The Institute for Healthcare Improvement takes a unique approach to working with health systems, countries, and other organizations on improving quality, safety, and value in health care. This approach is called the science of improvement.

The science of improvement is an applied science that emphasizes innovation, rapid-cycle testing in the field, and spread in order to generate learning about what changes, in which contexts, produce improvements. It is characterized by the combination of expert subject knowledge with improvement methods and tools. It is multidisciplinary — drawing on clinical science, systems theory, psychology, statistics, and other fields.

We start by identifying a clear aim for improvement and a measurement plan, and then immediately begin with small tests of the changes we think will lead to improvement over a short period of time. As these small tests are refined and successfully implemented in the given context, we begin to broaden the testing and scale up of the changes. IHI experts are testing and learning alongside our partners as the best path for improvement and implementing changes in a sustainable way emerges. We emphasize starting improvement efforts on a small scale, and leveraging all the generated learning to plan for spread and, later, scale up. 

IHI’s methodology traces back to W. Edwards Deming (1900-1993), who taught that by adhering to certain principles of management, organizations can increase quality and simultaneously reduce costs. Based on Deming’s work, the Model for Improvement was created by Associates for Process Improvement (API) as a simple, effective tool for bringing about positive change.

The Model for Improvement asks three questions — What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? — and then employs Plan-Do-Study-Act (PDSA) cycles for small, rapid-cycle tests of change. IHI uses the Model for Improvement in all of its improvement efforts.

IHI improvement experts work hand-in-hand with our partners to ensure that all improvement efforts include:

• A clear, measurable aim
• A measurement framework in support of reaching the aim
• A clear description of the ideas (content) and how these ideas are expected to impact the results (the causal pathway from changes to desired outcomes)
• A clear description of the execution strategy (what will be done to ensure reliable adoption of the content?)
• Dedication to rapid testing (PDSA cycles), prediction, and learning from tests
• Understanding, describing, and visualizing systems (e.g., using a process map or value stream map)
• Learning from variation and heterogeneity:
• Use of time-ordered data to detect special cause and improvement
• Understanding why results differ by location (ward, organization, etc.)
• Application of behavioral and social sciences

Learn more about the science of improvement in the How to Improve section.