Reengineering Reengineering and quality improvement initiatives can increase profits, but this does not mean that they will or that they will do so easily. Nothing guar- antees that costs will fall, and nothing guarantees that revenues will not fall faster than costs. Especially in hospitals, improvement initiatives often coin- cide with downsizing efforts, making the staff wary (and sometimes causing the organization to lose the employees it most wants to keep).
Skilled leadership does not guarantee success but is essential to improvement initiatives. Many projects fail, but alignment of the board, management, and clinicians appears to increase the odds of success. Reengineering and quality management initiatives demand the time and attention of everyone in the organization, meaning that other things are left undone or are done less well. If not done skillfully, reengineering and quality management initiatives can make things worse.
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