I recently attended the annual forum of the Institute for Healthcare Improvement (IHI), which is probably the leading health improvement organization in the world. The forum has grown from under 100 attendees in 1989 to almost 6,000 this year—half of whom were there for the first time—with now thousands more virtual participants. It has become a cliché that invokes my gag reflex when participants say, “Oh, I go to get my batteries charged.” And I always wonder, on hearing this, Why were they drained?

Because many organizations are trying for formal certification, the pressure is on to standardize and document processes. This is also true for any robust improvement effort. Organizations are currently drowning in processes that have evolved over time and consequently become rife with confusion, conflict, complexity, and chaos. There are wide gaps between how these processes should work and how they actually do work.

Finally, the medical industry is putting aside its “We’re medicine; we’re different” mindset and taking a more practical look at quality improvement. Bravo! Although an element of physician culture remains convinced that improvement is all about outcomes and double-blind clinical trials, the executive culture at least has become so well-versed in quality jargon they can now use it to disguise a cost-cutting program. They’ve caught up with the rest of American management.