Achieving the best health care outcomes is constrained by systems’ ability to reliably deliver evidence-based care, every time, to the people who need it. Systems include not only the design of care models and care delivery processes, but also supporting structures and the human interactions in between. These human interactions at every level put improving healthcare squarely in the arena of complex, adaptive systems.

The field of improvement has evolved to address the complex, systemic nature of health care challenges, particularly through the use of adaptive, iterative testing and implementation of changes which empower teams to use data in real-time to test changes which address systems issues and lead to improved outcomes. These teams engage all the key stakeholders involved in the outcome of interest, and can include various cadres of healthcare workers as well as patients, families and communities. For several decades the application of modern improvement methods has evolved from working to improve simple processes in facilities, for example to reduce waiting times, to clinical improvements like reducing the incidence of hospital acquired infections, to more significant improvements in healthcare, like decreases in mortality, and achieving such results at scale.