THE IHI PHILOSOPHY
On the part of NICHQ leaders, it was the example of the non-profit Institute for Healthcare Improvement that led them to believe such an approach was possible and perhaps even desirable. Homer, in particular, admired Berwick's perspectives on organizational structure as well as quality improvement and had worked hard to make NICHQ's incubation within IHI over the first three years a possibility. Berwick, for his part, viewed the relationship as a means of having greater impact in an important area without having to expand IHI's core operations.

IHI had found, according to Berwick, that many of the philanthropies on which academic researchers traditionally relied were not interested in funding "implementation and change in the real world," which had led Berwick to focus his organization on the needs of the marketplace.

Berwick's inspiration for IHI's approach to quality improvements came from his close study of industrial quality management. Working with "QI" experts in industry, he and Maureen Bisognano, the IHI's chief operations officer, developed the first "Breakthrough Series" -- their trademark learning collaboratives, used the response of their "market"--hospitals and health maintenance organizations--to test novel approaches, transforming the traditional mode of delivering information through courses into what turned out to be a far more intensive and productive experience for participants.

The collaboratives quickly developed a reputation for getting participants to "walk the talk"--introducing change that improved the efficiency, effectiveness and ultimately, financial viability of their own organizations in any number of clearly identifiable ways--fewer hospital stays, fewer deaths, better allocation of staff--depending on the topic. Berwick and Bisognano continued to mold the topics and design of the collaboratives to what their new-found clients were willing to underwrite as well as what they felt might yield the kinds of identifiable outcomes that would validate their efforts. In addition to learning collaboratives, IHI had a diverse range of other kinds of profit-making activities, from the sale of its publications to organizing major national and international conferences on quality improvement whose participants numbered in the thousands.

NICHQ senior staff came to believe that IHI's "earn as we go" philosophy was right for them as well. They, too, became convinced that only the market offered the right mix of incentives to ensure that what NICHQ had to offer would end up having the "dramatic, measurable" effects they intended.

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