Implementing Quality Improvement Projects Across A Large Integrated Health Care System: Lessons from an ABMS Portfolio Program Sponsor

INTRODUCTION: Kaiser Permanente's National Quality Improvement (QI) Continuing Certification/Maintenance of Certification Program, an American Board of Medical Specialties Portfolio Program Sponsor, engages physicians in clinical improvement through organization-specific QI projects that fulfill continuing certification/maintenance of certification requirements. This study describes the program's structure, project development, and design choices that increase physician participation and organization-wide impact, and how this structure is applicable to many different types and sizes of health care organizations. METHODS: The program integrates national and regional leadership, with projects originating from grassroots (local leaders) and executive (national initiatives) levels. Data were collected through physician self-attestations on outcomes and reflections, aggregated and analyzed quantitatively and qualitatively at multiple levels. Case studies illustrate key success factors. RESULTS: Over 13 years, 7145 physicians have completed projects, with 88% meeting improvement thresholds. In 2024, 375 physicians engaged in 42 different projects, with 85% achieving at least one project goal. Case studies of grassroots and executive projects showed comparable clinical improvements, with 94% and 86% achievement rates, respectively. DISCUSSION: Engaging physicians in synergistic projects that support organizational priorities increases the impact of individual contributions. Flexibility in design and collaboration between regional and national teams are critical to effectively drive physician engagement and improvement. Supporting both grassroots and executive level QI projects allows for tailored interventions and broad alignment, enhancing physician participation and patient care.