History of the Institute for Healthcare Improvement (IHI)
Since 1991, the Institute for Healthcare Improvement (IHI) has advanced quality improvement in health and healthcare worldwide. Explore the people, ideas, and milestones that have shaped our work to make care safer, more equitable, and more effective for all.
More Than 30 Years of Improvement
The Institute for Healthcare Improvement (IHI) was officially founded in 1991, building on work that began in the late 1980s through the National Demonstration Project on Quality Improvement in Healthcare.
Led by Donald Berwick, MD, MPP, and a group of visionary collaborators, the work set out to redesign healthcare, reducing errors, waste, delays, and unsustainable costs. Since then, IHI has grown from a collection of grant-funded programs into a self-sustaining organization with worldwide influence. For more than 30 years, IHI has helped people and organizations meet healthcare’s most pressing challenges through teaching, coaching, convening, and practical improvement work.
While our programs and priorities have evolved, our mission has remained the same: to improve health and healthcare worldwide. We look ahead with the same commitment that shaped our beginning—putting courage, love, equity, and trust at the center of our work.
IHI's Work Is Grounded in Science
Our work is grounded in science and we use and teach practical quality improvement methods to enable sustainable changes in health and healthcare. In large systems and small villages, we have taken improvement methods originally used in the manufacturing industry and applied them to improving all aspects of health and care.
By combining evidence, local knowledge, and continuous learning, IHI helps teams understand what is happening in their systems, test practical changes, and build on what works. This approach makes improvement possible across settings, from individual care teams to entire health systems.
How We Work
Science of Improvement
IHI uses the science of improvement to help people and organizations make health and healthcare safer, more equitable, and more effective. Rooted in the work of W. Edwards Deming, this practical approach combines improvement methods and tools with knowledge of the setting, people, and challenge involved.1
Four Elements of Improvement
Effective improvement brings together four connected areas:2
Systems Thinking
Understand how the parts of a process work together to achieve a shared aim.
Understanding Variation
Identify what is normal variation and what signals a meaningful problem or opportunity.
Theory of Knowledge
Use data, testing, and evidence to learn what changes are likely to lead to improvement.
Psychology of Change
Recognize how people, relationships, and culture shape performance.
Together, these elements, known as Deming’s System of Profound Knowledge3, help teams see their work more clearly and make changes that last.
Deming’s System of Profound Knowledge
The Model for Improvement, developed by Associates in Process Improvement, puts these principles into action. It gives teams a simple, effective way to set aims, test changes, measure results, and spread what works.
IHI applies this approach to support innovation, test changes in real-world settings, and spread successful practices at scale. Just as importantly, we help build lasting improvement capability so organizations can continue improving long after a project ends.
Whole System Quality
Improvement is most effective when it is part of how an organization is led and managed, not a separate initiative. Since 2021, IHI has more explicitly drawn on the work of Joseph M. Juran to define the leadership practices and management structure needed to plan for, control, sustain, and improve quality. IHI’s Whole System Quality approach integrates three essential activities across an organization:
Quality Planning
Design systems and services around people’s needs.
Quality Control
Monitor performance and address problems.
Quality Improvement
Continuously make care and systems better.
Together, these practices help organizations close the gap between current performance and what people receiving care should be able to expect, building more responsive, resilient healthcare systems.
IHI Milestones
Watch this one-minute video highlighting key moments, ideas, and achievements from IHI’s first 30 years of advancing quality improvement in health and healthcare worldwide.
References
- Adapted from Associates in Process Improvement (apiweb.org).
- Perla RJ, Provost LP, Parry GJ. Seven propositions of the science of improvement: Exploring foundations. Quality Management in Healthcare. 2013;22(3):170-186.
- For more on the System of Profound Knowledge:
- Deming WE. The New Economics: For Industry, Government, Education. 2nd ed. Cambridge, MA: Massachusetts Institute of Technology Center for Advanced Engineering Study; 1994: Chapter 4.
- Berwick DM. The science of improvement. JAMA. 2008 Mar 12;299(10):1182-1184.
- Langley GJ, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco: Jossey-Bass; 2009: Chapter 4.
10 IHI Innovations to Improve Health and Healthcare
This curated publication highlights 10 ideas that have emerged from IHI's systematic 90-day innovation approach, including reflections on the Triple Aim, the concept of a healthcare Campaign, the Breakthrough Series Collaborative model, and other frameworks.
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