High Impact Leadership

Improve Care, Improve the Health of Populations, and Reduce Costs – IHI White Paper

By Tara Rivkin

This impressive white paper addresses the concept of leadership within the United States’ health care system (but applicable anywhere in the world) and outlines its importance in achieving ‘Triple Aim results for the populations they serve’. That is, better health, better care and lower cost. The paper was written by qualified health care professionals and academics in the field, and examines the integral role of High-Impact Leadership in achieving these goals.

Over the past 25 years of research, IHI developed key concepts and an approach to leadership for improvement and innovation in health care. The findings from a 90-day Innovation Project on Leadership – ‘High Impact Leadership’, five expert interviews and an expert leaders meeting of 12 recognised organisational leaders is presented here with an in-depth look at the three dimensions of High-Impact Leadership in Health Care that are necessary in order to obtain the optimal Triple Aim results.

Building on this foundation, three interdependent dimensions of leadership have now been incorporated into an approach for focusing and organising leadership Behaviours, and the IHI High-Impact Leadership Framework. The framework explicitly addresses three new areas of required leadership efforts and actions: driven by persons and community; shape desired organisational culture; and engage across traditional boundaries of health care systems.

Firstly, the paper examines a new mental model – that is, how leaders think about challenges and solutions. A philosophical shift in leader thinking is demonstrated in the paper as being crucial in order to shift from a ‘volume to value’ approach. This approach is more economically viable, and is made possible by leaders at every level adopting the following new mental models:

  1. Individuals and families are partners in their care.
  2. Compete on value, with continuous reduction in operating cost.
  3. Reorganise services to align with new payment systems.
  4. Everyone is an improver.

Also inherent to High-Impact Leadership as defined by this paper are the five key High-Impact Leadership Behaviours. These are:

  1. Person-centredness – Be consistently person-centred in word and deed.
  2. Front Line Engagement – Be a regular authentic presence at the front line and a visible champion of improvement.
  3. Relentless Focus – Remain focused on the vision and strategy.
  4. Transparency – Require transparency about results, progress, aims and defects.
  5. Boundarilessness – Encourage and practice systems thinking and collaboration across boundaries.

This five-pronged approach to behavioural change demonstrates that people and communities are integral to effective leadership. Participation and personalisation within a medical community are essential in order to gain the maximum benefits with minimum economic output. The paper cites examples of medical professionals and CEOs across America and their personal involvement and subsequent success in achieving Triple Aim results for their institutions. Through interviews with real-world leaders it is evident that this level of involvement on every level is essential in High-Impact Leadership and shows the importance of reinforcing their vision through their own actions and behaviours. These five pillars of leadership behaviour are critical in achieving outcomes.

The final dimension or leadership addressed in the paper is the IHI High-Impact Leadership Framework – Where leaders need to focus their efforts. This proposed framework outlined in the paper is built on social science leadership research and the collective learning of IHI and others over the past decades. It cites the work of Tom Nolan, Don Berwick, Maureen Bisognano, James Reinertsen, and many others at IHI who, over the years, have helped motivate health care leaders and have been responsible for improving and changing the system. As such, this framework serves as a guide for leaders and adds three essential areas of leadership It also represents the evolution of four major IHI works: Leadership Guide to Patient Safety, Seven Leadership Leverage Points for Organization-Level Improvement in Health Care, Execution of Strategic Improvement Initiatives to Produce System-Level Results, and Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs.