Establishing an ambulatory medicine quality and safety oversight structure: leveraging the fractal model.

Kravet SJ, Bailey J, Demski R, Pronovost P. Acad Med. 2016 Jan 27; [Epub ahead of print].

Oversight of safety improvement programs in the ambulatory setting is challenging due to variations in outpatient processes and complexity of care. This commentary describes an ambulatory accountability structure that involves a quality advisory council, led by a physician and a nurse, which established accountability, standards, and best practices across a large health care system to engage frontline staff in developing and sustaining improvements.