Effect of system restructuring on quality leadership.

As fully integrated systems are formed, leaders must develop new ways to manage quality. In interviews with leaders of four integrated health systems, we address the questions: How can formerly separate entities with different histories and cultures be united into a collaborative system? What is an appropriate role for a systemwide QI department? How should responsibility and authority be divided between the system board and subsidiary hospital or corporate boards? They gave no single answer to these questions. Each system is developing its own strategy for quality leadership in a restructured health system. First of two parts.