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IHI White Paper

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IHI White Paper:
Whole System Quality

A Unified Approach to Building Responsive, Resilient Health Care Systems

Decades of scholarship, coupled with insights from the COVID-19 pandemic, reveal a way forward for health systems that are pursuing quality in health care: through a process of rigorous learning, health care organisations can design resilient and responsive management systems to continuously deliver services that reliably and sustainably meet the evolving needs of patients, populations, and communities — in times of both stability and crisis.

Whole System Quality

This IHI White Paper proposes a more holistic approach to quality management — whole system quality — that enables organisations 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. 

Whole system quality requires leadership principles and practices that foster a culture of learning to reliably and sustainably meet the evolving needs of patients, populations, and communities. The paper details how these leadership principles and management practices can enable health systems to pursue quality — with ambition, alignment, and agility — through a commitment to learning.

Watch an Overview of Whole System Quality

User Experience

Fairview Health used 10 organisational commitments (e.g., 'set and hold standards') to organize and inform their quality transformation work, connecting all management interventions . . . to these 10 commitments, which enabled the health system to more broadly communicate their vision and build the foundation for a new way of working.

Organisations like East London NHS Foundation Trust start their journey by reducing quality assurance activities to create space for targeted quality planning, improvement, and control activities.

Kaiser Permanente adopted Kotter’s 8-Step Process for Leading Change. They used, in part, the continued 'quality chasm' highlighted at the beginning of the whole system quality white paper as part of their platform for change to create a sense of urgency, in addition to their own results compared to top-performing
health systems.