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Support for Large-Scale Improvement Initiatives

If you are seeking to spread improvement within your organization, system, region, or country, IHI can help. For nearly ten years, IHI has worked intensively with organizations and government entities to drive transformational change throughout a system or country.

In order to achieve bold aims in quality and safety and build long-term sustainability, IHI and partnering organizations work to implement a set of proven tools and strategies in a predetermined set of hospitals. At the same time, we develop a learning system to immediately spread knowledge and changes among all hospitals across the system or country.

Large-scale quality or safety initiatives can help an organization or system:

  • Realize new levels of performance in quality and/or safety within the organization or system;
  • Create a cadre of professionals equipped with improvement and safety knowledge, who are primed to test and fuel the spread of improvement within the organization or system;
  • Identify and test approaches for specific improvements, such as ideal medications management from the hospital to primary care; and
  • Build long-term sustainability and capability to support the improvements.

For example, IHI has provided technical support for the Scottish Patient Safety Programme (SPSP). From 2008 to 2013, SPSP achieved the following results: 61 percent reduction in ventilator-associated pneumonia rate; 70 percent reduction in central line-associated bloodstream infection rate; 24 percent improvement in compliance with critical care multidisciplinary rounds and daily goals; half-day reduction in ICU length of stay; 90 percent reduction in ward C. difficile rate; and 40 percent reduction in ward Staph aureus bacteraemia rate.

Drawing on extensive experience in large-scale spread initiatives, IHI offers the following options for support.


IHI’s Breakthrough Series Collaborative Model identifies best practices that are not widely observed, and creates a robust structure to support their implementation.

A Breakthrough Series Collaborative is a short-term (6- to 15-month) learning system that brings together a large number of teams from hospitals or clinics to seek improvement in a focused topic area. Collaboratives range in size from 12 to 160 organizational teams. Each team typically sends three of its members to attend Learning Sessions (three face-to-face meetings over the course of the Collaborative), with additional members working on improvements in the local organization.

Teams in such Collaboratives have achieved dramatic results, including reducing waiting times by 50 percent, reducing worker absenteeism by 25 percent, reducing ICU costs by 25 percent, and reducing hospitalizations for patients with congestive heart failure by 50 percent.

For more information about our Collaborative methodology, please see the IHI white paper, The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement.

IHI offers varying levels of support for Collaboratives and is pleased to explore possibilities that best serve the needs of your organization or system.

IHI has expertise in building and running campaigns to mobilize large numbers of people and institutions toward a common goal. Our 100,000 Lives Campaign and 5 Million Lives Campaign engaged thousands of hospitals in the US to increase patient safety and reduce avoidable harm. We have worked with partners in New Zealand and the UK on similar campaigns, and we may be able to work with your organization to launch a new campaign.

If your organization would like to engage with IHI in a large-scale initiative, we would work together to understand your specific needs and priorities, determine whether we have the resources to provide appropriate support, and if so, choose the best methodology to use. We typically, but not exclusively, conduct these kinds of initiative in the context of a Strategic Partnership.