Stability by Design

A concise field guide for leaders who want improvement to last.

Most healthcare organizations that struggle with sustained improvement aren't failing because of bad leadership or insufficient effort. They're failing because they're running good people through systems that were never designed to hold. The difference between organizations that improve and organizations that merely respond is not motivation. It is design.

"The book is clear, concise, and genuinely motivating."
Peter Fitzgerald, Chief Strategy Officer, National PACE Association

Stability by Design introduces the PACE Stability Framework, a practitioner-built quality improvement methodology developed over 25 years of field experience. The framework gives leaders a disciplined, practical system for improving performance and making those improvements last through leadership transitions, staff turnover, census shifts, and regulatory pressure.

This book is for PACE leaders, ACO executives, and quality improvement professionals who are done watching hard-won gains quietly unravel.

What readers will find inside:

• A clear explanation of why PACE's greatest strengths create its greatest operational vulnerabilities, and what to do about it.
• The four components of the PACE Stability Framework: Purpose and Psychological Safety, Assess the System, Co-Create Solutions, and Embed for Endurance.
• Practical tools including process mapping, PDSA cycles, and the Framework in Practice checklist for immediate application.
• Real-world examples drawn from complex care environments showing how data and human conversation work together to reveal what dashboards miss.
• Strategies for navigating the three forms of resistance (fear, turf dynamics, and professional culture friction) that derail most improvement efforts.

Whether you lead a PACE organization, an ACO, a value-based care program, or any model where disciplines must coordinate around people with serious needs, this book gives you the tools to stop hoping your organization holds together and start designing it to.

About the Author
Preston Choctaw, MSW, MPH, is a Lean Six Sigma Black Belt and healthcare quality improvement leader with more than 25 years of experience in PACE, managed care, and value-based care. He has served as a Quality Assurance Manager, Process Improvement Manager, Center Director, and Director of Quality Improvement.

Not by chance. Stability by design.