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To a rapidly changing environment, health‐care organizations are adopting a variety of value enhancement strategies. Typically characterized as quality improvement activities, these strategies generally include efforts to improve: clinical effectiveness; financial performance; consumer satisfaction; employee satisfaction; and risk management/quality assurance activities. Early efforts involved the use of continuous quality improvement (CQI) or total quality management (TQM) strategies with a focus on improving financial performance, while clinical effectiveness has been a greater emphasis more recently. This study examines the manner in which 14 US health‐care systems, noted for innovation in quality improvement and value enhancement, are utilizing these activities to promote productive organizational change. An interview format, for use with key informants in each organization, was developed using a model with four dimensions – strategic, cultural, technical, and structural.

The Family Support Opportunities program in the state of Washington has a unique component. People with extensive knowledge of local communities, referred to as community guides, were made available to all families enrolled in the program. Community guides assisted families by seeking information about community resources that families needed and helping families connect to those resources. Responses from a survey of 312 families were analyzed to determine the impact of the community guides' services. Results suggest that when families indicated satisfaction with their community guides, they reported better outcomes in terms of their needs being met, satisfaction with Family Support Opportunities, and connections to their local communities.