CROSSING THE BOUNDARY - CHANGING MENTAL MODELS IN THE SERVICE OF IMPROVEMENT

Assumptions constrain the vision and ability of health care systems th roughout the world to achieve unprecedented levels of performance. Lea ders who want to accelerate improvement should themselves question the se assumptions and provide a context in which others can do so. Six cu rrent assumptions are particularly troublesome and particularly worthy of careful reconsideration: (i) that future performance levels will b e approximately the same as current levels (rather than believing in t he pervasive possibility of breakthrough); (ii) that measurement induc es improvement (rather than emphasizing leadership of change as the ke y to improvement); (iii) that professional and organizational boundari es must be carefully preserved (rather than reducing those boundaries) ; (iv) that patients are passive and caregivers are active (rather tha n working from strong notions of equal partnership); (v) that traditio nal forms of space and equipment are well designed (rather than valuin g fundamentally new designs); and (vi) that medical care operates in a n environment of scarcity (rather than noticing and employing what it has in abundance).