Burnout, moral distress, moral injury, and compassion fatigue in the health care workforce continue to undercut well-being and mental health for health care workers, significantly contributing to retention challenges and staffing shortages, as well as leading to negative impacts on health care quality, workforce safety, patient safety, and patient experience.

Effective health care leaders at all levels seek to understand these key drivers of burnout and mental health struggles, partnering with health care workers on co-design and leading quality improvement efforts to address them.

The features of a thriving health care workforce are well understood: the most joyful, engaged, productive staff feel both physically and psychologically safe, perceive belonging, appreciate the meaning and purpose of their work, have some choice and control over their time, experience camaraderie with others at work, and perceive their work life to be fair and equitable.

Improvers can leverage proven methods for creating a positive work environment that creates these conditions and ensures the commitment to deliver high-quality care to patients, even in stressful times.

IHI aims to integrate workforce well-being, workforce safety, and patient safety, grounded in evidence and the science and methods of improvement, to ensure that every patient receives safe, reliable, effective, and equitable care from a fully-enabled health care workforce. 

Operating within a safe environment, physically and mentally, is crucial to individual preparedness for the manual and cognitive challenges characterizing health care workflows. Workforce safety recognizes the imperative to protect workforce members from physical harm so that they can deliver high-quality care, and recognizes the vital importance of psychological and emotional safety for engaging, communicating, and collaborating effectively to safely deliver patient care.

As described in Safer Together: A National Action Plan to Advance Patient Safety, health care organizations across all care settings can optimize workforce performance and safe, high-quality outcomes by:

• Ensuring work environments are free from physical hazards
• Seeking to learn from workforce harm events in parallel to patient harm events
• Shaping a culture of safety for both patients and the workforce
• Creating psychologically safe work environments
• Fostering perceptions of belonging in the workforce through activation of a just culture at all levels
• Nurturing a bias-free environment supported by diversity, equity, and inclusion across the workforce at all levels, which contributes to psychological and emotional safety and belonging

IHI aims to integrate workforce safety, workforce well-being, and patient safety, grounded in evidence and the science and methods of improvement, to ensure that every patient receives safe, reliable, effective, and equitable care from a fully-enabled health care workforce.

Despite major advances in health care, many health care systems around the world are troubled by the same set of quality and safety challenges, including the all too common “reactive quality” approach that does not yield transformational change. 

In contrast, the IHI Whole System Quality approach is more proactive, holistic, and strategic, helping organizations anticipate and mitigate risk and integrate their quality activities. Whole System Quality informs an organization-wide, strategic approach to quality and organizational transformation. 

Whole System Quality is based on three interrelated quality activities — quality planning, quality control, and quality improvement — that allow health systems to develop the structures and capabilities needed to sustainably move toward better meeting customer needs, reliably eliminating quality and safety defects, and building true resilience in the system.

When successfully deployed, Whole System Quality shifts a health care organization from a position in which the quality department comes to the “rescue” when an event occurs, to one that is proactively identifying risk points in real time and mitigating them before an event occurs.

IHI first articulated the Triple Aim in 2008 as a provocation and ultimate destination for the high-performing health systems of the future. In subsequent years, the Triple Aim has evolved to also include a focus on the well-being of the health care workforce and advancing health equity — referred to as the Quintuple Aim. In this time of rapid transformation of health care ecosystems, this comprehensive framework has provided leaders with a North Star as they create new value-based, equity-centered models of care for populations that are increasingly heterogeneous and complex. 

IHI is helping partners to understand and stratify the needs of their populations, to activate those populations to improve their health, and to map and utilize all assets in their communities to achieve equitable outcomes. We convene learning networks to share best practices and proven approaches, and we develop capacity within organizations for population and community health improvement.

IHI’s focus on populations includes:

• New models of population health management
• Change packages to support specific population segments
• Large campaigns and other population health initiatives to improve population outcomes at scale, with a particular focus on advancing equity
• Strategic guidance to both organizations advancing population health and multistakeholder efforts to improve health and well-being in communities
• Extending reach and impact by building capacity and skills for population and community health improvement
• Providing assessment, design, and capability for comprehensive quality strategies for nations and other large health systems

At the heart of IHI's work is the science of improvement — an applied science that emphasizes innovation, rapid-cycle testing in the field, and spread in order to generate learning about what changes, in which contexts, produce improvements. 

Whether in daily work, departmental processes, or across a system, the application of improvement methods can lead to better health outcomes and experiences for our patients, as well as a more effective and joyful workforce. 

IHI offers a variety of opportunities for individuals, teams, and organizations to learn improvement methods, including in-person and online programs as well as tools and other resources.

Systemic, avoidable, predictable, and unjust differences in access, treatment, and outcomes between individuals and across populations should be particularly troubling for quality improvers. These types of differences are often referred to as inequities or disparities. 

Inequities are the worst type of unwanted variation in a system — variation linked to the complicated history and reality of racism, classism, sexism, ableism, ageism, and other forms of oppression. Quality improvers have a role to play and tools to use in health care systems and communities to end inequities.

Partnering with experts and health care organizations around the world, IHI innovates approaches that transform patient and workforce safety, demonstrably eliminate harm and save lives, and build capability and competencies for the health care workforce to enable continuous improvement, spread, and sustainability for safety in all care settings. 

As described in Safer Together: National Action Plan to Advance Patient Safety, IHI seeks to advance a total systems approach to safety: integration of safety science and high-reliability principles to mitigate and prevent risks; committed leaders who foster a culture of safety and ensure workforce safety and well-being; meaningful engagement of patients and families to co-design safety; and learning systems that continuously improve and enable safety to propagate within and beyond organizations. 

IHI aims to integrate patient safety, workforce safety, and workforce well-being, grounded in evidence and the science and methods of improvement, to ensure that every patient receives safe, reliable, effective, and equitable care from a fully-enabled health care workforce.

In May 2022, the National Steering Committee for Patient Safety (NSC) issued the Declaration to Advance Patient Safety to urge health care leaders across the continuum of care to recommit to advancing patient and workforce safety.

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The NSC called for immediate action to address safety from a total systems approach, as presented in the Safer Together: A National Action Plan to Advance Patient Safety, and implored leaders to adopt safety as a core value and foster collective action to uphold this value.

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Recommit to Advance Patient and Workforce Safety

To achieve the vision of health care that is safe, reliable, and free from harm, the Declaration to Advance Patient Safety calls for health care leaders to take collective and coordinated action by doing the following:

1. Review the 17 recommendations and tactics to advance patient safety presented in Safer Together: A National Action Plan to Advance Patient Safety, a report that harnesses the knowledge and insights of the National Steering Committee for Patient Safety members.
2. Identify a senior sponsor and core team charged with deploying the Self-Assessment Tool, a companion resource to the National Action Plan, to evaluate your organization’s current state across each of the four foundational areas, prioritized as essential to create total systems safety.
3. Establish and enact strategies, tactics, and measurement and improvement plans to meaningfully fortify and sustain your organization’s performance in each of the four foundational areas by leveraging the Implementation Resource Guide, a companion resource to the National Action Plan.