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How to Cite This Paper:

Scoville R, Little K, Rakover J, Luther K, Mate K. Sustaining Improvement. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016. (Available at ihi.org)



This white paper presents a framework that health care organizations can use to sustain improvements in the safety, effectiveness, and efficiency of patient care. The key to sustaining improvement is to focus on the daily work of frontline managers, supported by a high-performance management system that prescribes standard tasks and responsibilities for managers at all levels of the organization.

To inform this work, we reviewed selected literature and interviewed leading organizations. The result presented in this white paper is a description of high-performance management in theory and practice, along with recommendations for organizations interested in pursuing these methods: