The April 2007 program is now full. If you would like to be placed on an interest list for future offerings, please contact Yael Gill at (617) 301-4851 or by email at ygill@ihi.org.
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The aspirations of health care organizations are high — as expressed in their mission and vision statements that invariably contain words or phrases such as:
The best at…
The leader in…
The national model for…
Highest quality health care
Improve the health of the community
Leave no one behind
In recent years, quality improvement in health care has progressed from a fringe philosophy to mainstream movement. Nearly all care delivery organizations are participating in some quality improvement, and many or most organizations can now reach results on a focused project. These improvement projects are often initiated by an internal champion such as a surgeon motivated to lead an effort to lower surgical site infections, or a nurse interested in management of anticoagulants. External forces also give rise to projects — for example national patient safety goals or an IHI Campaign. This plethora of "ignition sources" predictably results in a long list of worthwhile projects and measures, each of which makes sense on its own.
The collection of projects, however, often are not coordinated or aligned with the strategic direction of the organization. No one initiative or set of unaligned projects will likely be enough to produce high levels of performance for the whole organization. Therefore, the development of a method for executing a portfolio of projects which are aligned with strategy is a vital component.
The Weak Link
The key elements for strategic improvement are Will – Ideas – Execution. Improvement of any system requires all three of these elements.
Will — The recognition that defects exist and the desire to change
Ideas — Novel approaches for dramatically improving performance
Execution — Testing, implementing, and sustaining proven changes
Obtaining 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. Some of these ideas may come from sources internal to the organization but many will come from outside.
Experience with participants in the 100,000 Lives Campaign, IHI’s IMPACT network, and the Pursuing Perfection initiative, as well as other programs, has led IHI to conclude that execution is currently the weak link in the Will – Ideas – Execution chain. Health care organizations are increasingly demonstrating the will to change, and there are many proven ideas ready for implementation. But most organizations in health care today struggle with execution — making and sustaining measurable change.
World-Class Execution
As a result of this conclusion, IHI launched an R&D project to gather data on world-class approaches for execution used by organizations inside and outside of health care. Interviews were conducted with leaders from Caterpillar, Milliken, DuPont, Baldrige-winner OMI, and SRF from India (one of the few winners of the Deming Prize outside of Japan). Through its programs and alliances, IHI also had opportunities to observe, interview and learn from top-notch health care organizations such as Ascension Health, the Bellin Health System, HealthPartners, OSF, the health system of Jonkoping County in Sweden, and Cincinnati Children’s Hospital Medical Center. Each of these organizations contributed important insights on executing change when world-class performance at the system level is the goal.
No single approach to execution fits all of these organizations. However, each in their own way has found answers to questions such as:
- How do we connect improvement work to the organization’s strategic plan?
- How should we set breakthrough, system-level goals?
- How many breakthrough goals can we handle in a year?
- Is there an alternative to long lists of projects to accomplish system-level results?
- How does strategic improvement work at the system level connect with local improvement work at the microsystem level?
- What are the human resource development needs?
- How will we measure progress and provide executive oversight?
