Resource Center

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. Pockets of excellence exist in our health care systems, but knowledge of these better ideas and practices often remains isolated and unknown to others. One clinic may develop a new way to ensure that all diabetics have their HbA1c levels checked on a regular basis, or one medical-surgical unit in a hospital may develop a consistent way to reduce pain for post-operative patients.

People with multiple health and social needs are high consumers of health care services, and thus drivers of high health care costs. The elevated cost of care in this population offers a tremendous opportunity to understand the individuals and their priorities and needs, and to craft a service delivery plan that meets their needs more effectively at a significantly lower cost.

In 2001, the Institute for Healthcare Improvement (IHI) developed the “bundle” concept in the context of an IHI and Voluntary Hospital Association (VHA) joint initiative — Idealized Design of the Intensive Care Unit (IDICU) — involving 13 hospitals focused on improving critical care. The goal of the initiative was to improve critical care processes to the highest levels of reliability, which would result in vastly improved outcomes.

Despite significant efforts to improve the care provided to patients in clinics and office practices, it is still not nearly what it should be. Patients often cannot access or do not receive the care necessary to ensure positive health outcomes. Compounding this, the structure of service delivery, traditional workforce roles, and the reimbursement system all create barriers to making widespread improvements to primary care. A different system is needed, one that is reliable, proactive, efficient, and engages patients in ways that ensure the best outcomes.

The Pursuing Perfection initiative was an eight-year demonstration program (2001 through 2008) funded by the Robert Wood Johnson Foundation (RWJF) in the US. Supported by technical assistance from the Institute for Healthcare Improvement (IHI), the initiative’s goal was to learn if and how health care organizations could make dramatic improvements in performance across the organization, resulting in a considerably more efficient and effective health care system.

Because waits, delays, and cancellations are so common in health care, patients and providers assume that waiting is simply part of the care process. But recent work on assessing the reasons for delays suggests otherwise.

This IHI 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.

This IHI white paper aims to support 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. It is a preparation tool which is meant to guide conversation and thinking prior to the launch of a large-scale improvement effort (i.e., one that seeks to stimulate change in complete, geopolitical areas through mobilization of hundreds or thousands of constituent organizations).

Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims.

The model described in this white paper represents the Institute for Healthcare Improvement’s best current assessment of the components of the safest and most reliable system of perinatal care. The four key components of the model are:

In 2008 Don Berwick, Tom Nolan, and John Whittington first described the Triple Aim of simultaneously improving population health, improving the patient experience of care, and reducing per capita cost. The Institute for Healthcare Improvement (IHI) developed the Triple Aim as a statement of purpose for fundamentally new health systems that contribute to the overall health of populations while reducing costs. The idea struck a nerve.