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Commentary |

Achieving Large System Change in Health Care

John Oldham, OBE, MBA, MBChB, FRCGP
JAMA. 2009;301(9):965-966. doi:10.1001/jama.2009.228.
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When faced with big challenges, individuals or organizations are most likely to respond, “How can we?” One such challenge is large system change, ie, the holistic alteration in processes and behaviors across a system that leads to a step change in the outputs from that system. Meeting such challenges requires alternative framing of the question, and the contention is that several key principles assist in reframing the question from “how can we” to “why not?” In outlining these principles, this Commentary will describe lessons from my experiences with designing and delivering large system change across varying sectors (health, education, communities) in different countries.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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