Nolan TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. (Available on www.IHI.org)

Quality and safety occupy a prominent place in the strategic plans of many health care organizations. However, a common organizational response to this emphasis on quality and safety is a long list of worthwhile projects and measures that are not well coordinated, let alone capable of achieving system-level results.

 

The Institute for Healthcare Improvement (IHI) uses a simple mantra to describe the essential elements for strategic improvement: Will, Ideas, and Execution. You have to have the will to improve, you have to have ideas about alternatives to the status quo, and then you have to make it real — execution.

 

Achieving results at the system or organizational level requires will at all levels, but especially the will of top management to make a new way of working attractive and the status quo uncomfortable. The new system will require new ideas about how work gets done, how relationships are built, and how patients participate in their care. Processes to scan widely within and outside of health care will be needed to find ideas robust enough to form the basis of a new system that performs at unprecedented levels. No single initiative or set of unaligned projects will likely be enough to produce system-level results.