Linking quality assurance to performance improvement to produce a high reliability organization.

Three basic change management models are currently used in healthcare to produce and sustain quality improvement. We have presented the context to determine where any particular organization stands within these paradigms. We also have introduced a change-management tool used to assess, plan, and monitor leadership effort and commitment to quality improvement and culture change activities, tracked as "momentum for change." This "momentum" is measured at eight discrete levels, from recognizing a performance gap to officially implementing changes intended to improve quality.