their PIC through five key components: skills, systems, structure, strategy, and culture.
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