The State of Quality Improvement in Healthcare
How AI Accelerates QI and Automates Quality Interventions at Scale
2025 Survey of 100 Clinical Quality LeadersTable of Contents
Introduction
The regulatory clock is ticking—are healthcare quality leaders ready?
In January 2026, CMS will apply its Transforming Episode Accountability Model (TEAM) to payments at over 700 acute care hospitals — one in five nationwide.
Even for institutions unaffected in January, TEAM represents a bellwether for the future of Medicare payment. Episode-based models are expanding, quality accountability is intensifying, and all acute care hospitals increasingly face the same fundamental challenge: How do you ensure consistent, evidence-based care delivery across complex episodes involving multiple providers and care settings?
Our survey of 100 quality leaders at acute care hospitals reveals an alarming gap: 77% aren't fully prepared for this level of accountability.
The problem isn't awareness—it's execution. TEAM requires hospitals to train staff on evidence-based protocols, ensure adherence across all surgical teams, and respond rapidly to quality performance data. To achieve these goals, clinicians need workflow-integrated solutions for QI and knowledge dissemination.
When we asked quality leaders to name their biggest barrier to quality improvement success, 76% cited variations of the same root cause: knowledge chaos. Fragmented information systems, insufficient training infrastructure, and zero visibility into whether clinical protocols are actually being followed.
This matters far beyond regulatory compliance. Care inconsistency costs the U.S. healthcare system $345 billion annually, and the evidence-to-practice gap continues to widen. This report examines why that gap persists—and what separates high-performing quality programs from those that struggle.
The data reveals an uncomfortable truth: throwing more resources at knowledge management won't solve the problem. What works is fundamentally different: activating knowledge rather than simply managing it, building cultures of empowerment rather than just deploying technology, and using AI to accelerate implementation rather than generate more content.
With the TEAM deadline approaching, healthcare organizations face a choice: patch symptoms, or use this moment as a catalyst to fix the foundations of how best practices are implemented at their institutions.
Key Findings
Key Findings
- → 77% of healthcare quality leaders are not fully prepared for TEAM requirements
- → 76% cite knowledge chaos—fragmented systems, inconsistent training, and lack of protocol visibility—as the top barrier to QI success
- → 64% do not feel fully empowered to implement meaningful change
- → 74% said they could use more resources for quality improvement
- → High performing quality leaders are 42% more likely to leverage a KMS or LMS
- → High performers are 9X more likely to believe AI will significantly improve quality outcomes
Methodology
The data for this report was collected via a third-party digital survey platform in Q3 2025. The 100 respondents are U.S.-based healthcare professionals for whom quality improvement, clinical governance, or patient safety initiatives are a primary part of their role. All participants are currently employed at acute care hospitals—the same type of institution required to participate in TEAM.
We used post-stratification weighting for cohort analysis, eliminating statistical variation due to age, gender, and ethnicity. Throughout the report, we reference:
- "High performers": Quality leaders whose initiatives succeed >60% of the time (74% of respondents)
- "Low performers": Quality leaders whose initiatives succeed <60% of the time (20% of respondents)
Qualitative responses reflected in quotes were collected through an anonymous form in August 2025.
The Knowledge Chaos Problem
The real barrier to quality improvement isn't resources—it's fragmented, inaccessible knowledge
Healthcare organizations aren't struggling with quality improvement because they lack commitment or investment. The problem runs deeper: clinical knowledge exists in silos, stored across incompatible systems, making it nearly impossible for clinicians to find what they need when they need it.
When we asked quality leaders to name their biggest barrier to implementing quality initiatives—excluding funding—the top three responses all pointed to the same underlying issue:
What is your biggest barrier to implementing quality initiatives?
- Fragmented systems and information storage (30%)
- Insufficient training and onboarding (29%)
- No visibility into staff usage of protocols/guidance (17%)
- Staff resistance to change (15%)
- Competing priorities (9%)
💡 What is knowledge chaos?
Knowledge chaos is what happens when clinical best practices exist but can't be reliably accessed or applied. It's protocols stored in SharePoint while training materials live in the LMS and updated guidelines sit in someone's email. It's onboarding that varies by preceptor, compliance that can't be measured, and clinicians who waste precious minutes hunting for information they know exists somewhere.
Low performers feel this pain even more acutely. Among that cohort, half (50%) cited insufficient training and onboarding processes as their greatest barrier—nearly double the rate of their high-performing peers.
The digital transformation illusion
Here's the uncomfortable part: nearly every organization has already invested in digital solutions to counter these exact issues. 89% of quality leaders say their organizations use some form of digital knowledge management. Among high performers specifically, 52% have implemented dedicated knowledge management systems.
Yet they're still struggling. The problem isn't lack of technology—it's that the technology creates new silos rather than eliminating them. Consider what quality teams with dedicated knowledge management systems are also using.
