Seven Leadership Leverage Points for Organization-Level Improvement in Health Care

Note: Spanish translation of this paper also available for download.

Leadership models and frameworks can provide a roadmap for leaders to think about how to do their work, improve their organizations, learn from improvement projects, and design leadership development programs. As part of IHI's work of supporting and encouraging leaders of innovative health systems, this white paper presents what we believe to be some important leverage points for leaders who want to achieve dramatic, system-level performance improvement. 

Seven Leadership Leverage Points:

1. Establish and Oversee Specific System-Level Aims at the Highest Governance Level
2. Develop an Executable Strategy to Achieve the System-Level Aims and Oversee Their Execution at the Highest Governance Level
3. Channel Leadership Attention to System-Level Improvement: Personal Leadership, Leadership Systems, and Transparency
4. Put Patients and Families on the Improvement Team
5. Make the Chief Financial Officer a Quality Champion
6. Engage Physicians
7. Build Improvement Capability

This set of leverage points is not offered as a tried-and-true method, but as a theory — one that we hope will be useful for individual leaders in planning their work and for us in organizing a support and learning system to share best practices and results across organizations; and from which all of us can learn about what works, and what doesn't in bringing about large-system change in health care. The leverage points are not intended to be a comprehensive framework for the leadership of organizational transformation, nor are they intended as a substitute for a coherent quality method such as the Toyota Production System or the Model for Improvement. 

The Second Edition (2008) white paper incorporates continued learning, particularly on the subject of execution, provides specific examples of the field application of each leverage point, and describes the relationship between the leverage points and other IHI leadership frameworks. The paper also includes a self-assessment tool designed to help leaders design and plan their work to lead to a significant reduction in one or two system-level measures.

How to Cite This Paper:
Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available at ihi.org)