The population health journey: A change framework and lessons learned in a large clinically integrated network

Traditional change models, while valuable, often lack the structure and flexibility needed to address the complexities of today’s healthcare environment. The adoption of population health requires a coordinated, systematic approach with executive leadership sponsorship and a well-articulated change management strategy. The Ambulatory Quality Improvement Collaborative (AQIC) is a framework to drive populationlevel change to meet quality initiatives, including accountable care organisation (ACO) all-payer reporting models. The framework’s design includes an oversight committee of executive leaders utilising a unified change management strategy supported by an experienced project management team. The AQIC model emphasises a multidisciplinary, collaborative approach, bringing together stakeholders from across the healthcare system to drive system-wide quality improvement. The framework’s structure is detailed, outlining its important workstreams and their roles in driving change. Using case studies focused on hypertension control and depression screening, the effectiveness of the AQIC model in translating system-wide goals into tangible clinical improvements is demonstrated. This work highlights the critical role of data aggregation, performance management and health equity considerations in driving successful change initiatives. By leveraging data to identify disparities and track progress, the AQIC model enables targeted interventions and promotes equitable care delivery. The importance of continuous improvement and the AQIC model’s adaptability in addressing evolving healthcare challenges are emphasised.