Improvement is a Mindset, not a Department


Lynn M Garofalo-Wright, MD

There is no such thing as perfect. Leaders are reminded of this daily: stoplight dashboards flash red on metrics not meeting goals, tightening margins call for greater affordability, and regulators visit often to scrutinize our safety. Although many of our regional offices and service areas have departments called “Performance Improvement” (PI) or “Quality Improvement” (QI), the responsibility to design systems that optimally deliver safe, affordable care does not reside with them alone.

In companies that are the best at continuously improving, employees from the frontline to the “C-suite” have a role in identifying and in addressing improvement opportunities. We are no different in Kaiser Permanente. Each of our unit-based teams is responsible for improving service, safety, quality, and affordability in their departments. Managers are responsible for leading improvement within or across multiple departments. Labor and management leaders serve as sponsors for larger, strategic initiatives.

The PI/QI boot camp was created for the emerging leader who is new to the world of improvement or who is seeking a refresher. It provides participants with basic concepts and tools to: Differentiate problems from symptoms, identify improvement opportunities, design systems around the patient, test system changes quickly using Plan-Do-Study-Act cycles, implement controls that make it easy to do the right thing (and hard to do the wrong thing), and use data to interpret variation and drive improvement.

Ultimately, it is incumbent upon all of us to understand these basics because PI and QI are not just departments, they are a state of mind. 

To learn more, contact your local PI leader.

Reprint Permissions

The Permanente Journal welcomes requests for reprints and reproduction. Use of any and all published materials is copyrighted and protected.


Journal subscriptions for The Permanente Journal are entered for the calendar year. Advance payment in US dollars is required.


27,000 print readers per quarter, 15,350 eTOC readers, and in 2018, 2 million page views of TPJ articles in PubMed from a broad international readership.


Indexed in MEDLINE, PubMed Central, HINARI, EMBASE, EBSCO Academic Search Complete, rdrb, CrossRef, and SciVerse/Scopus.




ISSN 1552-5767 Copyright © 2019

All Rights Reserved.