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• What If We Flipped the Patient Discharge Process?
  At Sheffield Teaching Hospitals in the United Kingdom, an improver came up with the idea of assessing frail elder patients’ needs in patients’ homes instead of at the hospital. One PDSA cycle led to another, and another. Eventually, 10,000 patients got home 3 to 4 days faster in one year.
• Avoiding Overuse: The Next Quality Frontier
  In this editorial, IHI President Emeritus Don Berwick makes the case that quality of care — that is, better matching care to needs, and practice to science — is central to addressing underuse of effective care and overuse of ineffective care. The editorial accompanies the "Right Care" series of articles that explores medical underuse and overuse worldwide.
• WIHI: Improving the Rate of Recommended Care: Looking Back and Looking Ahead
  January 12, 2017 | A study published in 2003 reported that adults in the US receive only about half the care that’s recommended to prevent, treat, and manage some 30 leading causes of illness and death. Has the situation improved? Not nearly enough.

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• What If We Flipped the Patient Discharge Process?
  At Sheffield Teaching Hospitals in the United Kingdom, an improver came up with the idea of assessing frail elder patients’ needs in patients’ homes instead of at the hospital. One PDSA cycle led to another, and another. Eventually, 10,000 patients got home 3 to 4 days faster in one year.
• WIHI: Improving the Rate of Recommended Care: Looking Back and Looking Ahead
  January 12, 2017 | A study published in 2003 reported that adults in the US receive only about half the care that’s recommended to prevent, treat, and manage some 30 leading causes of illness and death. Has the situation improved? Not nearly enough.
• WIHI: Getting Right Care, Right!
  October 1, 2015 | There’s growing awareness of the need to curb health care’s overuse of interventions that lack a strong evidence base, unnecessarily subject patients to potential harm, and are more expensive than equally effective, cheaper alternatives.
• WIHI: Bundles and Buy-In for Value-Based Care
  March 12, 2015 | There’s no question that public and private payers in the US are moving towards more global payment arrangements with health care providers. But the picture of how health care delivery systems take up the challenge is still coming into focus.
• WIHI: The Ups and Downs of Health Care Costs and Reform
  February 12, 2015 | Against the backdrop of the Affordable Care Act and other significant US initiatives, this WIHI touches on recent progress with efforts to achieve better care and lower costs, global payments and various payer-led financial efforts designed to improve health care delivery, statewide reforms, Medicaid expansion, and more.
• WIHI: Better Care and Better Value for Hip and Knee Replacement
  October 23, 2014 | The frequency of a surgical hip and knee replacement that has comparatively low rates of harm and complications brings new scrutiny of performance and opportunities for improvement.
• WIHI: Preventing Financial Harm to Patients: The Costs of Care Initiative
  August 21, 2014 | On this WIHI, learn about an innovative effort in the US to help caregivers make more high-value decisions that can protect patients from unnecessary care and expenses.
• WIHI: From Prehospital to In-Hospital: The Continuum for Time-Sensitive Care
  July 24, 2014 | In this WIHI, we discuss the dramatic changes underway with emergency medical services (EMS) in both the US and globally.
• WIHI: Slowdown in the Growth of US Health Care Spending
  July 11, 2013 | This WIHI examines indications that pressure from both public and private payers, reinforced by reimbursement reforms rolling out in the Affordable Care Act, may be making a dent in the growth of the country’s health care spending.
• WIHI: Clinicians and Financial Staff Can Improve Quality and Lower Costs, Part 2
  February 21, 2013 | This WIHI discusses cost reduction and quality improvement strategies that two organizations — Northeast Health and Hackensack University Medical Center — used to improve their bottom lines without sacrificing patient care.
• WIHI: Employers and Employees Can Improve Quality and Lower Costs: Stories from the Front Lines, Part 1
  February 7, 2013 | This WIHI discusses what promises to be the next wave of employer engagement in improving health and controlling health care costs in the US, including taking a deeper dive into the underlying, often chronic health conditions affecting today’s employees.
• WIHI: Navigating the Elections with a Clear-Eyed View
  October 12, 2012 | This WIHI focuses on ways to help you navigate this US election cycle with a clarity of purpose that health care improvement requires more than ever in these tumultuous times.
