In 1997, the Allegheny Conference on Community Development, a group of business leaders, and a local philanthropic organization in Pittsburgh came together to explore how to bring new jobs, capital investment, and a better quality of life to the 10-county region of Southwestern Pennsylvania. The Allegheny Conference zeroed in on health care—the region's largest economic sector, employing one in eight workers and generating more than $7.2 billion in business at the time.  Pressures on the healthcare sector were resulting in operating losses, bankruptcies, consolidations, and a high rate of employee turnover.

Karen Wolk Feinstein, PhD, president of the Jewish Healthcare Foundation and first-ever woman on the Allegheny Conference Board, recruited former Alcoa Chairman and U.S. Treasury Secretary Paul O'Neill to help spearhead the effort. Together they formed the Pittsburgh Regional Health Initiative—one of the first regional, multi-stakeholder collaboratives in the nation.

The Pittsburgh Regional Health Initiative, or PRHI, would respond to these challenges by targeting the improvement of quality and safety issues. PRHI was the first to adapt and apply industrial improvement methods to healthcare settings.

Then, in 1999, the former Institute of Medicine (now Health and Medicine Division) issued its report "To Err is Human," a national wake-up call to the crisis in healthcare quality and safety. It revealed that up to 98,000 people were dying every year from medical errors in U.S. hospitals.  A subsequent report from the Centers for Disease Control and Prevention showed that another 80,000 people were dying each year from preventable hospital-acquired infections. By 2005, when the IOM called for the application of engineering principles to the daily work of health care, PRHI and its partners had already been doing so — with stunning results — for about five years with its Perfecting Patient CareSM Lean methodology.

Since it began, PRHI has changed the way the nation thinks and talks about health care. Research has shown that for every dollar spent on health care, 40 cents represented waste in the form of errors, inefficiencies, unnecessary treatments, and avoidable complications. Much of PRHI’s prescription for delivery system redesign, payment reform, workforce development, and harm reduction appears throughout the Patient Protection and Affordable Care Act of 2010.

Healthcare leaders and policymakers continue to consult with PRHI, following and replicating its progress throughout Pennsylvania and the nation. PRHI continues to test and prove methods to contain healthcare costs by improving quality and integrating services— see Success Stories.