Inter-mountain Health Care (IHC) is an HMO system which controls 22 hospitals and some 70 other clinical sites. It has had a substantial history of clinical and administrative process analysis and standardization. Top management has committed to a strategic plan which has included physician self-governance and common protocols for care. Exhibit 4 shows a twenty million dollar net annual clinical savings already achieved. There are more savings still to be identified. The organization is committed to both clinical process improvement and to organizational learning.

Introduction
1. How has Dr. James gone about introducing the concepts of Deming’s
total quality management into the health care environment?
2. How effective has this effort been overall? What has been its measurable
impact at IHC?
Basics
3. What are the fundamental attitudes toward variability in clinical
practices exhibited in this case?
CONTINUOUS QUALITY IMPROVEMENT IN HEALTH CARE
4. How does Intermountain Health Care illustrate the role of the
shadow organization in clinical CQI? Why has this aspect of the
organization undergone so many changes over time?
5. Compare and contrast the CQI effort at IHC with the models of team
building in Chapter 6. How would you describe the current stage of
team development at the end of the case?
Implementation
6. How has IHC set itself up to be a learning organization?

7. What have been the contextual variables affecting the implementation
of CQI at IHC?
Application
8. IHS provides a wide range of services at its many locations and facilities?
What can you learn from their experience about the application
of CQI concepts in multisite and diverse organizations?

Class Exercise
Use the Internet to follow up on any changes in the clinical quality program
at Intermountain Health Care (www.ihc.com/xp/ihc). Then interview
quality improvement leaders and implementers at institutions in your
area to ascertain how their clinical quality improvement efforts have been
proceeding? How have they paralleled or differed from the IHC approach?
Have the results been similar or different? Why?