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BMJ 1996; 312 doi: (Published 09 March 1996) Cite this as: BMJ 1996;312:0

We need to change systems not change within systems

Faced with frustration in your work or life, you have four options - to suffer, moan, exit, or change. Most of us opt for a combination of all four, but Don Berwick argues in a paper on making improvements in health care that to make substantial improvements we need not just to change within systems but to change the system (p 619). Berwick discusses in his paper methods that can be used to achieve major improvements and the barriers to making changes: one important point is to …

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