RESUMEN
Although the Institute of Medicine of the USA has recommended elements for healthcare reform, the optimal means for incorporation of these elements into a healthcare setting remain undefined. A process for the implementation of potentially better practices is described that incorporates a computerized medical record into an evidence-based, multidisciplinary continuous quality improvement effort. Steps in the process include the following: fostering a culture change that incorporates key habits for improvement; identification of a potentially better practice; review of existing evidence and analysis of local experience; delineation of proposed outcomes and potential confounders; guideline formulation and implementation; monitoring of change effectiveness; ongoing multivariate data analyses; and policy formulation. Trainee education and family participation characterize all steps in the process. Consequently, the process incorporates all of the elements recommended by the Institute of Medicine of the USA for healthcare reform and may be adapted to any healthcare setting.