Slide Presentation of the 2007 Annual Meeting of AHRQ

Hurdles

• Lack of organizational commitment
• Turf issues
• Training
• Long term evaluation is problematic
• Disruptive physicians
• Middle management not engaged
• Up-front costs
• Cultural model (top down versus bottom up)
• Punitive history difficult to eradicate
• Disincentives for improvement
• Difficulties in linking improvement with outcome