Spreading at Scale: A Practical Leadership Model for Change

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NEJM Catalyst: Innovations in Care Delivery


Changing health care is a complex adaptive problem, with variation introduced at the patient, physician, geographic, supply, and reimbursement levels, resulting in wide discrepancies in health care practices, costs, and outcomes. Since 2015, Providence St. Joseph Health has employed a simple model for leading complex change at scale. The simple concepts that we used to achieve meaningful change can be summarized into five essential foci: Vision (the “Why”), Trust (the “Who”), Data (the “What”), Capacity (the “How”), and Alignment (the “What’s In It For Me?”). PSJH has applied this change model along with a “tight, loose, tight” management style, which serves to standardize a few critical elements across the system while allowing each local group to customize implementation based on their context, environment, and innovation.


Health Care Administration