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John Oldham, OBE, MBA, MBChB, FRCGP

JAMA. 2009;301(9):965-966.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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.

Status Quo Is Not an Option

Any analysis of recorded episodes in human activity that have made a leap change yields one clear conclusion. Whether it be the Romans constructing the self-supporting domed roof of the Pantheon 2000 years ago or a human mission to the moon's . . . [Full Text of this Article]

Author Affiliations: Quest4Quality Ltd, Glossop, United Kingdom.

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