Who We Help

Region: Europe
Location: England
Setting Type: Health care system
Topics: Quality improvement capability, improvement methodology, improvement infrastructure and culture, leadership for improvement, sustainability

East London NHS Foundation Trust (ELFT) is a provider of community health, mental health, primary care, and specialist services in England to a population of approximately 1.7 million people across Bedfordshire, Luton, and East London, UK.

In 2015, the Institute for Healthcare Improvement (IHI) and ELFT entered into a Strategic Partnership with IHI providing technical expertise and leading large-scale education in quality improvement (QI) methodology throughout the Trust. This built on years of engagement with IHI’s educational offerings such as Improvement Science in Action and the Improvement Advisor Professional Development Program.

IHI implemented tools such the High-Impact Leadership Framework, new mental models and behaviors, and helped develop a sustainable, organization-wide QI infrastructure. IHI continues to provide strategic support and leadership coaching to a wide range of ELFT’s leaders, including the senior management team.

Results

• Quality improvement has become fully embedded at ELFT, informing all operational and strategic planning.
• The UK’s Care Quality Commission awarded ELFT with three “Outstanding” ratings (2014, 2018, and 2021) making it the only organization of its kind in the UK to attain this standing.
• ELFT has also become a national center of learning for quality improvement, with 20 percent to 25 percent of participants in their Quality Leaders Programme (modeled on and a successor to IHI’s Improvement Science in Action course) coming from other organizations by 2023.

Related Information

Fostering an Improvement Culture: Learning from East London NHS Foundation Trust’s Improvement Journey Over 10 Years

Building a Culture of Improvement at East London NHS Foundation Trust

Region: Africa
Location: Ethiopia
Setting Type: Hospitals, national health system
Topics: Quality improvement, improvement capability, Breakthrough Series Collaborative, national quality strategy, spread and scale up, culture of quality, maternal and neonatal mortality

Through a partnership with the Ethiopian Federal Ministry of Health, (FMoH), with the support of the Bill & Melinda Gates Foundation and Margaret A. Cargill Philanthropies, this multi-year initiative was created to foster a culture of quality throughout the Ethiopian health system and reduce maternal and neonatal mortality. The Institute for Healthcare Improvement (IHI) and the FMoH co-designed a three-pronged approach to accelerate health system improvement nationally:

1. Develop a National Health Care Quality Strategy (NHQS) that built on existing quality and equity initiatives in Ethiopia 
2. Launch and test a scalable model of the health system improvement in health facilities and communities linked by learning Collaboratives 
3. Strengthen and develop a sustainable Ethiopian health care quality culture and capability across the health system 

Results 

• 212 federal, regional, and woreda managers trained in context-specific QI methods, and development of a national FMoH-owned in-service curriculum. 
• Improvement capability-building programs trained more than 16,000 health care professionals on quality improvement (QI) and developed more than 1,200 QI coaches. 
• 70 percent of Ethiopian health care facilities reported improvement in at least one service coverage outcome, while 90% reported adherence to the labor and delivery clinical bundle. 
• 100+ change ideas for maternal and newborn health were tested, with 83 successfully tested ideas.

Region: Global
Location: Global (18 countries)
Setting Type: Health care systems
Topics: Quality improvement methodology, pediatric care, experience of care, palliative care

The “Global Comfort Promise” (GCP) bundle — use of topical anesthetics, comfort positioning, age-appropriate distraction, use of breastfeeding or sucrose, and praise and reward — has demonstrated to be effective in reducing needle-based procedural pain for pediatric patients. Building on the success of a pilot project implemented in four hospitals in four countries, St. Jude Global and the Institute for Healthcare Improvement launched the Global Comfort Promise Quality Improvement (QI) Demonstration Collaborative — a project aimed at reducing the percentage of children with cancer who experience needlestick procedural pain by 50 percent, from a baseline mean of 64 percent, in 22 participating hospitals in 18 countries between July 2023 and June 2024.

This 12-month initiative used a multi-level QI strategy, including an intermediate-level QI curriculum, a shared theory of change (see Figure 1) and measurement strategy, 90-minute bi-weekly virtual Learning Sessions, Action Periods, monthly 60-minute office hours, and monthly 60-minute team coaching to promote the systematic adoption and adaptation of the GCP bundle. This initiative leveraged the IHI Breakthrough Series Collaborative model, the Model for Improvement, and Deming’s System of Profound Knowledge.

Image

Results

• Participating teams engaged in the Collaborative through 20 virtual Learning Sessions, 200 one-to-one coaching calls, and 50 dedicated office hour sessions.
• The teams were able to reduce the incidence of needle-based procedural pain from 64 percent to 24 percent (see Figure 2), resulting in more than 4,800 pain-free procedures.

Image

Related Information

St. Jude’s Palliative Care Programs

Region: Latin America
Location: Mexico, Brazil, Haiti, Peru, Paraguay, Panama
Setting Type: Health care systems
Topics: Quality improvement, Breakthrough Series Collaborative, pediatric hematology-oncology care, infections, sepsis

Since 2019, the Institute for Healthcare Improvement (IHI) has been partnering with St. Jude Global, the global branch of St. Jude Children’s Research Hospital, to reduce treatment-related morbidity and mortality among children with cancer globally. Building on the success of the 1st Mexico in Alliance with St. Jude (MAS) Collaborative, in November 2021, IHI helped launch the 2nd MAS Collaborative.

