CFHI's Six Levers to Help Organizations Accelerate Healthcare Improvement

“Every system is perfectly designed to get the result it gets.”
Paul Batalden, M.D.

As an organization, if you want a different result, then you need a different set of inputs. If the result you’re seeking is high-performance, then CFHI’s six levers for accelerating healthcare improvement can help you get there. Together, these levers will guide your organization towards becoming a high performer in healthcare improvement. These six levers were developed after an examination of the key attributes of three high-performing healthcare organizations — Southcentral Foundation in Alaska, Jönköping County Council in Sweden, and Intermountain Healthcare in Utah (read the full paper) and a review of Canadian literature on healthcare transformation (read the full paper).


Focusing on population needs

Focusing on population needs means understanding the population you serve (e.g., conducting a needs assessment of your catchment area). This will enable your organization to provide the right care, at the right place and at the right time.


  • Our organization monitors its performance against its population health goals.
  • Our organization addresses the varying needs of its patient population.
Engaging healthcare providers and front-line managers in creating an improvement culture

Engaging your healthcare providers and front-line managers to collaborate and become agents for improvement helps build a culture committed to providing better care, better health with better value-for-money.


  • Our organization engages all types of healthcare providers and front-line managers to develop clinical leadership for improvement initiatives.
  • Our organization regularly communicates change and priority objectives for change within its units.
Building organizational capacity

Building capacity and self-reliance for improvement within your organization means training staff in healthcare improvement, giving them the ability to identify necessary improvements based on evidence, supporting them in implementing these changes and recognizing them for doing so.


  • Our organization has a quality improvement framework that guides its efforts.
  • Our organization makes relevant, timely, performance data available to healthcare providers, front-line managers and senior leaders to support improvement.
Creating supportive policies and incentives

Creating supportive policies and incentives means implementing organizational policies that ensure a healthy workplace and support employees to acquire and use improvement skills.


  • Our organization aligns its improvement efforts with the Accreditation Canada standards.
  • Our organization promotes a safe and healthy workplace (e.g., flexible work hours for staff).
Engaging patients and citizens

Engaging patients and families can drive quality improvement and enable your organization to tap into a wealth of ideas and knowledge about the design, delivery and evaluation of services. 


  • Our organization encourages its patients to play a defined role in establishing improvement goals.
  • Our organization defines and measures the patient improvement goals.
Promoting evidence-informed decision-making

Promoting evidence-informed decision-making means ensuring that healthcare providers and their managers have access to up-to-date information and are trained in finding, assessing, adapting and applying data and evidence for improvement.


  • Our organization has resources dedicated to finding and synthesizing evidence to better support its front-line managers and healthcare providers’ decision-making (e.g., knowledge brokers).
  • Our organization has a strategy to develop healthcare providers and front-line managers’ ability to find, assess and apply the best available evidence in delivering services.

What’s next?

CFHI is currently piloting an organizational self-assessment tool based on the levers, which aims to help health delivery organizations:

  • Identify their improvement expertise, assets and strengths;
  • Understand their capacity to identify improvement efforts and amplify them;
  • Enable and accelerate healthcare improvement; and
  • Take next steps for improvement.

This self-assessment tool builds on CFHI’s Is Research Working For You? self-assessment tool.