QOS: Activity 2 – Organization Viewed as a System

This is part of a series on Quality as an Organizational Strategy (QOS). Read the introduction or explore other activities: Activity 1 – Purpose, Activity 3 – Information, Activity 4 – Planning, Activity 5 – Managing Improvement.

Beyond the Org Chart

Ask someone to describe their organization, and they’ll likely show you an org chart—boxes and lines depicting reporting relationships from executives down through layers of management. An org chart maps accountability, but it reveals little about how work actually gets done.

To lead for quality, you need a different view. You need to see the organization as a system of interdependent processes working together to fulfill your purpose and serve customers.

Understanding Your Organizational System

All work can be described as a process. Some processes are well-documented and standardized. Others have evolved informally, shaped by habit and circumstance rather than intentional design. Whether formalized or not, these processes exist and interact.

Within any organization, processes typically fall into three categories:

Mainstay Processes represent the core work directly tied to fulfilling your purpose. In healthcare, this might include patient care delivery, diagnosis, treatment, and follow-up. In manufacturing, it’s designing, producing, and distributing products. These processes define what you exist to do.

Driver Processes help the organization plan, improve, and adapt. They include strategic planning, innovation, responding to regulatory requirements, adopting new science or technology, and improvement initiatives. These processes ensure your mainstay evolves to meet changing needs.

Support Processes enable the mainstay to function. Facilities management, information technology, human resources, training, and finance fall into this category. Without effective support processes, even excellent mainstay processes struggle.

Creating a System Map

A system map visualizes how key processes connect and depend on one another. Unlike an org chart that shows people and hierarchy, a system map shows work and relationships.

Start by identifying your mainstay processes—the 5-10 core activities that deliver your products or services to customers. Write each on a sticky note and place them in the center of a large surface.

Next, identify your driver processes and place them above the mainstay. These are the processes that guide, direct, and improve the system.

Finally, identify support processes and place them below the mainstay. These enable the core work to happen.

Now draw connections. Which processes provide inputs to others? Where are the handoffs? What dependencies exist? No first attempt will be perfect—expect your map to evolve as you learn more about how your system operates.

Figure 1 is an example of a first draft conceptual map of a public health organization.

Figure 1. Conceptual view of a public health organization using sticky notes
(Source: The QOS Field Guide, 2025, p.148)

Your system map will reveal patterns you didn’t expect. You’ll discover misalignments, duplicated efforts, missing connections, and opportunities for improvement. Most leadership teams find this exercise illuminating and sometimes uncomfortable—it shows how work really happens, which often differs from how leaders think it happens.

As leaders mature in viewing their organization as a system, the conceptual picture evolves into a true road map depicting the major process and interdependencies. The system serves as a method to understand the work and focus improvement. Figure 2 is an example of system map of a healthcare system.

Figure 2. Healthcare system: integrated payer and provider viewed as a system
(Source: The QOS Field Guide, 2025, p.162)

The Vector of Measures

A system map shows structure, but how do you know if the system is performing? This requires measurement displayed in ways that support learning.

A vector of measures (figure 3) is a carefully selected set of outcome measures that together provide multiple views of system performance. Each measure relates to your organizational purpose and tells the story of a specific area of interest.

Figure 3. Vector of sixteen measures for a hospital (special causes are circled)
(Source: Quality as an Organizational Strategy, 2024, p.194)

The key is displaying these measures together as Shewhart charts. This visual approach shows performance over time and reveals:

• Current performance and trends
• Whether a process is predictable or unstable
• Special causes of variation that require investigation
• The impact of improvement efforts
• How different parts of the system interact
• Predictions about future performance

Think of your vector of measures as the vital signs for your organization. Just as a physician uses multiple measures (blood pressure, heart rate, temperature) to understand a patient’s health, leaders need multiple measures to understand organizational health.

The Challenge and Reward

Developing a system map and vector of measures challenges most leadership teams. The work can feel abstract at first. Many leaders resist, preferring to dive into action rather than spend time understanding their system.

But those who persist discover something valuable: this work is intensely practical. It reveals where the organization is misaligned, where processes need attention, where definitions lack clarity, and where improvement efforts should focus. The system view builds shared understanding among leaders about what the organization is and how it functions.

More importantly, it creates the foundation for strategic improvement. You can’t improve a system you don’t understand. The system map and vector of measures make the invisible visible, enabling leaders to work on the system rather than just in it.

When leadership teams complete this work, they often experience a shift in perspective. They begin to see their organization differently—not as separate departments competing for resources, but as an interconnected system where improvement in one area can strengthen or weaken others. This systems view becomes essential for making wise decisions about where to improve and how to align effort.

Next: In Activity 3, we’ll explore building a system for obtaining information that feeds learning and improvement.

Sources:

Clifford M. Norman, Lloyd P. Provost, and David M. Williams. Quality as an Organizational Strategy: Building a System of Improvement. (Provident-Heierman Press, Austin, TX). 2024

Clifford M. Norman, Lloyd P. Provost, and David M. Williams. The QOS Field Guide: Guidance, examples, tools, methods, and exercises for using Quality as an Organizational Strategy to build a system of improvement. (Provident-Heierman Press, Austin, TX). 2025

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David M. Williams, Ph.D. works with leaders and improvement teams to learn and apply Improvement Science to achieve results and adopt quality as a strategy. He is coauthor of Quality as an Organizational Strategy and The QOS Field Guide.