The aim of this project was to increase the percentage of febrile pediatric hematology-oncology patients presenting to the emergency department who receive the first dose of antibiotics within 60 minutes from triage from a baseline of 47 percent to 70 percent between November 2021 and May 2023.

This 60-minute time frame — referred to as the “Golden Hour” — is an evidence-based best practice that has been shown to reduce incidence of sepsis and infection-related mortality, which were also measured in the project.

The 2nd MAS Collaborative followed the IHI Breakthrough Series model coupled with two certified improvement science capability-building programs and was organized around three two-day Learning Sessions and three Action Periods. During the Action Periods, participating teams tested change ideas using Plan-Do-Study-Act (PDSA) cycles based on a common theory of change; attended monthly learning calls; received coaching; and reported PDSAs and data in a shared repository.

Results

• 60 percent increase in patients receiving the first dose of antibiotics within 60 minutes (see Figure 1)
• 60 percent decrease in incidence of sepsis
• An estimated 347 cases of sepsis prevented
• An estimated 27 deaths avoided
• An estimated 5,458 inpatient bed days reduced
• At least (an estimated) $8 to $10 million in avoided costs

Image

Related Information

The Power of Applying Improvement Science to the COVID-19 Response

St. Jude Research: In the "Golden Hour," Antibiotics Save Lives in Latin America 

Region: Asia-Pacific
Location: Victoria, Australia
Setting Type: Government
Topics: Quality improvement, improvement capability, patient safety, Whole System Quality, improve health outcomes

Since 2018, the Institute for Healthcare Improvement (IHI) has been engaged in a multi-year strategic partnership with Safer Care Victoria (SCV), a peak state authority for quality and safety improvement in health care. IHI is supporting SCV in its efforts to deliver safer, more effective, and person-centered health care across Victoria. To accelerate the pace of improvement, IHI is assisting SCV to deploy a strategy to achieve Whole System Quality, build multi-level capability across the health sector, and deliver measurable results through the application of improvement science. 

IHI is also supporting SCV’s work to achieve system-wide transformation by designing and implementing initiatives to improve health outcomes in priority areas, including maternal and newborn health, delirium, heart failure, health worker well-being, Age-Friendly Health Systems, patient flow, and residential care for children and young people.

Region: Africa
Location: Ethiopia, Uganda, Tanzania, South Africa
Setting Type: Hospitals
Topics: Quality improvement methodology, patient safety, perioperative care, maternal health

Saving Lives After Surgery is an ongoing initiative in Africa that started in 2023. The Institute for Healthcare Improvement (IHI) partnered in this work with Queen Mary University of London, University of Cape Town Global Surgery, and the UK’s National Institute for Health and Care Research.

The burden of surgical safety gaps in Africa is heartbreaking. There are an estimated 600,000 post-operative deaths each year across the continent, and half of them are preventable. This staggering total equals the deaths caused worldwide each year by HIV. In Africa, women undergoing C-section deliveries are 50 times more likely to die than women in high-income countries and at least half of all surgery survivors incur a catastrophic financial expenditure.

The goal of the initiative is reliable delivery of an evidence-based intervention focused on the “5Rs”: Risk identification; Recognize deterioration using an early warning system; Respond to physical deterioration; Reassess the patient after responding; and Reflect and redesign.

IHI helped design and implement phase 1 of the project, which focused on building a prototype model to decrease postoperative deaths by 25 percent using an intensive innovation approach. Phase 2 aims to scale up the project, doubling the number of participating hospitals, refining the model for broader testing and implementation, and helping teams achieve higher reliability in the processes that make up each “R”.

Results

• A subset of 4 participating hospitals (N=7) that were able and permitted to share data reported a 36 percent decrease in postoperative mortality (from 2.2 percent to 1.4 percent) during the project period.

Region: North America
Location: United States (national)
Setting Type: Nursing homes
Topics: Quality improvement, large-scale change, spread and scale up, COVID-19, infection control

In 2020, the COVID-19 pandemic devastated nursing homes across the country, disproportionately affecting residents and staff. The United States Agency for Healthcare Research and Quality (AHRQ), Project ECHO (Extension for Community Health Outcomes), and the Institute for Healthcare Improvement (IHI) established the National Nursing Home COVID-19 Action Network. This initiative sought to increase access to best-practice knowledge around COVID-19 infection control, answer questions about context-specific implementation, and encourage peer learning — thus providing both knowledge and emotional support for nursing home staff. 

IHI was recruited as a core partner to develop a curriculum for infection control and quality improvement. By the end of the program’s second wave in March 2021, more than 30,000 individuals at 9,058 nursing homes had participated. Participants joined from all 50 states, the District of Columbia, and Puerto Rico. Most of those who participated were either nursing home administrators or registered nurses.