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Introduction
In the last decade, a series of Institute of Medicine reports, 1 2 major studies on quality of care by respected analysts, 3 and a greater appreciation of data on practise variations 4-10 have led to the widely-accepted conclusion that the quality of healthcare falls short of expectations. This conclusion comes at a time of unprecedented growth in diagnostic and therapeutic options that have transformed previously fatal conditions into chronic health conditions or outright cures. There is also important underappreciated evidence that improved routine care, such as the treatment of cardiovascular disease, cancer and arthritis, has resulted in declining mortality rates. 11
There are many reasons for the dichotomy between major advancements in diagnostics and therapeutics, and the perception of suboptimal quality of care, including changing expectations, specialisation leading to loss of the human touch, and factors outside the purview of our delivery system such as patients' lifestyles. Alternatively, it may be that healthcare professionals are failing to capture important aspects of quality in extant measures.
Rather than continuing to challenge current conclusions about quality, we may be better off trying to mobilise healthcare organisations around quality improvement. Many industries such as retail, aerospace and pharmaceuticals have used long-term overarching quality goals to galvanise organisational efforts around improving quality. These goals have received little attention in the healthcare industry. The aims of this report are to present the merits and cautions of overarching quality goals to achieve quality improvement, and to address the question of whether healthcare organisations should adopt these goals.
Methodology
We conducted a comprehensive literature review using multiple search strategies. We searched the PubMed database for medical literature and the Abstracted Business Information (ABI) Inform database for management literature, using the search terms 'goal setting', 'overarching goal' and 'quality improvement'. We identified additional literature through references from the initial data set and suggestions from subject matter experts. Articles were included if they described or evaluated overarching goals as a tool for quality improvement.
Overarching goals in other industries
Management literature reveals that many organisations that enjoy enduring success have a core ideology that remains fixed while their strategies and practises continuously adapt to a changing environment. 12-15 A well conceived organisational vision consists of two major components: a core ideology...