Founded in 1991

The Institute for Healthcare Improvement (​IHI) was officially founde​d in 1991, but our work began in the late 1980s as part of the National Demonstration Project on Quality Improvement in Health Care, led by Donald Berwick, MD, MPP, and a group of visionary individuals committed to redesigning health care into a system without errors, waste, delays, and unsustainable costs. Since then, we’ve grown from an initial collection of grant-supported programs to a self-sustaining organization with worldwide influence.

Now, with more than 30 years of experience on which to build, IHI has evolved to meet current and future health care challenges. Three decades of teaching, coaching, convening, and caring — learning what works, and what we can do better. While our programs, projects, and priorities have changed with the times, we remain steadfastly committed to our mission to improve health and health care worldwide.​

We hope to one day reach a place where health care doesn't need improving. Until that time comes, we look forward to another 30 years of making it better, with courage, ​love, equity, and trust at the center of all that we do.

Science of Improvement

IHI takes a unique approach, based on the science of improvement, to working with individuals, teams, leaders, organizations, systems, states, regions, and countries to improve quality, including safety, equity, and value in health and health care. The science of improvement traces back to W. Edwards Deming, who taught that by adhering to certain principles of management, organizations can increase quality and simultaneously reduce costs.

The science of improvement is an applied science that includes:

The interaction of systems thinking, understanding variation, the theory of knowledge, and the psychology of change that are applied to improve the performance of processes, products, systems, services, organizations, and communities. The proper application of this science requires integration of a set of improvement methods and tools with knowledge of subject matter to develop, test, implement, spread, and scale up changes that lead to improvement.¹

Essential in this definition of the science of improvement are four elements:²

• Appreciation for a system: A focus on how the parts of a process relate to one another to create a system with a specific aim.
• Understanding variation: A distinction between variation that is an inherent part of the process and variation that is not typically part of the process or cause system.
• Theory of knowledge: An appreciation for the need for theory to make predictions to incorporate the scientific method in improvement.
• Psychology: Understanding how the interpersonal and social structures impact performance of a system or process.

These four elements are based on what Deming referred to as the System of Profound Knowledge.³ The System of Profound Knowledge provides an outside view – a lens – that serves as a map of theory to understand the organizations and contexts in which we work. Deming emphasized that it is the interaction of the four elements with each other, and with subject matter knowledge, that produce insights that lead to improvement. The System of Profound Knowledge is depicted below.

Deming’s System of Profound Knowledge

Applying Deming’s Theory of Profound Knowledge, Associates for Process Improvement created the Model for Improvement as a simple, effective tool for bringing about positive change. IHI uses the Model for Improvement as the foundational method for all its improvement efforts.

The science of improvement and the Model for Improvement provide the scientific basis that IHI uses to drive innovation, testing in the field, and spread and scale up to generate and disseminate learning about what changes, in which contexts, produce the improvements we seek with our customers, partners, and funders. As part of our approach, we seek to build improvement capability with those we work so that they also may apply the science of improvement in our work together and long after our work together concludes.

Whole System Quality

Since 2021, IHI has more explicitly drawn from works originating with Joseph M. Juran to articulate a management structure and leadership practices necessary to plan for, control, maintain, and improve quality. Whole System Quality: A Unified Approach to Building Responsive, Resilient Health Care Systems outlines a more holistic approach to quality management — whole system quality — that enables organizations to close the gap between the quality that customers are currently receiving and the quality that they could be receiving by integrating quality planning, quality control, and quality improvement activities across multiple levels of the system.

References

1. Adapted from Associates in Process Improvement (apiweb.org).

2. Perla RJ, Provost LP, Parry GJ. Seven propositions of the science of improvement: Exploring foundations. Quality Management in Health Care. 2013;22(3):170-186.

3. For more on the System of Profound Knowledge:

• Deming WE. The New Economics: For Industry, Government, Education (2nd edition). Cambridge, MA: Massachusetts Institute of Technology Center for Advanced Engineering Study; 1994: Chapter 4.
• Berwick DM. The science of improvement. JAMA. 2008 Mar 12;299(10):1182-1184.
• Langley GJ, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass; 2009: Chapter 4.

Values

IHI's values are at the core of everything we do.

Courage

We stay true to our values, even in the face of risk or loss. We speak up. We do this all in the service of personal and organizational integrity.

Love

We build relationships grounded in patience, kindness, gratitude, and respect. In our teams and in our work, we bring our whole selves in an authentic and caring spirit and encourage others to do the same.

Equity

We work to prevent and undo unfair systems, policies, and forms of racism and discrimination that drive gaps in our organization and in our work. We tell the truth about inequities and value all voices. We believe that we are interconnected and that inequities lead us all to lose. We want everyone to thrive and none of us can truly thrive until we all do.

Trust

We recognize the unique experience that each of us brings and believe in each other’s strengths. We ensure that people feel empowered and supported. We engage in genuine dialogue and encourage feedback with one another and our customers.

Impact

We work to improve all aspects of health and health care for patients, caregivers, the health workforce, and populations. We do this by applying improvement science to create better results for our partners and communities.

Equity Is One of IHI's Values

Over the past 10 years, IHI has learned that pursuing equity is a continuous improvement journey. On this journey, we’ve learned the importance of working at the individual, interpersonal, and institutional levels. To achieve our mission to improve health and health care worldwide, IHI is committed to diversity, equity, inclusion and being an anti-racist organization. In 2018, staff came together to redefine IHI’s organizational values of love, courage, equity, and trust. Ideally, equity, as with all of our values, is embedded in all of our systems, processes, and actions.

At IHI, holding equity as one of our values means: We work to develop and maintain systems, policies, and procedures to eliminate gaps in our organization and in our work. We tell the truth about inequities and value all voices. We believe that we are interconnected and that inequities lead us all to lose. We want everyone to thrive and none of us can truly thrive until we all do.

Improving Equity at IHI

We recognize that to successfully work with others to improve equity, IHI must do our own work on equity internally. Diversity, inclusion, and equity do not happen by accident or without the expertise and perspectives of people from a variety of backgrounds and experiences. IHI works to ensure that diversity, inclusion, and equity within our organization is an integral part of IHI’s strategy.

Our work to improve equity at IHI has a dual aim:

• Develop a workforce representative of the communities where IHI lives and works; and
• Cultivate a working environment where all staff can thrive and achieve their full potential.

There is no one-size-fits-all approach to diversity, inclusion, and equity. IHI currently has 167 US-based staff, 22 staff based in our Ethiopia office, and 35 staff members IHI engages through Professional Employment Organizations in Australia, Bangladesh, Brazil, Colombia, Ecuador, France, Ghana, New Zealand, Nigeria, Portugal, Qatar, Singapore, South Africa, and the United Kingdom. We continue our partnerships with staff around the world to ensure that IHI maintains diverse, equitable, and inclusive workplaces wherever staff are based.

We have committed to reporting these data publicly because we advocate for all of our partners do the same. IHI believes it is important to be transparent about both our successes and challenges with equity work, and we believe that it is important to model behavior that we hope others might emulate in health and health care around the world. In 2020, IHI committed to publish our data on diversity, inclusion, and equity and below you will find the first iteration. At IHI, we commit to annually reporting these data and to enhance and improve them over time.

Develop a Representative Workforce

With the guidance and support of the IHI Board of Directors, our internal equity efforts began with a focus on increasing the diversity of IHI staff, leaders, and board members. These data are tracked over time and used to evaluate equity in IHI recruiting and hiring processes to improve talent pools at every stage and ultimately contribute to improving diversity across IHI. While improving diversity is important, IHI recognizes that diversity on its own is never enough to foster inclusion and equity.

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Cultivate an Environment Where All Staff Thrive

While IHI’s diversity statistics have steadily improved, we believe this is only the beginning of the story. We need to go many steps further and take the time to seek out and listen deeply to staff experiences. We need to be willing to look for inequities in the experience of people in the workplace.

For years, IHI’s quarterly employee satisfaction scores were consistently high when reviewed in the aggregate. In staff surveys, approximately 90 to 95 percent of staff agreed or strongly agreed with the statement, “Overall, IHI is an excellent place to work.” In 2017, as part of our internal equity improvement efforts, on internal surveys IHI staff had the option to identify, if they chose, as White or as a Person of Color. This enabled IHI to begin stratifying the data by race and ethnicity, and to couple data with stories of staff experience.

