Creating a fractal-based quality management infrastructure

Peter J. Pronovost, Jill A. Marsteller

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Purpose – The purpose of this paper is to describe how a fractal-based quality management infrastructure could benefit quality improvement (QI) and patient safety efforts in health care. Design/methodology/approach – The premise for this infrastructure comes from the QI work with health care professionals and organizations. The authors used the fractal structure system in a health system initiative, a statewide collaborative, and several countrywide efforts to improve quality of care. It is responsive to coordination theory and this infrastructure is responsive to coordination theory and repeats specific characteristics at every level of an organization, with vertical and horizontal connections among these levels to establish system-wide interdependence. Findings – The fractal system infrastructure helped a health system achieve 96 percent compliance on national core measures, and helped intensive care units across the USA, Spain, and England to reduce central line-associated bloodstream infections. Practical implications – The fractal system approach organizes workers around common goals, links all hospital levels and, supports peer learning and accountability, grounds solutions in local wisdom, and effectively uses available resources. Social implications – The fractal structure helps health care organizations meet their social and ethical obligations as learning organizations to provide the highest possible quality of care and safety for patients using their services. Originality/value – The concept of deliberately creating an infrastructure to manage QI and patient safety work and support organizational learning is new to health care. This paper clearly describes how to create a fractal infrastructure that can scale up or down to a department, hospital, health system, state, or country

Original languageEnglish (US)
Pages (from-to)576-586
Number of pages11
JournalJournal of Health, Organisation and Management
Issue number4
StatePublished - Aug 12 2014


  • Health and safety
  • Health care
  • Management
  • Quality improvement
  • Safety
  • Safety measures

ASJC Scopus subject areas

  • Business, Management and Accounting (miscellaneous)
  • Health Policy


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