{"id":3815,"date":"2015-04-17T12:00:00","date_gmt":"2015-04-17T19:00:00","guid":{"rendered":"https:\/\/www.carnegiefoundation.org\/?p=3815"},"modified":"2026-02-09T12:28:12","modified_gmt":"2026-02-09T20:28:12","slug":"learning-from-healthcares-use-of-improvement-science","status":"publish","type":"post","link":"https:\/\/www.carnegiefoundation.org\/learning-from-healthcares-use-of-improvement-science\/","title":{"rendered":"Learning from Healthcare\u2019s Use of Improvement Science"},"content":{"rendered":"
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Don Berwick, founder of the Institute for Healthcare Improvement (IHI)<\/a>, gave an inspiring keynote at the Carnegie Foundation\u2019s second annual Summit on Improvement in Education. Berwick shared lessons from the use of improvement science and systems thinking in health care settings and proposed how these lessons could apply in education.<\/p>\n\n\n\n

Berwick began by discussing the similarities between health care and education. Both fields are largely publicly funded, are for the social good, possess roots in a professional working base, deal with human beings and relationships, and are under intense public and media scrutiny. Although he does not want to \u201cfall victim to the assumption that [the two fields are] just the same\u201d he does believe that \u201cmaybe we can learn from each other.\u201d Berwick believes education can learn from the quality improvement movement in health care that has countered an overreliance on inspection and replaced it with a balanced approach to improvement.<\/p>\n\n\n\n

After walking through the history of quality improvement in health care, Berwick said, \u201cThen and now there is a hegemonic view about what to do when there are problems.\u201d When analyzing data on performance (which both education and health care are increasingly well-equipped to do), there is a tendency amongst managers to want to address the \u201cbad apples\u201d\u2014i.e., those people with the lowest performance. However, Berwick argued that a reliance on inspection to improve does not work to advance performance. Merely culling the worst performers out of the workforce not only does not improve results, but it also creates a culture of fear that is an anathema to an open improvement environment. Any field needs some degree of culling, but it is not a model for improvement.<\/p>\n\n\n\n

Every system is perfectly designed to achieve exactly the results it gets.\u201dTwitter<\/a><\/p>\n\n\n\n

But without using reliance on inspection, what can we do to get the improvement that the health care and education fields need? Berwick argued that we need to start looking at these sectors as systems<\/em>. The \u201cfirst law of improvement\u201d that Berwick said is \u201ctattooed on the body\u201d of everyone that works with IHI: \u201cEvery system is perfectly designed to achieve exactly the results it gets.\u201d To illustrate this, he offered the analogy of a driver trying to make a car go faster. When the driver has reached the top speed, he or she cannot make the car go faster by telling it to go faster or by \u201cgiving it an incident report in its file.\u201d Since the top speed of a car is dependent on the system, then if you want improvement, you need to change the car, i.e., change the system. For health care and education, if you are unsatisfied with the current performance, you need to change the system. Simply urging individuals to do better does not make them better. Relying exclusively on the performance of individuals undervalues the potential for human error and the limits of human capacity. Systems thinkers do not \u201cask people to be superhuman; they accept people for their humanness and help them avoid error.\u201d Education practitioners must learn that a system designed around making every individual superhuman does not attend to the complexity present in an interdependent system.<\/p>\n\n\n

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Systems thinkers do not \u201cask people to be superhuman; they accept people for their humanness and help them avoid error.\u201d<\/p>\n\n\n\n

This change in mentality is crucial. And reaching success is possible with it. Berwick gave a number of examples of health care practitioners using systems thinking and innovations to improve care. For example, the Southcentral Foundation\u2019s Nuka System of Care in Alaska<\/a>, the native-owned system of care for 60,000 Alaskans, has thoroughly redesigned care through a series of ten principles. One of the principles focuses on team-based care, for which doctors, nurses, nutritionists, and others sit together to treat patients together: \u201cYou cannot be cared for at Nuka without being cared for by a team.\u201d As a result of this and the other principles, Nuka saw, from 2004 to 2009, 50% reductions in emergency room visits and hospital admissions, 65% reduction in use of specialty services, and over 90% patient and staff satisfaction ratings. This example and others show that focusing on changes in systems through innovations can lead to improvement.<\/p>\n\n\n\n

Yet while it has become clear that using these methods can lead to better outcomes for a lower cost, the problem is that existing systems are very powerful in acting against change. This places a large burden on leaders to challenge the status quo in order to make changes in their system. In order to shift the energy from inspection-oriented improvement (which doesn\u2019t work) to change-oriented improvement (which has been proven to work), Berwick argued that three things have to occur: a new technique<\/em><\/strong>, a new culture<\/em><\/strong>, and a new strategy<\/em><\/strong>.<\/p>\n\n\n\n

Three things have to occur: a new technique, a new culture, and a new strategy.Twitter<\/a><\/p>\n\n\n\n

When you\u2019re in an interdependent, complex system, you need a technique<\/em><\/strong> that allows people to work together using common tools and principles. Berwick proposes the Model for Improvement as a powerful learning system. It forces people to answer three questions: What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Along with a method for testing, these three questions allow one to be focused when developing their aim, measures, changes, and testing mechanisms. But changes will not result in improvement if the workplace does not possess a culture that values testing, systems knowledge, and change. Berwick offered IHI\u2019s Breakthrough Series Collaboratives<\/a> as emblematic of a project for which leaders created a culture<\/em><\/strong> focused on people learning faster together rather than separately: \u201cIf you set up an environment where testing changes is the norm, then faster learning will happen.\u201d Establishing these norms of moving toward change is critical to countering the norms that typically inculcate fear. Lastly, a strategy<\/em><\/strong> is needed in order to reorganize systems around continuous learning and development. Leaders can set the direction for improvement work in order to make an interdependent system perform well.<\/p>\n\n\n\n

Berwick concluded by offering lessons for the education field from health care. Perhaps the most important was to \u201cabandon reliance on inspection to improve. It infects our culture, it infects our world.\u201d He argued that health care has advanced a great deal by keeping a focus on patients, highly valuing cooperation, and investing in measurement for learning. Finally, Berwick urged attendees to connect with and foster the kind of energy that motivates people to continually improve. As Berwick said, \u201cThe mainstay of improvement energy is a trust in the native capacity of people to want to learn.\u201d With this in mind, we can accomplish the kind of change that our students need and deserve.<\/p>\n\n<\/div>\n<\/div>\n\n\n

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Don Berwick, founder of the Institute for Healthcare Improvement (IHI), gave an inspiring keynote at the Carnegie Foundation\u2019s second annual Summit … Read more<\/a><\/p>\n","protected":false},"author":2,"featured_media":3491,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"ghostkit_customizer_options":"","ghostkit_custom_css":"","ghostkit_custom_js_head":"","ghostkit_custom_js_foot":"","ghostkit_typography":"","footnotes":""},"categories":[20],"tags":[],"client_controls":[],"class_list":["post-3815","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories"],"acf":[],"yoast_head":"\nLearning from Healthcare\u2019s Use of Improvement Science - Carnegie Foundation for the Advancement of Teaching<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.carnegiefoundation.org\/learning-from-healthcares-use-of-improvement-science\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Learning from Healthcare\u2019s Use of Improvement Science - Carnegie Foundation for the Advancement of Teaching\" \/>\n<meta property=\"og:description\" content=\"Don Berwick, founder of the Institute for Healthcare Improvement (IHI), gave an inspiring keynote at the Carnegie Foundation\u2019s second annual Summit ... 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