In response to the statement, “Overall, IHI is an excellent place to work,” the data from the first stratified survey in 2017 indicated a 28 percent difference between staff of color and white staff, with around 96 percent of white staff agreeing or strongly agreeing with this statement compared to 68 percent of staff of color. This information challenged us to look deeper, to carefully consider the qualitative feedback in the survey and other markers of staff experience. It compelled us to consider how organizational policies and practices could widen or narrow that gap. We continue to work with our staff on changes and improvement ideas that will help to improve the experience of all staff in the organization.

Some of IHI’s efforts to address this gap include:

• Designated safe spaces for staff of color to come together to discuss their experiences and offer mutual support;
• Racial justice affinity groups for white staff and staff of color led by external coaches;
• Diversity, equity, and inclusion trainings provided to all staff on a regular basis; and
• Ongoing efforts to improve the transparency of IHI’s promotion and compensation processes.

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IHI Equity Advisory Group

IHI’s equity work is guided by the IHI Equity Advisory Group (EAG), an independent group of advisors chartered by the IHI Board of Directors in 2016 to provide expert review and guidance to improve the consistency and credibility of IHI’s internal and external equity work. The EAG helps us advance our learning in equity, focus IHI’s strategy and programs, review and help develop IHI activities, advise on advocacy opportunities, and support new partnership development.

IHI Statement on Modern Slavery

The Institute for Healthcare Improvement is committed to conducting our business responsibly and sustainably. As a global organization committed to improving health and well-being, it is our responsibility to ensure that we are not complicit in any form of modern slavery in any aspect of our operations, including our supply chain. 

Read the IHI Statement on Modern Slavery

IHI uses the Model for Improvement as the framework to guide and accelerate improvement work.

The Model for Improvement,* developed by Associates in Process Improvement, is a simple yet powerful framework for accelerating improvement.

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The model is compatible with any change models that organizations may already be using and can help to accelerate improvement.

The Model for Improvement has two parts:

• Three fundamental questions, which can be addressed in any order.
• The Plan-Do-Study-Act (PDSA) cycle** to test and adapt changes to ensure they result in the desired improvement.

The three fundamental questions in the Model for improvement can be addressed in any order, although teams typically start with the first question — What are we trying to accomplish? — to guide them in setting aims.

Answering the model’s three questions is an iterative process — the team moves back and forth between them as changes in thinking in one question or learning from PDSA cycles results in changes in thinking in another.

The Model for Improvement has been used successfully in many industries, including thousands of health care organizations in numerous countries to improve countless different processes and outcomes. The model can also be used to ensure that improvements result in closing equity gaps rather than maintaining or widening them by applying an equity lens at every step of the process.

An Illustrated Look at Quality Improvement in Health Care

Science of Improvement on a Whiteboard

These popular videos feature IHI's Bob Lloyd drawing on a whiteboard to explain fundamental improvement methods and tools: Model for Improvement, PDSA cycles, run charts, control charts, flowcharts, driver diagrams, and more!

*Source:

Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.

**For permission requests to use the Model for Improvement figure and/or related content, please contact the book publisher, Jossey-Bass (Wiley).

According to the US Census Bureau, the US population aged 65+ years is expected to nearly double over the next 30 years, from 43.1 million in 2012 to an estimated 83.7 million in 2050. These demographic advances, however extraordinary, have left our health systems behind as they struggle to reliably provide evidence-based care to every older adult at every care interaction.

What Is an Age-Friendly Health System?

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA), designed to meet this challenge head on.

Age-Friendly Health Systems aim to:

• Follow an essential set of evidence-based practices;
• Cause no harm; and
• Align with What Matters to the older adult and their family caregivers.
   

Learn more about upcoming Action Communities and the new Online Course with Coaching

What Does It Mean to Be an Age-Friendly Health System?

Becoming an Age-Friendly Health System entails reliably providing a set of four evidence-based elements of high-quality care, known as the “4Ms,” to all older adults in your system: What Matters, Medication, Mentation, and Mobility.

4Ms Framework of an Age-Friendly Health System

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Learn more about How to Practice the 4Ms by Care Setting

Connect and Learn with the Age-Friendly Health Systems Movement

Join Friends of Age-Friendly Health Systems for updates about the movement, notification about quarterly webinars, access to experts, and further support on the 4Ms Framework.

