To improve quality, the most effective hospitals and leaders focus on processes and systems, instead of just lecturing and cajoling their employees and physicians to do better. W. Edwards Deming famously stated that the problem with posters and exhortations was that “they take no account of the fact that most of the trouble comes from the system.” His words still ring true today.

Hospitals are places where quality and safety should be paramount, given the number of things that can go wrong and the harm that can occur to patients or staff. Dramatic, high-impact errors such as medication errors (for example, the heparin dosage error that harmed the newborn twins of actor Dennis Quaid) and wrong-site surgeries (estimated to occur 40 times per week in the United States) seem eminently preventable with better processes and improved communication.

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