• WIHI: Pioneering ACOs: What Do We Know So Far?
  September 27, 2012 | This WIHI discusses a major study of the factors enabling accountable care organizations (ACOs) to get up and running and to successfully implement new forms of care delivery, as well as examples of early adopters of the ACO concept.
• WIHI: Testing,Testing! Is This Procedure Necessary?
  May 17, 2012 | This WIHI discusses tests and procedures that tend to be overused and that should trigger discussions to ensure that they’re really needed and of value, and the key role that physicians play in these efforts.
• WIHI: Going, Going, Green! Embedding Environmental Health and Sustainability into Health Care Delivery
  April 5, 2012 | The Healthier Hospitals Initiative aims to enlist hospitals in efforts to increase use of safer materials and products for patients and staff alike, reduce energy consumption and waste, and adopt policies to ensure sustainability.
• WIHI: The Social Imperative to Demonstrate That Better Care = Lower Costs
  February 9, 2012 | This WIHI discusses what dedicated legions of health professionals, already deeply immersed in improvement work, can do differently or better to connect better care with lower health care costs.
• Passport Exclusive: Building Strong Connections Between Cost and Quality
  This module focuses on three approaches used by the UK's National Health Service (NHS) to increase quality in care while decreasing cost: 1) better care, better volume indicators; 2) high-volume care; and 3) the production series.
• How Can Primary Care Be More Fulfilling?
  Primary care suffers from a lot of problems, says physician executive Douglas Eby. Clinicians often have to work too quickly to get to know their patients, which makes for unfulfilling work and an ineffective care model. At Anchorage-based Alaska Native Medical Center, however, things are different.
• WIHI: The Power of Specialty Care – and the Necessity to Use It Wisely
  January 13, 2011 | A framework to help providers get closer to an appropriate use of specialty services, to reduce unnecessary health care costs and deliver better care to patients, is explored.
• WIHI: Finding the Will to Bend the Cost Curve
  December 2, 2010 | This WIHI reviews Maryland's all-payer hospital rate-setting system (one of the longest-running payment and cost control initiatives in the US) that has pushed hospital costs steadily downward, and some important ideas and framing for "bending the cost curve" are explored.

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• Quality Metric Advisor Tool
  The IHI Quality Metric Advisor is a simple algorithm that assists organizations to identify and address crucial balancing measures in order to maintain and even improve clinical quality during cost-savings improvement initiatives.
• Quality Improvement Savings Tracker Worksheet
  This standard tool may be used throughout the organization to track cost savings associated with waste reduction efforts and to adjust for annual changes.
• Adverse Events Prevented Calculator
  This tool allows one to track the change in rate of any one type of adverse event over time and, when appropriate additional data are added, the consequent change in unnecessary deaths, cost savings, and return on investment of quality improvement work targeting those adverse events.

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• Avoiding Overuse: The Next Quality Frontier
  In this editorial, IHI President Emeritus Don Berwick makes the case that quality of care — that is, better matching care to needs, and practice to science — is central to addressing underuse of effective care and overuse of ineffective care. The editorial accompanies the "Right Care" series of articles that explores medical underuse and overuse worldwide.
• New Payment Models Drive Value
  Standardizing processes, enhancing efficiency of care delivery systems, and optimizing capacity across care delivery systems are all essential in driving value and preparing care teams for managing patients in a bundled payment program.
• This Coalition of 20 Companies Thinks It Can Change US Health Care
  Based on IHI’s learning from work with employers to improve health care, this article offers five strategies to help employers — like those in the recently formed Health Transformation Alliance — achieve better care and better health for their employees, while also lowering costs (the Triple Aim).
• Applying Radical Redesign Efforts
  MemorialCare Health System's (California) strategy to provide high-quality care, reduce waste, and keep costs in line demonstrates three of the ten “New Rules for Radical Redesign in Health Care” developed by IHI Leadership Alliance members: standardize what makes sense; make it easy; and return the money.
• Medicare at 50: Reflections from Former CMS Administrator Donald M. Berwick
  IHI President Emeritus Don Berwick comments on the 50th anniversary of the US Medicare program, including the shift to payment based on the quality of care provided to patients, and the role of accountable care organizations (ACOs) in improving quality of care and reducing costs.
