People often want to know about the relationship between IHI-QI and Lean, and how they can best utilize one or both approaches to improve their own care systems. This white paper aims to address these issues, and argues that because IHI-QI and Lean are complementary ways of approaching improvement, it is not necessary to choose one over the other as a guide to action.

Furthermore, integrating perspectives and lessons from the two approaches has the potential to strengthen both Lean and IHI-QI. As practitioners of IHI-QI, the authors see specific Lean lessons worth adopting, like the Lean requirement to ground analysis and improvement in the workplace, with expectations for all levels of a management hierarchy to engage in standard work and continuous improvement. For practitioners of Lean, we believe that IHI-QI offers diverse conceptual frameworks for managing change, techniques for implementing changes in complex systems, program formats for spreading change, and learning models that have been developed and implemented in a broad array of health care settings.

This paper begins with a brief overview of the issues and some key definitions, followed by more detailed descriptions of Lean and IHI-QI. For each approach, we discuss the key conceptual foundations, the principles that lead the way to improved system performance, the project roadmaps typically followed under each approach, and the tools that characterize them in practice. We also point out the fundamental congruence between the two approaches, as well as key differences. Finally, we suggest ways that practitioners of both Lean and IHI-QI can use the principles and methods of the other to extend their capabilities. Appendix A provides additional detail about the intertwined histories of Lean and IHI-QI.

After reading this paper, you will have clear answers to the following questions:
* What are the basic concepts and principles of IHI-QI and Lean? 
* How are they similar (in history and approach)?
* How are they different? 
* For what purposes is IHI-QI the most appropriate approach? For what purposes is Lean the best approach?