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Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days



Health system change requires quality improvement (QI) infrastructure that supports frontline staff implementing sustainable innovations. We created an 8-week rapid-cycle QI training program, Stanford Primary Care-Project Engagement Platform (PC-PEP), open to patient-facing primary care clinicians and staff.


Examine the feasibility and outcomes of a scalable QI program for busy practicing providers and staff in an academic medical center.


Program evaluation.


A total of 172 PCPH team members: providers (n = 55), staff (n = 99), and medical learners (n = 18) in the Stanford Division of Primary Care and Population Health (PCPH) clinics, 2018–2021.

Main Measures

We categorized projects by the Institute for Healthcare Improvement’s (IHI) Quintuple Aim (QA): better health, better patient experience, lower cost of care, better care team experience, and improved equity/inclusion. We assessed project progress with a modified version of The Ottawa Hospital Innovation Framework: step 1 (identified root causes), step 2 (designed/tested interventions), step 3 (assessed project outcome), step 4 (met project goal with target group), step 5A (intervention(s) spread within clinic), step 5B (intervention(s) spread to different setting). Participants rated post-participation QI self-efficacy.

Key Results

Within 1000 days, 172 unique participants completed 104 PC-PEP projects. Most projects aimed to improve patient health (55%) or care team experience (23%). Among projects, 9% reached step 1, 8% step 2, 16% step 3, 26% step 4, 21% step 5A, and 20% step 5B. Learner involvement increased likelihood of scholarly products (47% vs 10%). Forty-six of 47 (98%) survey respondents reported improved QI self-efficacy. Medical assistants, more so than physicians, reported feeling acknowledged by the health system for their QI efforts (100% vs 61%).


With appropriate QI infrastructure, scalable QI training models like Stanford PC-PEP can empower frontline workers to create meaningful changes across the IHI QA.

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Data Availability

The data that support the findings of this study are available from the corresponding author, AS, upon reasonable request.


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The authors acknowledge the support of the PCPH Division and SHC ambulatory operations leadership for their ongoing support, as well as the engagement, dedication, hard work, and enthusiasm of the Stanford PC-PEP participants.


This work was supported by the Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine.

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Correspondence to Amelia Sattler MD.

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Sattler, A., Phadke, A., Mickelsen, J. et al. Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days. J GEN INTERN MED (2023).

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