Question: Chapter 4 Exercise 4.1 Objective: To explore below the waterline factors that can impede quality improvements in healthcare organizations. Managers must recognize whether these factors

Chapter 4 Exercise 4.1 Objective: To explore "below the waterline" factors that can impede quality improvements in healthcare organizations. Managers must recognize whether these factors exist in their work setting and determine how best to overcome these barriers when initiating operational improvements. Instructions: Read the following article: Berwick, D. 2003. "Improvement, Trust, and the Healthcare Workforce." Quality & Safety in Health Care 12 (supplement 1): 12-16. www.ncbi.nlm.nih.gov/pmc/articles/PMC1765768/pdf/v012p00012.pdf. In this article, Dr. Berwick describes several historical and present-day "below the waterline" factors that inhibit healthcare quality improvement. For example, he observes that improvement is limited when the workforce is not encouraged to actively participate in reinventing the system. . Identify three factors described by Dr. Berwick that are the most difficult for healthcare organizations to overcome and explain why

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