RT Journal
A1 Oldham J
T1 AChieving large system change in health care
JF JAMA
JO JAMA
YR 2009
FD March 4
VO 301
IS 9
SP 965
OP 966
DO 10.1001/jama.2009.228
UL http://dx.doi.org/10.1001/jama.2009.228
AB 
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.