Improving the quality of health care in the United Kingdom and the United States: A framework for change

Fueled by public incidents and growing evidence of deficiencies in care, co ncern over the quality and outcomes of care has increased in both the Unite d Kingdom and the United states. Both countries have launched a number of i nitiatives to deal with these issues. These initiatives are unlikely to ach ieve their objectives without explicit consideration of the multilevel appr oach to change that includes the individual, group/team, organization, and larger environment/system level. Attention must be given to issues of leade rship, culture, team development, and information technology at all levels. A number of contingent factors influence these efforts in both countries, which must each balance a number of tradeoffs between centralization and de centralization in efforts to sustain the impetus for quality improvement ov er time. The multilevel change framework and associated properties provide a framework for assessing progress along the journey.