IHI’s Innovation Series white papers were developed to further our mission of improving the quality and value of health care. The ideas and findings in these white papers represent innovative work by organizations affiliated with IHI. White papers are designed to share with readers the problems IHI is working to address; the ideas, changes, and methods we are developing and testing to help organizations make breakthrough improvements; and early results where they exist.

	20. Reducing Costs Through the Appropriate Use of Specialty Services This white paper describes a framework that primarily focuses on changing professional practice culture by engaging physicians in developing and implementing practice standards that will work best in local circumstances to reduce high or escalating costs, reduce exposure to risk of harms, sustain or improve health outcomes, and improve the patient experience.

	19. Increasing Efficiency and Enhancing Value in Health Care: Ways to Achieve Savings in Operating Costs per Year This white paper proposes a set of steps health care organizations can undertake to systematically identify and eliminate inefficiencies to create a portfolio of work leading to a 1 percent to 3 percent savings in operating costs per year. Methods for developing a balanced portfolio of projects and for calculating and tracking cost savings are also described.

	18. Using Evidence-Based Environmental Design to Enhance Safety and Quality The purpose of this white paper is to show health care leaders how, as part of an integrated improvement strategy, evidence-based environmental design interventions can measurably enhance the care they provide, improve the perceptions of the experience of that care by patients, families, and staff, and actually have a positive economic impact on their organizations.

	17. Planning for Scale: A Guide for Designing Large-Scale Improvement Initiatives This white paper may be used as a preparation tool by those that are planning to take effective health care practices from one setting or isolated environment and to make them ubiquitous across a health care system, region, state, or nation. A list of fundamental questions are meant to guide conversation and thinking prior to the launch of a large-scale improvement effort.

	16. Whole System Measures This white paper describes and promotes the use of a system of metrics, called the Whole System Measures, to measure the overall quality of a health system and to align improvement work across a hospital, group practice, or large health care system.

	15. Execution of Strategic Improvement Initiatives to Produce System-Level Results This white paper proposes a framework for execution of strategic initiatives aimed at producing system-level results.

	14. Engaging Physicians in a Shared Quality Agenda This white paper presents a framework on which hospital leaders might build a written plan for physician engagement in quality and safety. The paper includes tools to help hospital leaders assess organizational factors that will inform the degree of difficulty in engaging physicians, as well as to identify and prioritize initiatives for which physician engagement is essential.

	13. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition) UPDATED May 2009: This white paper provides comprehensive information on the development and methodology of the IHI Global Trigger Tool, with step-by-step instructions for using this easy-to-use method to accurately identify adverse events (harm) and measure the rate of adverse events over time.

	12. Leadership Guide to Patient Safety This white paper presents eight steps that are recommended for leaders to follow to achieve patient safety and high reliability in their organizations. Each step and its component parts are described in detail, and resources for more information are provided where available.

	11. A Framework for Spread: From Local Improvements to System-Wide Change A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to rapidly spread innovations and new ideas. This white paper describes the major spread projects that IHI has supported, and harvests the lessons learned about the most effective ways to spread change.

	10. Innovations in Planned Care IHI is developing and testing a new design for the delivery of primary care for all patients, which reaches high levels of effectiveness, efficiency, and patient-centeredness. This design is based on the idea that in order to ensure reliable care delivery, every patient should have a plan for his or her care.

	9. Idealized Design of Perinatal Care Reviews of perinatal care have consistently pointed to failures in communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. This white paper provides detail about IHI's Idealized Design process and examines some of the initial work of the Idealized Design of Perinatal Care innovation project.

	8. Reducing Hospital Mortality Rates (Part 2) A number of hospitals working with IHI have been testing the theory that mortality can be consistently reduced through the use of a combination of evidence-based interventions, and the preliminary results generally are encouraging. This white paper presents an update on IHI's work to reduce mortality first introduced in the "Move Your Dot" white paper.

	7. Going Lean in Health Care Lean management principles have been used effectively in manufacturing companies for decades, particularly in Japan. IHI believes that lean principles can be — indeed, already are being — successfully applied to the delivery of health care.

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

	5. Transforming Care at the Bedside This white paper describes work being done in 13 pilot hospitals to dramatically improve the outcomes and experiences of patients and providers on medical/surgical units, particularly focusing on improvements in safety and reliability; care team vitality; patient-centeredness; and increased value.

	4. Improving the Reliability of Health Care This white paper describes principles and strategies used successfully in other industries to help evaluate, calculate, and improve the overall reliability of complex systems, and explains the application of reliability principles to health care.

	3. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement IHI developed the Breakthrough Series to help health care organizations make "breakthrough" improvements in quality while reducing costs.

	2. Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings In this white paper, IHI offers new perspectives on the impediments to timely and efficient flow of patients through acute care settings.

	1. Move Your Dot™: Measuring, Evaluating, and Reducing Hospital Mortality Rates (Part 1) This white paper helps hospitals know more about their organizational performance as it relates to mortality, and explains one of many current approaches being used to improve health care safety throughout the health care system.