Building the conditions for sustainable improvement: evidence from HPO transformation cases and failure research

Purpose This study synthesizes why quality-improvement initiatives fail and identifies how organizations undertaking high-performance organization (HPO) transformations mitigate these failure risks. Design/methodology/approach A structured review of 45 academic studies derived recurring failure reasons and suggested remedies. Then, a comparative case survey of 54 published HPO transformation cases was performed, extracting reported failure dynamics and countermeasures. Deductive-inductive coding mapped evidence to a shared taxonomy and consolidated similar actions into method families. Findings The most common empirical failure dynamics were limited resources/capacity, poor fit or over-complex designs, capability gaps, technology/data barriers and resistance or weak engagement. Frequently reported countermeasures included strategy-linked performance management (dashboards/scorecards), disciplined execution cadences (PDCA and review rhythms), simplifying and phasing interventions, building internal improvement and leadership capability, strengthening psychological safety and learning routines and co-creation with employees and partners. Explicit capacity protection (e.g. stopping other work, protected time) was reported less often than the prevalence of capacity constraints. Research limitations/implications Because the study synthesizes published case evidence, the reported patterns indicate recurrence rather than causality; future research should test configurations and sequencing longitudinally across successful and stalled transformations. Originality/value The study links generic improvement-failure evidence with cross-case HPO practice and provides an evidence-informed framework of countermeasures and design principles mapped to major failure modes.