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IHI launches map toward improved healthcare

IHI president asks attendees to simplify practices, focus on healing patients

At the Institute for Healthcare Improvement's (IHI) 20th annual National Forum on Quality Improvement in Health Care in December 2008, attendees from around the globe were challenged to take the idea seriously that they can change the future of healthcare for the better.

Don Berwick, MD, MPP, FRCP, president of the IHI, urged hospitals to take part in its newest campaign, called the Improvement Map. The new campaign builds on the IHI’s previous efforts—the 100,000 Lives and 5 Million Lives campaigns—which focused on reducing unnecessary deaths in hospitals.

The goal of the Improvement Map is to identify and improve hospital work flow processes in order to deliver better patient care.

“What if we could map out 100 processes that explain 70% or 80% of what a hospital does and then take that as our sense-making agenda for the task of improvement? Perfect 100 streams of work—is that possible? Sure it’s possible,” Berwick told attendees at the Nashville conference.

The Improvement Map will be built in the coming months as the IHI works with national experts to identify these processes.

In addition, Berwick introduced three new interventions to add to the 12 laid out through the IHI’s previous two campaigns. These new interventions are:

  • Linking quality and financial management strategies to reduce costs and increase patient safety
  • Preventing catheter-associated urinary tract infections
  • Using the World Health Organization’s (WHO) surgical safety checklist to prevent surgical errors

Berwick challenged campaign hospitals to adopt the WHO checklist in one operating room in each hospital in the United States within 90 days in order to see a profound effect on the prevention of surgical errors.

Using these three interventions as starting points, the IHI hopes that hospitals worldwide will embrace the idea of identifying and improving processes within a hospital that affect patient care.

Although the 5 Million Lives Campaign has officially ended, its interventions will be useful as part of the Improvement Map. Berwick said measuring whether 5 million lives were saved from harm has been more difficult than he originally thought. In the coming years, measuring this will be possible, as the Agency for Healthcare Research and Quality and the National Quality Forum are developing global safety measures to provide these types of data.

To simplify standards, the IHI needs to work together with other major players in the patient safety and quality field to align goals so facilities are not required to collect different sets of data for each organization, Berwick said.

“We’re going to build the full Improvement Map: a master, overarching agenda of processes whose improvement can lead any hospital as a whole system to totally new levels of performance. And I promise you, we will coordinate that agenda with the good work of the major influencers in the system, especially the priorities of the National Quality Forum,” said Berwick. “We’re going to reach out to you, walk with you at any speed you are comfortable with. We’ll meet you where you are, and together we will get a sense of direction and we will try to get you traction where, just now, you might feel like you’re spinning your wheels.”

Imagining the future of healthcare

Much of Berwick’s speech focused on the future of healthcare and how it is dependent on actions healthcare workers take today.

Using his daughter Jessica, a medical student, as an example, Berwick presented a scenario of what might happen in the future.

“For Jessica and all of the students here today, we will create, or fail to create, the context to give her a chance to do what she wants to do most with her career—to heal,” Berwick said.

To imagine the future, Berwick constructed a “what could have been” scenario, presenting what he expects would happen if conference attendees were to take on the burden of changing healthcare for the better in the near future.

Some of the opportunities the healthcare industry can take to change for the better are:

  • Deciding that healthcare is a human right.
  • Realizing that racial equity in healthcare requires making immense shifts in investment.
  • Ceasing to confuse the pursuit of health with the pursuit of care. The best single measure of the success of U.S. investment in health should be the degree to which healthcare becomes unnecessary. “The best hospital bed is an empty bed; the best doctor visit is the one cancelled because we don’t need it anymore,” Berwick said.
  • Investing in improving global health. December 10, 2008, the date of the conference, was the 60th anniversary of the signing of the Declaration of Human Rights, Berwick noted.
  • Reducing waste by focusing on primary care physicians, not hospitals, as the introduction to the healthcare system.
  • Realizing that excessive care is as dangerous, if not more so, than omitted care and working to reduce the number of tests and procedures for patients.
  • Making patient safety a primary, inalienable goal that leads into the boardroom.

Editor’s note: To read more about the IHI’s Improvement Map, visit