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SVRPLOT map of severe thunderstorm reports for November 1988 , representing the geographic domain for monthly report totals . The researchers interviewed 14 senior health professionals and managers taking part in a quality improvement collaborative organized by the Institute for Clinical Systems Improvement in Minnesota , asking them to identify difficulties or successes they had experienced using patient feedback or survey data.While the respondents described more barriers than successes , they also tapped into the potential secrets of success : focusing on system changes , rather than assigning individual blame , and developing cultures that support patient-centered care by emphasizing physician leadership , technical expertise , and organizational capacity.Organizational BarriersOrganizational barriers reported by the participants ran the gamut — from the obstacles created by a traditional hierarchical management structure , to a lack of quality improvement infrastructure , to the issue of competing priorities like financial goals . There is also a large shade tree , which the deck was built around , which provides more nature watching and coolness for outdoor summer entertaining . For subsequent years , it is anticipated that the number and type of corrections allowed will decrease . " I think it 's wonderful , " said Dr. Maurie Markman , vice president for clinical research at the University of Texas M.D. Anderson Cancer Center . Also , you may be reported for disciplinary action . A microbiological challenge test of the product , preferably with toxigenic Staphylococcus aureus and evaluation for subsequent toxin production , can provide a basis to re-evaluate the potentially hazardous nature of the product .