Support for Organizational Transformation

If you are seeking to transform and spread improvement within your organization, system, region, or country, IHI's Customized Services team can help. For more than fifteen years, IHI has worked intensively with many organizations, including government entities and nongovernmental organizations, to drive transformational change throughout a system or country.

To achieve bold aims in quality and safety and build long-term sustainability, IHI and partnering organizations work together to implement a set of proven tools and strategies while also developing a learning system to immediately spread knowledge and changes among a variety of health care settings 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
Equip a cadre of professionals with improvement and safety knowledge, and prime them to test and fuel the spread of improvement
Identify and test approaches for specific improvements such as ideal medications management
Build long-term sustainability and capability to support the improvements

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

Organizational Transformation

IHI identifies and spreads best practices in health delivery that address pressing population health needs. Starting small, IHI helps organizations rapidly test changes to find the best process improvements while focusing on positively influencing outcomes. We provide guidance for how to sustainably spread the improvements across a system, region, or nation. IHI strives to meet our partners where they are today and work side-by-side with them to chart the path to future success. We have a special focus on building capacity for self-reliance in order to allow for continuous improvements, scale-up, and sustainability of quality interventions over time.

Quality Planning and Execution

IHI helps organizations assess safety and quality, existing strengths, and opportunities for improvement. We then assist with developing implementation plans to address gaps using a multitiered, pragmatic approach to quality as a business strategy, called the Quality Operating System, to support the achievement of strategic quality, safety, and value goals. With this approach, IHI works deeply with an organization to develop a robust strategy based on a strong foundation of quality improvement (QI). We also work with leaders, middle managers, and frontline clinicians to execute the strategy.

Health Equity Assessment and Strategy

IHI works in collaboration with organizations, communities, and individuals to accelerate the elimination of inequities — differences that are systematic, avoidable, and unjust. Using IHI’s Equity Assessment tool (tailored for the specific local context), interviews with stakeholders, and a review of relevant documents and data, IHI helps organizations understand their current context, strengths, weaknesses, opportunities, and aspirations for health equity.

Based on the assessment findings and depending on an organization’s needs, IHI works alongside organizations to develop a health equity strategy, including actionable recommendations, an articulated vision and goals, and ideas for early wins. For organizations seeking additional support, IHI also provides virtual coaching and technical assistance for health equity improvement efforts and strategy implementation.

Collaboratives and Learning Systems

IHI’s Breakthrough Series Collaborative model identifies best practices that are not widely adopted and creates a robust structure to support their implementation. A Breakthrough Series Collaborative is a short-term (6- to 18-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 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.

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

Campaigns and Scaling Up

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 IHI welcomes the opportunity to explore how we might support your organization in launching a large-scale improvement initiative or campaign.

When an organization engages IHI to implement a large-scale initiative, we 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 for implementation.

Examples of Customized Organizational Transformation Initiatives

Lessons in Leadership for Improvement: Kaiser Permanente’s Improvement Journey Over 10 Years: Kaiser Permanente (KP) has achieved impressive improvements in quality of care over the past decade — a testament to their engaged and effective leadership and staff, and also due in part to a unique 10-plus-year collaboration with IHI that accelerated improvement at KP, greatly informed IHI’s own learning, and helped KP build system-wide capacity for improvement.
Age-Friendly Health Systems: In 2017, four core organizations set a bold aim and began work toward the goal of rapidly spreading the 4Ms Framework of an Age-Friendly Health System to 20 percent of US hospitals and medical practices by 2020. Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and IHI in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA).
Supporting Execution of a Strategic Vision: A US health system has engaged IHI for support in implementing a three-pronged approach to meet the system’s strategic vision: 1) quality planning: using improvement methodology and gaining a deep understanding of current-state measures, identifying the most strategic areas of improvement across the organization; 2) once priorities are identified, determining whether the organizational structure supports the work and the improvement capability needed by staff to work on the prioritized areas; and 3) developing frontline daily management skills to support and sustain improvement across the system.
Using Daily Management to Optimize Organizational Value: IHI has pioneered a new approach to helping frontline teams improve the quality and reduce the cost of their services, documented in Harvard Business Review. A US-based health system engaged IHI to work with teams to introduce a set of analytic and improvement tools that increase productivity while reducing the cost of operating its services (e.g., drugs, supplies, supplementary personnel).
The Scottish Improvement Journey: A Nationwide Improvement Journey: Scotland’s 10-year effort to apply quality improvement on a national scale to improve patient safety and “make Scotland the best place to live in.”
Building a Culture of Improvement at East London NHS Foundation Trust (ELFT): UK-based ELFT provides mental health and community services to a diverse and largely low-income population. By establishing an organization-wide culture of continuous improvement, and integrating quality improvement methodology and training at every level of work, ELFT has significantly reduced incidents of inpatient violence and improved staff satisfaction, among other achievements.
Large-Scale Patient Safety Improvement Program in 12 Portugal Hospitals: A charitable foundation established in 1956 in Portugal with cultural, educational, social and science interest, the Gulbenkian Foundation is committed to transitioning today’s hospital-centered and illness-based system to one that is person-centered and health-based, in which citizens are partners in health promotion and health care. In close partnership with the Foundation, in 2015 IHI began providing technical assistance and quality improvement coaching to a large-scale patient safety improvement program across 12 hospitals in Portugal, using a collaborative learning system focused on reducing hospital-acquired infections in prototype units by 50 percent over three years.
Reducing One of the World's Highest C-Section Rates: Unnecessary Cesarean sections result in longer recovery times for women and more intensive care for babies than vaginal births. A project called Parto Adequado — a partnership between IHI, the Hospital Israelita Albert Einstein, and the Brazilian National Regulatory Agency — is achieving great success in reducing medically unnecessary C-section procedures in Brazil, a country with one of the world's highest C-section rates.
Adios Bacteriemias: Improving Patient Safety across Latin America: In many parts of Latin America, the quality improvement (QI) and patient safety movement is just getting started. But one project, known as Adios Bacteriemias, has made remarkable progress using QI: 111 intensive care units (ICUs) in 40 participating hospitals in seven countries have reduced central line-associated bloodstream infections by 43 percent, improving patient safety in ICUs across Latin America.

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