TABLE 4.

Robust Process Improvement and High Reliability: Stages of Organizational Maturity

Performance Improvement	Beginning	Developing	Advancing	Approaching
Methods	Organization has not adopted a formal approach to quality management.	Exploration of modern process improvement tools begins.	Organization commits to adopt the full suite of Robust Process Improvement (RPI) tools.	Adoption of RPI tools is accepted fully throughout the organization.
Training	Training is limited to compliance personnel or to the quality department.	Training in performance improvement tools outside the quality department is recognized as critical to success.	Training of selected staff in RPI is under way, and a plan is in place to broaden training.	Training in RPI is mandatory for all staff, as appropriate to their jobs.
Spread	No commitment to widespread adoption of improvement methods exists.	Pilot projects using some new tools are conducted in a few areas.	RPI is used in many areas to improve business processes as well as clinical quality and safety; a positive ROI is achieved.	RPI tools are used throughout the organization for all improvement work; patients are engaged in redesigning care processes, and RPI proficiency is required for career advancement.