UMass Chan Medical School Faculty Publications


Large-scale improvement initiatives in healthcare: a scan of the literature

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Health Services Administration | Health Services Research


CONTEXT: The goal of this article is to provide a succinct scan of the literature as it relates to the current thinking and practice in large-scale improvement initiatives in healthcare.

METHOD: We employed a scan of the literature using a modified Delphi technique. A standard review form was used. The scan was limited to large-scale spread efforts in hospitals and healthcare systems. Each of the main factors that emerged during the scan was linked to secondary factors and organized using a driver diagram.

FINDINGS: Four primary drivers (factors) emerged during our scan that inform large-scale change initiatives in healthcare: Planning and Infrastructure; Individual, Group, Organizational, and System Factors; The Process of Change; and Performance Measures and Evaluation.

CONCLUSION: Our scan identified a tremendous amount of work being done around the world to improve healthcare. In general, our findings suggest these initiatives tend to be fragmented from an implementation standpoint. We identified primary and secondary drivers (factors) that can be used by those responsible for implementing large-scale improvement initiatives both at a strategy level and in their daily work. These drivers could serve as a "checklist" of ideas to consider in different testing and implementation situations.


healthcare, improvement, large-scale change

DOI of Published Version



Perla, R. J., Bradbury, E. and Gunther-Murphy, C. (2013), Large-Scale Improvement Initiatives in Healthcare: A Scan of the Literature. Journal for Healthcare Quality, 35: 30–40. doi: 10.1111/j.1945-1474.2011.00164.x. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Journal for healthcare quality : official publication of the National Association for Healthcare Quality

PubMed ID