Lift All Boats: How Five Public Hospital Systems Are Raising Clinical Care and Operational Efficiency

Denise Gonzalez, California Health Care Safety Net Institute
Sasha Morduchowicz, California Health Care Safety Net Institute


This is archived content, for historical reference only.

While often seen as separate functions, operations and clinical care are intrinsically linked within health care — the success of one depends on the success of the other.

Through its Seamless Care Center Initiative, the California Health Care Safety Net Institute worked with five California public hospital systems to improve both functions together. The two-year project involved more than 300 executives, clinicians, and staff members from 29 clinics across the five participating public hospital systems.

One year focused on clinical quality and effective chronic disease management, and the other focused on operational efficiency and access to care. Among the key lessons:

  • A robust information technology infrastructure, including a disease registry and adequate staffing, is the foundation for primary care improvement.
  • Providing the tools and training to empower frontline clinic staff fosters the development of a team-based approach to care.
  • A two-year period is insufficient to see aggregate improvement.
  • Access to quality improvement expertise and practice coaching is essential for primary care transformation.
  • Improvement champions are important to spark change but insufficient for large-scale implementation and spread.
  • Communication is key to achieving success when multiple improvement efforts occur simultaneously.

The report, which summarizes the initiative and describes the progress of the participating systems, is available under Document Downloads.

Independent Project Evaluation

CHCF contracted with Ruth Brousseau, PhD, and Melissa Ramos, MA, of Learning Partnerships to assess the achievements of the SCCI. Were hospitals and health systems able to make the improvements they were aiming to achieve? Were the meta-skills supporting these and other improvement efforts attained and maintained? The evaluation report is available as a Document Download.