IHI: Starting small is more likely to lead to large-scale improvement

Although healthcare leaders may be tempted to implement large-scale changes quickly, the Institute for Healthcare Improvement contends starting small often is more effective at achieving large-scale improvement. Paul Howard, MPA, IHI’s lead advisor, innovation, content design and methods, says healthcare teams should first test small changes to learn quickly, adapt promising interventions, strengthen implementation approaches and build confidence in the intervention and support system necessary for success. He cautions that broadly implementing interventions before testing and refining them sufficiently can lead to costly work and redesign, staff frustration and resistance, variation in results across sites or no measurable improvement and delays associated with correcting avoidable problems. Organizations that learn the fastest often attain full-scale first, he says. (Institute for Healthcare Improvement blog article, 10/14/26)