What Is IHI’s “Triple Aim?” Founders Don Berwick, Maureen Bisognano Lay Out Campaign for Change

Healthcare is Hard Podcast | Episode 004


Don Berwick and Maureen Bisognano lived and breathed different sides of the healthcare industry before starting the Institute for Healthcare Improvement (IHI) – a $60 million not-for-profit organization with 150 employees across more than 70 countries that drives results in health and healthcare improvement worldwide.

What most people don’t know is that Don and Maureen hatched the idea for IHI while working together – Don as a research and quality guide physician and pediatrician, and Maureen as a nurse and hospital CEO. They would discuss each other’s work problems in-depth from very different perspectives, but in a way that helped facilitate actionable improvements.

In the mid-1980s, Don, Maureen, and a larger group started meeting people from outside healthcare who understood how to improve things systematically, without having to rely on incentives. They began teaching people around them what they were learning from different industries, and quickly understood that it’s unfair to send a “changed” person back to an unchanged organization. It became quickly apparent to them that it would take a new breed of leaders, as well as people on the front lines, to create long-term change in healthcare.

IHI was born with an aggressive goal, literally written on the back of an envelope. Don and Maureen set out to solve six problems in US healthcare, and engaged 2,000 hospitals and saved 100,000 lives[to date?]. With the guidance of their children who fortunately had political campaign experience, they started their own campaign to change healthcare. Originally supported by the John. A. Hartford Foundation, the IHI became a reality in 1991 – and the rest is history.

In this episode of Healthcare is Hard: A Podcast for Insiders, Don and Maureen draw upon their extensive industry experience to cover a number of pressing topics with host Keith Figlioli, including:

  • Achieving the “Triple Aim” in Healthcare – the Triple Aim is the trifecta of achieving better care for individuals, better health outcomes, and lower per capita costs. Don and Maureen saw this happening in other industries and in healthcare markets across the world. They talk about how they took this aim and created a leadership alliance within IHI where 40 organizations came together with a common goal of achieving the Triple Aim.
  • Healthcare’s Defects in Areas that Other Industries Don’t Tolerate – among these areas are safety issues, effectiveness, reliability, patient focus, coordination, waste and delay, and most importantly, equity. Don and Maureen discuss how they understood that people were aware of this in the mid-1980s, but no one had a way to deal with it directly at the time.
  • The Will for Change in Healthcare – who needs this inspiration and how can the will for change be built? As Maureen explains, painting the story of a patient can help build such inspiration, especially for senior-level executives who may be a little further removed. It doesn’t matter whether it’s a good or bad story; it’s about providing a background for these ideas to grow.
  • The Next Big Things in Healthcare – telemedicine, telehealth, global budgeting, and healthcare for millennials are just some of the innovations Don and Maureen are excited about.

To hear Don Berwick and Maureen Bisognano talk about these topics and more, listen to this episode of Healthcare is Hard: A Podcast for Insiders.

Podcast Guest


Maureen Bisognano

President Emerita & Senior Fellow

Institute for Healthcare Improvement

Maureen Bisognano previously served as IHI’s President and CEO for five years, after serving as Executive Vice President and COO for 15 years. She is a prominent authority on improving health care systems, whose expertise has been recognized by her elected membership to the National Academy of Medicine (IOM), among other distinctions. Ms. Bisognano advises health care leaders around the world, is a frequent speaker at major health care conferences on quality improvement, and is a tireless advocate for change. She is also an Instructor of Medicine at Harvard Medical School, a Research Associate in the Brigham and Women's Hospital Division of Social Medicine and Health Inequalities. Additionally, she chairs the Advisory Board of the Well Being Trust, co-chairs the Massachusetts Coalition for Serious Illness Care with Dr. Atul Gawande, and serves on the boards of the Commonwealth Fund, Cincinnati Children’s Hospital Medical Center, Indiana University Health and Nursing Now.


Donald M. Berwick, MD, MPP, FRCP

President Emeritus and Senior Fellow

Institute for Healthcare Improvement

Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, is also former Administrator of the Centers for Medicare & Medicaid Services. A pediatrician by background, Dr. Berwick has served on the faculty of the Harvard Medical School and Harvard School of Public Health, and on the staffs of Boston's Children's Hospital, Massachusetts General Hospital, and the Brigham and Women's Hospital. He also served as Vice Chair of the US Preventive Services Task Force, the first Independent Member of the American Hospital Association Board of Trustees, and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality. Recognized as a leading authority on health care quality and improvement, Dr. Berwick has received numerous awards for his contributions. In 2005, he was appointed "Honorary Knight Commander of the British Empire" by Her Majesty, Queen Elizabeth II, in recognition of his work with the British National Health Service.

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Meet Our Host


Keith Figlioli

As a healthcare executive and operator for more than two decades, Keith J. Figlioli developed a deep understanding of the market and a network of healthcare insiders that he brings together in his role at LRVHealth, a venture capital firm focused exclusively on digital health investments.



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