So I’m at the Institute for Health Improvement…Your next question may well be – “what’s so special about this ‘IHI’ place anyway?”
I would describe the IHI as a cross between a movement and an improvement organisation. They are an innovator, a partner, a trusted conveyor of experts and a driver of results.
IHI is a ‘not-for-profit organisation’ started 25 years ago by previous CEO Dr. Don Berwick who had gathered a small group of like-minded people. His first project was to think outside the box and sent quality hungry CEOs to learn principles from non-health care companies with a track record of quality improvement. Today the 5 key areas on the portfolio in order of foundational principles are:
- Improvement capability
- Patient Safety
- Patient and family centered care
- Cost, Quality and Value
- Triple Aim for Populations: Cost, Quality and Patient Experience
How do they go about this? They aim to reach specific groups at specific levels.
- 100’s of people: Innovation with strategic partnerships at the frontline (free)
- 1000’s of people: Bespoke training programs in improvement, safety, flow, etc. (costs)
- 10,000’s of people: Forums and large scale events (costs)
- 100,000’s of people: Online training at the Open School (free)
Clinicians who visit IHI describe it like their ‘batteries have been recharged’. Okay, so it’s not a busy clinical setting with patients braying at the doors. However, there’s something about this place that’s inspirational and transferable.
The first thing you realize when you walk in is the quite literal complete transparency. It’s open plan with glass pods and meeting rooms. Even Maureen Bisognano, CEO, shares an office and welcomes staff to swing by. People don’t see boundaries here and it affects the level of thinking. The finances of the whole organisation are shared each month at the weekly staff meeting. Fellows are invited to observe senior meetings. The walls are covered with the mission, strategy, projects, outcomes, charts. When it comes to taking the learning away, content resources from programs are made permanently available. Turns out that transparency brings about trust, belongingly and a sense of respect.
Despite a significant number of the 150 employees spread across the country, there’s a real sense of one team. I put this down to the fact that working for IHI is not merely a job – its call to action and requires complete sign up to the vision “to improve the health and healthcare worldwide”. Personal guidance is explicit but in no way command and control. Amongst other things, being an IHI ‘citizen’ means being prepared to ‘say sorry’. The IHI forum is the largest quality conference globally attracting nearly 6000 delegates. Except the hire of the hotel, it’s all managed in house by about 60 people. That’s a pretty good ratio and testimony to IHI’s focus on investing in people to build both internal capacity and capability.
While there’s very little bravado there’s a sense of relentless optimism but certainly not naivety. Is it easy managing collaboratives and programs of diverse health care individuals, hospitals and systems across the globe? Usually not. Spreading initiatives across whole countries is of course hard work but the difference with so many health care settings is that these people believe they have the will power, the strategy and the tools to enable and manage change for the better – even through others. As an improvement organisation, both learning and it’s application is in the DNA, and is applied at every opportunity as the oil to an engine.
Finally, being at IHI is infectious. Gene therapy aside, it gets inside of you. That may explain how IHI so effortlessly maintains huge networks, develops strategic partnerships with prestigious organizations and are able to draw on such an array of world class specialists.
The good news – there’s no ‘secret ingredient’ here, so let’s be bold and commit to improvement from the inside out.
Week Two – The Driver Diagram
Last week we looked briefly at the Model for Improvement. Question (1) is all about defining your AIM – what by when.
A Driver Diagram is a helpful way of moving theory to action and describing the key concepts required to achieve the aim. The big buckets are the ‘PRIMARY DRIVERS’ (or main areas of consideration). SECONDARY DRIVERS break each primary driverone down into specific areas to work on and from these we can list our CHANGE CONCEPTS.
Essentially a driver diagram tells us everything inour system that we need to work on to reach our aim. This is crucial on considering that ‘every system is perfectly designed to achieve the results it gets’
The driver diagram helps link the concepts of our project, define our measures (especially helpful for process measures) and the key areas to apply the PDSA cycles – sometimes termed ‘PDSA RAMPS’.
For example: AIM – lose 10kg weight in 4 months (in order to compete in the Olympics of course)
Now for a clinical example on reducing infant mortality…