This exploration finds structural barriers to quality improvement in health systems, suggesting alignment with local needs.
To advance as HROs, health systems must go beyond high-level endorsement and invest in skill development and provide protected time to enable local leaders and frontline providers to do QI. Future work should explore how leaders can create sustainable conditions for improvement efforts and better align system-level goals with local realities.
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Evans et al. (2026) studied this question.
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