Of quality teams that have dedicated KMS for clinical best practices:
- 60% also use a Learning Management System (LMS)
- 32% also use SharePoint or another digital file manager
- 17% also use physical binders and documents
When knowledge lives in four places, clinicians don't know where to look. So they don't look. They rely on memory, ask a colleague, or make their best guess. The result: documented best practices that never reach the point of care.
We need one source of truth for communication. The fragmentation of our systems creates inefficiencies and increases the risk of errors. A unified platform would transform how we manage quality initiatives.
– Quality Leader, Health SystemEven more telling: 6% of quality leaders admitted they have no way to measure whether their quality improvement initiatives succeed at all. These performance outliers rely almost exclusively (98%) on physical binders and documents. Without visibility into what clinicians are actually doing, quality improvement becomes aspirational rather than operational.
More money, more staff — same problems
To dig deeper into the issue of knowledge chaos, we examined the overlap with funding and staffing challenges. Both constraints are endemic to most quality improvement efforts and healthcare is no exception.
74% of quality leaders surveyed said they could use more resources for quality improvement, underscoring the universality of the resource challenge. 25% explicitly stated that budget constraints stand in the way of quality improvement. 23% claimed staff shortages adversely affect QI.
Quality assessments, auditing, and reporting are incredibly labor intensive. CMS and insurance companies often have requirements, and it's difficult to correlate ROI. We're caught between the necessity of quality improvement and the reality of financial sustainability.
– Technology Strategy Leader, Academic Medical CenterThese findings are hardly surprising, given recent healthcare-related budget cuts and chronic workforce shortages. When budgets tighten, quality initiatives are often the first to be cut. It's time to reconsider that approach, because QI affects more than patient outcomes — these initiatives also benefit bottom lines through improved ratings and higher reimbursements.
But our data reveals a more nuanced reality. Among well-resourced quality leaders, 75% still cite knowledge chaos as the top challenge. Knowledge chaos persists regardless of resource levels—because the problem isn't how much you invest, but how knowledge moves through your organization.
Knowledge chaos in focus
The data makes one thing clear: solving knowledge chaos isn't about buying more tools or hiring more people. It's about fundamentally changing how clinical knowledge flows through an organization—from creation and storage to delivery and application.
The organizations succeeding at quality improvement haven't just digitized their knowledge management. They've activated it. The difference between those two approaches becomes clear when we look at what else separates high performers from everyone else.
What High Performers Do Differently
Quality improvement success depends on the right combination of culture and technology
A 2023 study from THIS Institute looked at the factors driving QI success in the Michigan Collaborative Quality Initiatives Programme. The study found that success came down to having rigorous measurement and a strong QI culture — and removing administrative burden wherever possible.
Our data supports these findings. Quality leaders in our high-performing cohort had these characteristics in common:
- They are empowered to affect change within their organization
- Their teams are less resistant to change
- They leverage digital tools for knowledge dissemination
- They're optimistic about AI — and its potential to counter burnout — in QI
The formula for a strong QI culture
1. Empower quality leaders with a clear mandate
Only 36% of quality leaders overall said they feel very empowered to implement meaningful quality changes at their organizations; 64% said they do not feel fully empowered. Without this empowerment, future quality improvement possibilities are blocked—90% of low performers said they are not very empowered to implement meaningful quality changes at their organizations.
The correlation between empowerment and success is striking: 98% of quality leaders who feel very empowered also report that the majority of their initiatives succeed. This isn't coincidental. Empowered leaders can secure resources, drive adoption, and sustain momentum through implementation challenges.
2. Solicit buy-in from clinical leadership
We also heard that earning buy-in from managers, department heads, and top-level leadership is crucial to QI success. Even when the funding is available, budgets are approved, and both tech and human resources are firmly in place, getting healthcare executives and on-the-ground practitioners to see eye to eye can make or break an implementation.
I feel empowered in my role, but the disconnect comes when clinical leadership doesn't have buy-in. You can have all the authority and resources in the world, but without clinical champions at every level, quality initiatives struggle to gain traction.
– MBS Director/Chief of Surgery/Chief of Quality, Community HospitalBy contrast, leadership alignment removes friction and encourages teams to rally behind quality initiatives.
Our department chair is a beacon of quality improvement. When leadership truly champions quality initiatives, it creates an environment where meaningful change can happen. We review all safety event reports, develop action plans, and prepare team education—but it's the visible commitment from the top that makes the difference.
– Lead APP & Quality Team Member, Academic Medical Center3. Encourage flexibility and experimentation
While only 15% of quality leaders overall cite staff resistance as a major barrier, that number jumps to 40% among low performers—nearly 3X higher. This isn't just about individual reluctance; it's a symptom of organizational cultures that haven't been prepared for transformation.
The right QI tech stack
Respondents in our high performing cohort claim to have sophisticated tools for quality measurement, knowledge management, training, and more. While knowledge chaos persists across the board, this group is further along the path to solving it.
