Institute for Healthcare Improvement: IMPACT Leadership

You Are Not Alone…It Takes a Community

It is exponentially easier to improve together than it is alone. We at IHI have learned this simple principle through our many years of improvement work. And nowhere is this more true than with leadership.

The leadership challenge is like none other. System-level improvement requires vision to establish aims, clarity of purpose to prioritize the work, and exceptional execution to make it happen at the front line. And now more than ever, effective leadership requires collaboration. It requires a Community.

The IMPACT Leadership Community brings together like-minded leaders from a diverse set of health systems, providing unique opportunities to work with each other and with IHI experts. The Community offers an energizing, results-oriented, customized platform for senior executives to collaborate on system-level performance.

A Customized Leadership Support System

The IMPACT Leadership Community has been redesigned for members participating in fall 2009 and beyond. The core work of the Community will be to help leaders reliably implement the key leadership processes outlined in the IHI Improvement Map – our new online resource of key process improvements for exceptional hospital care.

With an unyielding focus on system-level results and a reduced emphasis on didactic face-to-face meetings, the Community will create a comprehensive, customized leadership support system to help each participating organization implement the changes necessary to achieve excellence in these leadership processes. In the true spirit of the Collaborative model, which IHI has pioneered for over a decade, the IMPACT Leadership Community will help leaders set aims, develop plans to achieve those aims, track progress, make adjustments, and achieve the desired results.

How Can We Help You?

Your organization’s experience in the IMPACT Leadership Community will be customized to help you achieve the specific aims that you declare. IHI faculty will work with you to design a program that’s just right for you, tapping into structured group activities and available individualized services. The elements of the program from which you and your IHI faculty partners will choose include:

Annual improvement plan. You’ll work with IHI experts to identify your leadership improvement agenda, using methods such as a “gap analysis” tool from the IHI Improvement Map. Then, you’ll determine and declare your organization’s annual improvement aims. These are what IHI refers to as your “Big Dots” – the major systemic results that you aspire to achieve by the end of the year. Most importantly, IHI will help you select aims that are ambitious and achievable – and will commit to helping you achieve those aims.

Disciplined measurement and tracking systems. As with all IHI collaboratives, participants in the IMPACT Leadership Community will post aims and track progress on IHI’s extranet system. There, all participants will be able to share data and results with all others in the Community. In addition, IHI will provide participants with valuable system-level data, such as the Hospital Standardized Mortality Ratio (HSMR). This and other information in our “Good to Great” report will offer an easy means for tracking overall system performance.

Monthly Community calls. Once each month, the Community will gather telephonically for an engaging discussion on ideas and progress. These critical knowledge sharing sessions will build on each other throughout the year, based on the IHI Leadership for Improvement Framework and with a particular focus on the leadership processes outlined in the IHI Improvement Map. Participating teams will share how they are applying the work and detail their lessons learned. Once each quarter, the call will feature special guests on hot topics identified by Community members.

Customized support. Your leadership team will have the opportunity to work intensely with IHI to help you get where you want to go. At your option, you can schedule a monthly individualized check-in call with your IHI faculty partner. On these calls, you will focus on your progress toward your goals, ensure that you’re on the right track, and discuss ideas for overcoming the barriers you face.

Results-focused workgroups. Based on the aims declared by each participating organization, IHI faculty will cluster members into workgroups organized by similar aims (e.g. patient-centeredness). These workgroups will establish expected outcomes for a 90-day work period, during which time they will collaborate through monthly calls and other activities. After this period, workgroup participants will report their results and findings to the entire Community.

Affinity Groups. The IMPACT Leadership Community will also create networking opportunities for leaders of similar organizations with similar conditions and issues. For example, we expect to create affinity groups for leaders of integrated systems, individual hospitals, and critical care access hospitals.

