Intended for healthcare professionals

Analysis Essay

Flipping healthcare: an essay by Maureen Bisognano and Dan Schummers

BMJ 2014; 349 doi: (Published 03 October 2014) Cite this as: BMJ 2014;349:g5852
  1. Maureen Bisognano, president and CEO1,
  2. Dan Schummers, chief of staff1
  1. 1Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138, USA
  1. Correspondence to: M Bisognano mbisognano{at}
  • Accepted 22 September 2014

Maureen Bisognano and Dan Schummers argue that to meet today’s healthcare challenges, we need to flip our thinking to develop innovative models of care that can improve health, improve care delivery, and lower costs

More than 25 years ago, a small group of thoughtful, committed healthcare leaders, including Don Berwick and Paul Batalden, began to meet as a group. The questions that brought them together were: Is the quality of healthcare good? Is it excellent? Could it be better? For answers, the group looked outside healthcare to other industries that were implementing innovative ways to measure and improve quality and safety. They learnt from aviation, from commercial manufacturing, and from organisations renowned for their innovation, such as Bell Laboratories, Corning, and Florida Power and Light. The lessons these leaders learnt led to a revolution in healthcare: quality and safety were no longer assumed; they were measured, reported, and improved.1

Twenty five years later quality and safety are universal priorities for healthcare executive teams, boards, and governments. But today there are new challenges. In addition to the quality and safety of the care they deliver healthcare organisations are increasingly held responsible for the overall health of the people they serve. Improving both care and health requires deeper engagement with patients and families. At the same time, the revolution in communications technology has created new opportunities for, and expectations of, a different kind of interaction with healthcare, especially among an emerging demographic of people for whom immediate communication and access to knowledge around the clock is the norm. And the burdens of an ageing population and the rise of chronic disease are stressing healthcare resources more than ever. Meeting today’s challenges requires new models of care and new ways of thinking. As ever, we need to look beyond our industry and …

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