• Sign up for the Friends of Age-Friendly newsletter
• Friends of Age-Friendly Webinars: Recording links and descriptions for each webinar

Upcoming Webinar: Coming Soon

The Institute for Healthcare Improvement (IHI) Health Improvement Alliance Europe is a coalition of leaders united for change, driven by collaboration, and focused on achieving health and health care results. 

The Alliance is an exclusive community dedicated to continuous learning and identification of best practices and new models from within and outside health and hea​lth care. The group aims to create new delivery models relevant to European health systems, and achieve the best health and best care at an affordable cost in the face of changing demographics, increasing chronic illness, and economic challenges.​

IHI, with its rich history of improving health and health care worldwide for more than 30 years, is uniquely positioned to convene forward-thinking health care organisation leaders in this bold, collaborative learning environment.

The current ​program year began in October 2024.​ For more information, please download the 2024–2025 Prospectus.

Bold and Visionary Health Care Leadership

Patients, families, providers, and communities within Europe are looking for bold and visionary health care leaders — leaders who believe that now, perhaps more than ever before, we must change the dialogue about health care.

How will our health and care systems cope with the demands if we do not generate new models of delivery that will improve the health and health care for all of our citizens? This is why a coalition of progressive leaders have formed the IHI Health Improvement Alliance Europe.​

Aims and Objectives

To achieve our aim to improve work processes, create new delivery models, disseminate our learning and ideas, and achieve the best health and best care at affordable cost, the Health Improvement Alliance Europe aims to:

• ​Surface common challenges across and within regions
• Develop a cadre of diverse innovators and encourage innovative thinking
• Leverage each other’s ideas and successes, sharing internationally
• Hone a strong, bold, collective voice
• Learn from past and present networks at IHI and worldwide

An "All Teach, All Learn" Network

Join the IHI Health Improvement Alliance Europe to connect with like-minded colleagues under a philosophy of “all teach, all learn” that can significantly accelerate the knowledge, skills, and experience needed to strive for best health.

• ​Learn and test new innovations with other leaders, spreading improvements in new systems
• Share ideas and strategies across organisational, regional, and national boundaries
• Create new delivery models relevant to European health systems to achieve the best care at affordable considering changing demographics, increasing chronic illness, and economic challenges​
• Meet and connect with like-minded colleagues who strive for the best health; best care; at affordable costs…for everyone.​

A Dynamic, Collaborative Learning Community for Health Care Executives and Their Teams

​The Institute for Healthcare Improvement (IHI) Leadership Alliance is a dynamic collaboration of health care executives who share a goal to work with one another as well as in partnership with our patients, workforces, and communities to deliver on the full promise of the IHI Triple Aim.

Alliance Members share generously with one another, confident that by collaborating and learning together, we can individually and collectively get better, faster.

At this critical moment, health care needs leaders with the courage to imagine, design, and scale new models of innovation, collaboration, and governance that can push health care beyond its traditional limits.

The Leadership Alliance provides that space for leaders to transform and innovate health care together and we are committed to rebuilding healthcare from the inside out.

The 2024–2025 IHI Leadership Alliance membership year began in October 2024.

Read the TIME article by Donald. M. Berwick, MD, MPP, FRCP, KBE, IHI President Emeritus, Senior Fellow, and Senior Advisor to the IHI Leadership Alliance, American Health Care Is Broken. Major Hospitals Need to Be Part of the Solution.
 

Who Should Join

The IHI Leadership Alliance is a dynamic, collaborative learning community for health system executives and their teams characterized by generosity, curiosity, courage, and commitment to delivering on the full promise of the Triple Aim.

We welcome organizations that believe that by sharing and learning with one another and partnering with patients, workforces, and communities can help us individually and collectively get better, faster. In other words, organizations that:

• Have commitments from the highest levels of organizational leadership that delivering on the full promise of the Triple Aim is of strategic importance
• Are willing to share generously and commit the time and resources required to meaningfully engage in developin​​​g, testing, implementing, and measuring care redesign efforts
• Are fully committed to moving from talking to doing, from aspiring to achieving​