About Us

The aim of the Reinertsen Group is to improve clinical quality and safety—to make health care demonstrably better and safer, as measured by mortality rates, nosocomial infection rates, harm rates, clinical outcomes, and other solid measures of clinical performance. We have made the strategic choice to do this work not at the project level, but rather, at the level of whole organizations. The Reinertsen Group therefore works primarily with leaders — hospital and health system Boards, CEOs, physician leaders, and senior executive teams — to activate and equip them to take their organizations to dramatically improved levels of clinical quality.

Our Approach

“Leaders are responsible for everything in an organization,
especially what goes wrong.”

(Paul O’Neill, former US Secretary of the Treasury, and CEO of Alcoa).

The climate established by an organization's leaders is a powerful driver of quality. Our approach focuses on leadership practices that influence health care quality, with the ultimate objective of achieving system-wide results across the entire organization, rather than “doing quality projects.” These are the kinds of specific questions we address:

  • We are doing great quality projects, but they don't seem to be spreading fast enough throughout the organization. How do we move from "doing CQI" to a complete transformation of the way we work, throughout the enterprise?
  • How can we really engage our physicians in clinical quality improvement?
  • Quality improvement gets a lot of nice words at meetings and in annual reports, but when times are tough, we seem to invest less in quality, rather than more. How can we make quality our core strategy?
  • Our “dashboard” for quality and safety was supposed to make it easier to monitor our progress, but instead it seems to be confusing to everyone. What should be on our dashboard, and how should we use it?
  • Our CFO is skeptical about our claims that quality improvement can help the bottom line. If he’s right, what are we doing wrong? Can you help us work with our payers to improve the business case for quality?
Our overall approach to these difficult problems is based on the classical quality theory of W. Edwards Deming. Our leadership development and organizational transformation work is grounded in complex adaptive systems theory, and in the broad framework laid out in the Institute of Medicine’s Crossing the Quality Chasm. Finally, we are convinced that the central focus of health care must be on the quality of the “healing relationships” that are developed between patients and their physicians and nurses, and that “touch time” is an essential element in the development of those vitally important relationships. Examples of our approach, as applied to specific challenges, can be seen in the links below.
  • Leading the Transformation: In response to numerous requests from health care executives, we have developed an overall framework for the quality transformation of health care, A Theory of Leadership for the Transformation of Health Care Organizations.
  • Leadership Leverage Points for Measured System-Level Improvement: The history of quality improvement in health care has largely been one of "science projects"--interesting efforts to apply quality theory to health care problems, but not strategically linked, with enough scale and pace to move whole system measures such as mortality rate, cost per capita, and other important measures of effectiveness, safety, efficiency, and other quality dimensions. The leadership group at IHI has developed a framework for how leaders can plan to improve system-level measures--to "Move the Big Dots." This approach, which has proved to be immensely helpful in framing the work of leaders, is laid out in this short white paper: Seven Leadership Leverage Points for System Level Improvement in Health Care.
  • Trustees and Quality: Hospital and Healthcare System Boards are becoming aware of their responsibility for quality and safety. But many board members—especially those who are not clinically trained—are uncertain about how to oversee clinical quality. This paper lays out what the best boards do to lead quality and safety, and more importantly, how they do it—by establishing Will to improve, driving the Execution of needed changes, and maintaining Constancy of Purpose over the long haul.
  • Engaging Physicians in Quality: One of the most frequently-asked questions is "How can we engage our doctors in our quality and safety agenda?" And since health reform, that question has broadened to something like "How do we engage with our doctors in becoming more clinically integrated, and accountable to our community?" My approach to this question is laid out in two white papers, one of which focuses fairly specifically on engaging with doctors in quality initiatives, and the other on true clinical integration. In both papers, you will see that we prefer to turn the questions around. The quality challenge, in our view, is "How can the organization engage in the doctors' quality agenda?" And in the case of clinical integration and ACOs, the real issue is not getting the doctors clinically integrated with the organization: it's getting doctors to clinically integrate with each other. Both papers outline useful, practical frameworks, and form the basis for our consulting and teaching work with medical staff leaders in a wide variety of healthcare settings. To get a better idea of how our approach translates into keynotes and presentations, please view an example presentation on the subject of clinical integration, accountable care organizations, and other reform-related current issues.

Many aspects of our approach to physicians as leaders of improvement and the professional challenge of clinical autonomy have remained constant for years, and are laid out in these classic papers in the Annals of Internal Medicine.

"Reinertsen's Rules"

Over several decades, Jim Reinertsen has realized that certain "rules" provide excellent guidance for approaching difficult leadership and improvement questions. Some of these rules were created or stated by mentors and colleagues, whereas other rules on this list are Jim Reinertsen's alone. Together, they provide a good summary of our philosophy.

Every system is perfectly designed to produce the results it gets. (Batalden)

Make the right thing the easy thing to do. (Abelson)

Practice the science of medicine as a team, so that you can practice the art of medicine as an individual.

Remove everything that steals "touch time" from doctors, nurses, and patients.

If your doctors and nurses are feeling joy and pride in their work, you're on the right track. If not, think again.

Our excuses for why we can't improve sound lame when patients are in the room.

You either have to change people, or change people.

If you want something done right, regularly, get a nurse involved. Organize and do your work as a team, not the way you got your different diplomas.

Organizations must be led from hundreds of places, not solely from the corner office.

The rate of improvement is inversely proportional to the time between measurements. (Berwick)

There are three ways to achieve a better number: improve the system, sub-optimize the system, and cheat. (Deming)

The only measure of leadership is results. (Drucker)