In a sprawling health system, leaders can struggle to spread improvements uniformly across hospitals, clinics and service lines. Large organizations tend to be intricate yet compartmentalized, and local variations often prevent successful approaches in one department from easily being adopted in another.
Many leaders are embracing a “systemness” mindset, viewing it as an integrated whole rather than a collection of parts. By applying systems theory principles to quality improvement, organizations can align their many moving pieces toward common goals and achieve results that no single unit could achieve alone.
The Power of Systemness in Healthcare
Systemness may sound like a buzzword, but its premise is simple: align and integrate all parts of a health system so they function as one cohesive unit. The goal is to move away from fragmented, site-specific efforts and toward a unified approach that ensures consistency across the organization.
Instead of each hospital or clinic optimizing its own performance in isolation, the entire system works in concert toward shared objectives. This requires breaking down silos, standardizing best practices and coordinating efforts across the care continuum. The payoff is a more consistent, high-quality patient experience everywhere in the network and improved patient safety because unwarranted variation and failure points are reduced.
Case Study: Depression Screening at Scale
A compelling example of systemness in action comes from Northwell Health, which recently launched a large-scale depression screening initiative. Leaders identified a significant gap: only 30% of patients visited primary care, meaning most patients go unscreened. To address this, Northwell adopted a systemwide screening approach. Leaders set a unified goal to make depression screening a routine part of care in every specialty, from cardiology to surgery.
The implementation was built as a learning system from the start. Screening protocols were standardized, and workflows were aligned across clinics and service lines. Teams used the Institute for Healthcare Improvement’s Plan-Do-Study-Act cycles to test workflow changes, study their effects and adapt rapidly. This rapid-cycle learning, combined with governance that removed barriers and data transparency, helped momentum compound.
The systems approach worked, and the results followed. Within four months the system’s depression screening rate increased by about 5%, translating to about 75,000 additional patients screened. Leaders emphasized progress over perfection—using the best available data to act now and improving data fidelity in parallel. That mindset kept the work moving amid complexity. By the end of the year rates improved by 12%, achieving the system’s stretch goal.
Actionable Steps for Scalable Quality Improvement
Before launching a large-scale quality improvement initiative, healthcare leaders should consider taking the following foundational steps:
1. Align on Purpose and Establish a Shared Vision
Translate the “why” into a clear outcome, such as improving screening rates or enhancing patient safety, while ensuring teams understand the importance of their contributions toward the goal. A clearly communicated objective keeps everyone aligned and is the bedrock of any successful quality improvement initiative.
2. Architect for Scale: Standardize the Core, Localize the Rest
Conduct a systemwide inventory of processes, data systems and workflows. Identify gaps or inconsistencies, such as incompatible EHR platforms or varied protocols, that could hinder execution. Aligning tools and infrastructure supports more seamless implementation. Incompatible systems and varied protocols are significant risk factors. Design the minimum standard while also permitting intentional local adaptation for context.
3. Engage Stakeholders at All Levels
Engaging everybody from leadership to front-line staff is vital for success, echoing principles for building a robust culture of safety in which everyone feels empowered to identify and address quality and safety concerns. Create cross-functional teams with defined roles and clear lines of communication. Early and broad engagement builds buy-in, surfaces local insights and helps break down silos. Tools like a responsibility assignment matrix (RACI) can help establish accountability and clarify who is responsible, accountable, consulted and informed. Celebrate bright spots and spread them deliberately.
4. Start Small, Then Scale
Begin with a pilot site or small-scale test using Plan-Do-Study-Act cycles. Make it a habit to test changes. Use early feedback and data to refine your approach, but don’t wait for perfection. A system-oriented mindset encourages learning and iteration. Progress over perfection is critical when pursuing enterprise-wide change.
Systemness is a leadership commitment. By viewing quality improvement through the lens of systemness, healthcare leaders can move beyond isolated gains and achieve measurable, scalable impact. With clear goals, aligned infrastructure and cross-functional engagement, even the most complex health systems can operate as one delivering consistent, high-quality care to every patient, everywhere.
Ramsey Abdallah, DHA, FACHE, is assistant vice president of quality and performance improvement, Northwell Health. Saumya Mamgain, CPHQ, is senior quality management specialist, Northwell Health Lenox Hill Hospital and a member of ACHE.