Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition)

Image_LeadershipLeverageCover08.jpgHow to cite this paper:

Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available on
[en Español: Spanish translation of this paper also available. See below.] 
Leadership models and frameworks can provide a roadmap for leaders to think about how to do their work, improve their organizations, learn from improvement projects, and design leadership development programs. Because IHI has gained a lot of new knowledge and field examples, and we are also faced with questions about relationships among various IHI leadership frameworks — such as Will-Ideas-Execution, the IHI Framework for Leadership for Improvement, and the IHI Framework for Execution — we thought it was timely to write a Second Edition of our white paper, Seven Leadership Leverage Points for Organization-Level Improvement in Health Care.
Since publishing the First Edition in 2005, we have learned a great deal about what it takes to achieve results in quality and safety at the level of entire organizations and care systems. We have noticed, for example, that many of the leverage points work well in the field without much modification, whereas others seem to need some reframing, or a special emphasis on particular elements within the leverage point, or even substantial revision.
The Second Edition (2008) white paper incorporates this continued learning, particularly on the subject of execution, provides specific examples of the field application of each leverage point, and describes the relationship between the leverage points and other IHI leadership frameworks. The paper also includes a self-assessment tool designed to help leaders design and plan their work to lead to a significant reduction in one or two system-level measures.
As part of IHI's work of supporting and encouraging leaders of innovative health systems, this white paper presents what we believe to be some important leverage points for leaders who want to achieve dramatic, system-level performance improvement. This set of leverage points is not offered as a tried-and-true method, but as a theory — one that we hope will be useful for individual leaders in planning their work and for us in organizing a support and learning system to share best practices and results across organizations; and from which all of us can learn about what works, and what doesn't in bringing about large-system change in health care.
IHI’s Innovation Series white papers were developed to further our mission of improving the quality and value of health care. The findings and tools in these reports provide you with an opportunity to understand and evaluate the issues, and begin testing changes that can help your organization make breakthrough improvements.
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