High performers have gone digital: Just 18% of this cohort claims critical protocols are still stored in binders, compared to 57% among low-performers (a more than 3x increase).
High performers were also more likely to leverage more advanced solutions. 64% of this group use a KMS or LMS, compared to 45% among low performers.
Finally, high performers are more strategically aggressive about AI adoption. While 61% of all quality leaders express optimism about AI's potential to improve quality outcomes, high performers are 9X more likely to say AI will significantly improve quality, not just reduce burnout.
The gap extends beyond sentiment. 57% of high performers are already extensively using AI tools for quality improvement, compared to just 5% of low performers. Meanwhile, 95% of low performers said that AI tools are overhyped for healthcare quality or that it's simply a solution for staff burnout instead of a contributor to quality.
Performance outliers—those who can't even measure their QI success—are even further behind: 99% said they have no plans for AI implementation toward quality improvement.
AI's biggest opportunity is in anticipation—alerting providers to potential safety lapses before they happen. We've investigated some solutions, but there's still tremendous opportunity to leverage AI for proactive quality improvement.
– Quality Team Lead, Academic Medical CenterThis isn't about being an early adopter for its own sake. High performers recognize that AI can accelerate the shift from reactive to proactive quality management—surfacing protocol deviations before they become safety events, identifying training gaps before they impact outcomes, and automating compliance documentation that currently consumes hours of manual labor.
The TEAM Deadline: A Catalyst for Change
TEAM will affect over 700 US hospitals as soon as January 2026. Unfortunately, less than a quarter (23%) feel fully prepared—largely because many aren't even aware of what TEAM requirements entail.
To be honest, we're not prepared at all for TEAM compliance. Many quality leaders aren't even aware of what TEAM requirements entail—it's a significant knowledge gap across the industry.
– Vice Chairman for QualityWhat to prioritize in 2026
Just 28% of respondents listed TEAM in their top three priorities for 2026. However, this can be framed positively if we look at what won out: education and training, protocol adherence improvement, and technology integration. Quality leaders are invested in addressing the root cause by reimagining best practices implementation.
Here's what that could look like:
1. Protocol adherence systems—not just documentation
Stop treating protocols as documents to be stored and start treating them as guidance to be activated. The right platform delivers protocols proactively based on clinician schedule, role, and procedure—no searching required.
2. Staff education infrastructure—not just onboarding
Move beyond one-time orientation to continuous learning that's integrated into daily workflow. Education should happen at the point of care, not in a separate LMS that clinicians access once and forget.
3. Regulatory agility—not just compliance
Build systems that can absorb new requirements without massive manual effort. When TEAM becomes TEAM 2.0, or when CMS updates quality measures, your infrastructure should adapt in days, not months.
To make the biggest impact today, quality leaders need a straightforward solution: A best practices implementation platform.
QI Success Through Best Practices Implementation
Best practices implementation is an antidote to knowledge chaos. Clinicians need to be able to see vetted information that is consistently tailored to their specific schedule, role, and department. The right platform will surface those resources proactively, helping hospitals achieve their quality goals and monitor adherence to care standards.
💡 What is a best practices implementation platform?
A best practices implementation platform transforms static protocols into activated guidance, ensuring that evidence-based care standards are consistently delivered at the point of care across every clinician, case, and workflow. Unlike a knowledge management system that waits to be consulted, it proactively delivers the right protocol at the right moment—no searching required.
When powered by AI, best practices implementation can also radically accelerate quality initiatives. The right solution gives clinicians real-time visibility into their quality metrics performance. Meanwhile, quality leaders get the tools to maximize adherence and transform behavior through personalized, timely quality interventions.
As trainees across all domains are educated with quality at the forefront, we'll continue to see change. The next generation of healthcare providers is being trained to think about quality from day one—that's the real opportunity for transformation.
– Chief of Surgery & Quality, Community HospitalAbout C8 Health
C8 Health is on a mission to eliminate care inconsistency by bridging the gap between clinical protocols and real-world practice. We combine AI with in-depth expertise in healthcare knowledge management to help hospitals implement their best practices by streamlining access to clinical standards and integrating them into the clinician's workflow, when and where they need them. Our solutions drive consistent adherence to vetted treatment protocols, empower clinical teams to proactively manage quality outcomes, and improve staff satisfaction.
Through our AI-powered platform, clinicians get instant access to locally vetted, searchable best practices that reduce time spent searching for knowledge while increasing confidence in care delivery.
Proven at 100+ hospitals, including Mount Sinai and Brigham & Women's
Recent multi-site study across 10 academic hospitals proves the value of C8 Health:
- 31-day rollout—minimal IT burden
- 95% adoption within 12 months
- 2.5 daily sessions per clinician, averaging 3.5 protocols accessed
- 50% weekly active usage—clinicians actually use what they adopt
- 8.9 EMR-initiated sessions daily per device—true workflow integration
The bottom line: clinicians don't just adopt C8 Health, they depend on it.