Face-to-face meetings. Community members will assemble in person twice per year for an exchange of ideas and a review of progress. One of these meetings will be at IHI’s National Forum in December and the other will be in May at a location to be selected. While these will be critical gatherings for networking and getting to know other members of the Community, these face-to-face meetings are designed to supplement the ongoing learning, sharing, and support.

Aim of the IMPACT Leadership Community

A Framework for Leadership of Improvement

Leaders of organizations work individually and collectively to achieve unprecedented levels of health care performance. They bring an extraordinary degree of commitment to delivering world-class quality care. We identify the best known performance and then improve care to meet or exceed this level. We share generously and fully in support of our shared intent—to deliver health care with no needless deaths, pain, delays, helplessness, or waste.

We accomplish this by:

Improving leadership capabilities and developing systems for leading improvement
Becoming transparent with data and improvement strategies and experiences
Identifying and sharing new and robust models for delivering world-class quality results
Testing, implementing, and sharing successful improvement
Consistently and systematically measuring results

We measure our progress through improvement in system-level measures, called Whole System Measures, that are centered on the Institute of Medicine (IOM) six dimensions of quality.

These Whole System Measures are:

Safe: Adverse Events: Inpatient and Outpatient
Safe: Incidence of Non-fatal Occupational Injuries and Illnesses
Effective: Hospital Standardized Mortality Ratio (HSMR)
Effective: Unadjusted Raw Mortality
Effective: Functional Outcomes
Effective: Readmission Percentage
Patient-Centered: Patient Satisfaction: Inpatient and Outpatient
Timely: Days to Third Next Available Appointment: Primary Care and Specialty Care
Efficient: Inpatient Days During the Last Six Months of Life
Efficient: Health Care Costs per Capita for the Region
Equitable: Stratification of the above measure

Read IHI’s Innovation Series white paper on Whole System Measures and learn how IMPACT Leadership member Cooley Dickinson Hospital in Northampton, Massachusetts uses them to set goals and provide focus for areas of continued improvement.

The primary function of leaders in health care is to influence their “followers” to develop behaviors, habits, processes, and technologies that result in dramatically improved performance. This influence can be thought of as a combination of “push” (making the status quo uncomfortable) and “pull” (making the future attractive). The influence comes about through a variety of five leadership activities:

Establish the Mission, Vision, and Strategy: Use the organization’s mission, vision, and strategy as a relentless drumbeat to communicate the direction of the organization to all stakeholders while maintaining constancy of purpose. It will be critical to obtain and maintain the long-term support of the governing board if constancy of purpose is to be achieved.

Build the Foundation for an Effective Leadership System: The extraordinary aims of the IOM vision will require extraordinary leaders, as well as an extraordinary level of alignment and teamwork among those leaders. The framework requires the care system to choose and align a leadership team capable of this transformational task. That team, in turn, must reframe operating values, develop a broad cadre of leaders throughout the organization, and establish exceptional levels of improvement capability.

Build Will: The challenges of the IOM dimension described above will engender significant resistance, hesitance, and second-guessing. The leadership framework requires leaders to prepare the organization for change; generate discomfort with the status quo; make the vision of the future attractive; and create and sustain the commitment for improvement in all areas of the organization.

Generate Ideas: The IOM challenge of delivering ideal care will not occur using the same thinking that led to the present state. Knowledge management systems must be designed to listen to patients and other stakeholders and turn their communications into ideas for change. In addition to investing in internal research and development, leaders will also need to find new ideas by reading and scanning widely to learn from other industries and disciplines outside of health care.

Execute Change: Ultimately, nothing will occur without solid execution of needed changes. The organization undergoing transformation will need to have in place a solid model for testing, adapting, and implementing new ideas in the systems of care. This will require the organization to possess exceptional capacity for improvement, project management skills, and highly disciplined methods for design and redesign of the structures, processes and services needed to implement, sustain, and spread the good ideas.

Download the entire IHI Leadership for Improvement Framework used to guide the learning and work in the IMPACT Leadership Community.