Date of Conferral



Doctor of Business Administration (D.B.A.)




Irene A. Williams


Health care spending accounts for 17.7% of the gross domestic product in the United States, and it is expected to continue rising at an annual rate of 5.3%. Despite high costs, health care quality lags behind other high-income countries; yet, over 70% of change initiatives fail. The purpose of this multiple case study was to explore strategies primary care leaders use for implementing quality improvement initiatives to improve patient outcomes and reduce waste in primary care facilities. The target population consisted of 3 health care leaders of 3 primary care facilities in southern California who successfully implemented quality improvement initiatives. The conceptual framework for this study was Kotter's 8-step of change management. Data were collected through face-to-face semistructured interviews with senior health care managers, document review, and quality reports. Member checking of interview transcripts strengthened the credibility of the findings. Data analysis included Yin's 5-phase process, which consisted of compiling, disassembling, reassembling, interpreting, and concluding the data. Themes emerged from the use of methodological triangulation of data. The themes included communication, leadership support, inclusive decision-making, and employee recognition. The implications of the findings of this study for positive social change include assisting primary care leaders in improving strategies for implementing quality improvement initiatives to increase efficiency, reduce health care cost, and improve patient and community health.