• The Employer-Led Health Care Revolution
  Intel is using Lean improvement methods to manage the quality and cost of its health care suppliers in Portland, OR. Their Healthcare Marketplace Collaborative model holds potential for employers, with their large purchasing power, to take the lead in securing better health for local populations and lowering costs for employees and companies alike.
• Patient-Reported Measures
  Patient-reported measures help clinicians and patients assess whether a patient’s symptoms, lifestyle, daily activities and functional status have improved as a result of care provided, and are a mechanism for patients to have a voice in their treatment planning and decision making based on their own self-assessments.
• Health Care, the Whole Person, and Community Engagement: Church Health Center of Memphis, Tennessee
  The Church Health Center in Memphis, Tennessee, is committed to encouraging healthy living for individuals as well as communities. Their work provides an inspiring example of a community that is working toward achieving the Triple Aim.
• Enhancing Prehospital Emergency Care
  This article makes the case that earlier prehospital interventions can positively affect downstream hospital patient outcomes and costs of care, describes how emergency medical services (EMS) are increasingly becoming part of an integrated care system, and discusses the expanded role of ambulance services and paramedics to increase access to care.
• ACOs: A Step in the Right Direction
  Accountable care organizations (ACOs) can be a step forward in the journey toward aligning payment and delivery mechanisms to achieve better care and better health at lower costs. This article includes recommendations that may serve to accelerate our collective efforts toward achieving cost- and quality-related improvements at scale.
• Eliminating Waste in US Health Care
  This article focuses on reducing costs in health care through waste reduction in six key categories that are estimated to comprise more than 20 percent of total health care expenditures.
• To Reconcile Mission and Margin, Deliver Better Outcomes at Lower Costs
  This article gives an overview of value-based health care delivery (using time-driven activity-based costing) and highlights the partnerships among the Harvard Business School, the Institute for Healthcare Improvement, and various orthopedic surgical groups.
• Appropriate Use of Medical Resources
  This white paper from the American Hospital Association (AHA) focuses on drivers of health care utilization and includes a "top five" list of hospital-based procedures and interventions they recommend should be discussed by patients and physicians before proceeding.
• Mobile Clinic in Massachusetts Associated with Cost Savings from Lowering Blood Pressure and Emergency Department Use
  A study of 10,509 patient visits to the Family Van, an urban mobile health clinic in Massachusetts, found that screenings and counseling resulted in significant reductions in high blood pressure from 2010 to 2012. The researchers argue that mobile health clinics are an effective delivery model for underserved communities with poor health status and frequent use of emergency departments.
• Preventing Infection After Hip and Knee Replacements
  IHI's Project JOINTS initiative is helping to speed the adoption of proven practices to prevent surgical site infections (SSIs) after hip and knee replacement surgery. This article describes simple, affordable, evidence-based practices organizations can put into place to reduce such infections.
• Enhancing the Effectiveness Effectiveness of Follow-Up Phone Calls to Improve Transitions in Care: Three Decision Points
  This study used a nonsystematic review of the literature focused on the use of telephone follow-up to improve postdischarge processes and reduce avoidable readmissions, and examined use of such calls among organizations participating in the STate Action on Avoidable Rehospitalizations (STAAR) initiative.
• Healthy Employees, Lower Premiums and Costs
  Employers, providers, and health plans have a new shared aim of collaboratively working together to improve the health of employees and reduce health care costs.
• A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost
  This white paper provides suggested measures for the three dimensions of the Triple Aim, accompanied by data sources and examples, and describes how these measures might be used along with process and outcome measures for particular projects to create a learning system to achieve the Triple Aim.
• Can Sustainable Hospitals Help Bend the Health Care Cost Curve?
  This study tracked sustainability practices at nine hospitals and health systems over five years, and revealed significant savings in waste management, energy use, and operating room supply procurement.
• More Quality Measures versus Measuring What Matters: A Call for Balance and Parsimony
  The authors propose a policy that quality measurement should be parsimonious: to measure quality, outcomes, and costs with appropriate metrics that are selected based on needs of patients, providers, and payers.