C-Section Rate Variability at MA Hospitals: A Tale of Culture & Performance Improvement Systems

This story in the Boston Globe Magazine is ostensibly about c-sections:

However, the underlying factors leading to high rates at some MA hospitals are all related to culture and/or implementation of performance improvement systems:

(1) Hospital Culture

(2) Physician Culture

(3) Monitoring of Outcomes

(4) Sharing of Outcomes

(5) Use of Report Cards

(6) Design of Systems to Facilitate Outcomes