"There is no substitute for knowledge."

When a student asked W. Edwards Deming how a complex organization should approach the improvement of quality, he answered: "There is no substitute for knowledge." Deming was one of the developers of the modern philosophy and methods associated with quality and quality improvement. He knew well that methods and tools were useful when applied by those with some knowledge of the underpinnings of improvement, but tools and methods did not substitute for this knowledge. Deming described this knowledge in four categories: appreciation for a system, understanding of variation, psychology, and the use of measurement and testing to develop knowledge. We aim to make this site a premier source of knowledge for the improvement of health care, as well as the source for methods and tools to apply that knowledge.

Modern health care has been improved in many dramatic ways by the application of subject matter, discipline-specific knowledge. This traditional improvement in health care has included organ transplantation, elimination or substantial reduction of viral diseases such as smallpox and poliomyelitis, and improvements in the quality of life for persons with chronic disease. The health care community would do well to heed Deming’s advice and add to its already prodigious biomedical knowledge the knowledge necessary to optimize the health care delivery system.

The system is more complex and the problems more intractable than almost anybody predicted. Creative solutions have been limited in part by the domination of biomedical knowledge to the exclusion of the broader range of knowledge that will be required to optimize health care systems for the benefit of patients. For example, designing a hospital system so that patients flow smoothly and appropriately from the community to the Emergency Department to various levels of intensity of care is a daunting task, but so too is the task of designing the hardware and the logic of message flow that allows the global Internet to function. These designers have knowledge that would help in the design of the logic of hospital flow. We at the Institute for Healthcare Improvement and others around the world have ongoing efforts to link with the best in industry and translate relevant knowledge and methods for use in the improvement of health care. IHI.org will serve as an archive of the insights that we gain from those inquiries.

The site will continue to develop as we all learn more about reliable methods for health care improvement. However, the site already contains an extensive library of information to aid aspiring health care improvers of various levels of capability.

• The 70 change concepts for developing improvements can be used by persons trying to develop creative alternatives to the status quo, by those who are helping a team that seems unable to come up with changes, or by those who wish to build their understanding of Deming’s four areas of knowledge for improvement and their ability to apply this knowledge.
• For novices in improvement, the site contains many of the basics that they will need to document their processes, to hold a good meeting, or to test some changes.
• From time to time we will focus on a particular theme and develop the theme as a virtual community using the functionality of IHI.org . My suggestions for themes include the use of statistical process control to reduce over-adjustment of medications, the use of concepts from reliability engineering to increase the reliability of delivery of care based on the best scientific evidence, and the spread of improvements from one site of care to another.
• Another potential for this site is to find the best performance anywhere in the world in a particular area, for example, patient self-management of their chronic disease.

Whether you are seeking to learn the basics of quality improvement or are attempting to develop and spread leading edge methods, I believe that the Improvement Methods area of IHI.org will be the place that you deem to be invaluable to your efforts. I look forward to interacting with all of you through this technology in ways that we cannot yet even imagine.