High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs

How to cite this IHI white paper:

Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013. (Available at ihi.org)


[en français: French translation of this paper also available. See below.]

Leaders at all levels in care delivery organizations, not just senior executives, are struggling with how to focus their leadership efforts and achieve Triple Aim results — better health, better care, at lower cost — for the populations they serve. High-impact leadership is required.

This white paper presents three interdependent dimensions of leadership that together define high-impact leadership in health care.

  • New Mental Models: We propose a set of ideas that constitute new mental models for leaders as they redesign care delivery systems to compete on value, rather than on volume, and deliver Triple Aim results for the populations they serve.
  • High-Impact Leadership Behaviors: Aligned with the mental models, we recommend five leadership behaviors to accelerate cultural change and support efforts to achieve Triple Aim results. These leadership behaviors, when practiced systematically, are cross-cutting, supporting many key leadership efforts and initiatives at once.
  • IHI High-Impact Leadership Framework: Building on IHI’s legacy leadership models and thinking, the IHI High-Impact Leadership Framework presents an updated, simpler leadership framework that serves as a guide for where leaders need to focus efforts and resources in order to drive improvement and innovation. This updated framework adds three essential areas of leadership efforts: driven by persons and community; shape desired organizational culture; and engage across traditional boundaries of health care systems.

The white paper also includes examples from a variety of health care leaders, to help illustrate High-Impact Leadership Behaviors in real-world practice.​


Author Michael Pugh gives a synopsis of the white paper's three major sections and explains why all leaders should read the paper.​

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