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  • Writer's pictureMaya Ber Lerner

IHI Forum 2023: Quality Improvement Trends

Updated: Dec 20, 2023

Our team is back from the IHI Forum in Orlando! I loved meeting and learning from healthcare professionals who share a passion for better healthcare. 


Three takeaways from the conference:


1.       “We don’t need to boil the ocean. Start by starting.” That’s probably my favorite quote from IHI president and CEO Dr. Kedar Mate’s keynote. Some quality and patient safety goals are overwhelming. “Zero harm”, “Eliminate medical errors”. These are ambitious goals. Where do you even start? Dr. Mate emphasized the importance of initiatives that fix problems fast. 


2.       “Embedded Quality” - Find how to embed quality in operations. Quality can’t be a separate entity. It needs to be a foundation, not an appendix. We must invest in operating systems that make quality, efficiency and user experience align. When an operating system becomes habitual, it moves to the background, and clinicians can focus on their patients again.


3.       Move QI  from ‘Project thinking’ to ‘Continuous Improvement thinking’. 

In order to embed quality in operations we need to look at quality as a continuous challenge, rather than something that could be fixed through a one-time effort. Using a  continuous framework for quality improvement was emphasized in a spotlight session with Marty Hatlie, Helen Macfie, Patricia McGaffigan and Kelly Randall. Macfie and Randall shared their experience deploying the National Action Plan and implementing a systemic approach for safety.


“Every time we focus on a specific metric we want to improve, like Sepsis or SSI or falls, we do a big project and manage to get this metric much better. But then we move on to the next project, and soon enough we slip back on the previous metric”. 


The real challenge of Quality Improvement is not improving. It’s sustainability and scale. In order to make it possible to sustain and scale improvement, an infrastructure for continuous improvement needs to be built.


Robert Lloyd, Sandip Godambe and Dave Williams dove into the practical side of it: presenting metrics in run charts as opposed to averaging. Less “green/yellow/red” quarterly reports, and more charts that show change over time. Changing from a static view to a dynamic view is critical: it allows identifying shifts and trends, and understanding why they happen.


 

Executive Safari


I loved the Kaiser Permanente team that shared their success implementing a safety huddle system. I may be a bit biased, but I love a good huddle story :). Lucy Phuong, Gorette Amaral, Carson Hibbard and Lorena de Anda got me at hello with fun music playing in the room before their presentation. It was clear that this is not your usual QI session.


They shared how their work was inspired by the 2017 “Joy at work” IHI whitepaper. Before they started their initiative, they visited another institution that implemented safety huddles. When they came in, the person who led the huddles initiative in that organization was away, but the receptionist was happy to show them the huddle board and enthusiastically explain the methodology. For them the fact that everyone on the team was part of the mission spoke for itself. They were sold. 


They explained that they didn’t have a mandate. They did not want a top-down implementation. They didn’t do mass training. They searched for teams that wanted to huddle. 



After creating initial success, they shared their wins with leadership. They did it in a fun way: They brought the leadership in for a “Safari.” They even got props.  They managed to get the executives excited, and got their sponsorship to expand.

 

They used gamification and positive reinforcement with a white-yellow-green-black belt maturity model (they also brought artifacts to the session), and managed to continue creating excitement and engagement.



The Kaiser Permanente “Huddle Artifacts Wall”


Repeating motifs in quality success stories we’ve heard at IHI Forum this year:


a.       They start with a small MVP (minimum viable product) to solve a real problem that the users actually wanted to solve.

b.       They implement bottom-up: working closely and iteratively with the frontline teams.

c.       Their moto is “not perfect but better than before”.

d.       They create feedback loops, where feedback is addressed quickly.

e.       They create a mechanism that allows solving small problems fast and create a separate mechanism for escalation and prioritization of bigger issues.

f.        They are transparent.

g.       They seek a better culture.

h.       They manage to get executive sponsorship by being creative and cleverly presenting early success.

i.         They have the guts to work outside the EMR.


The “How” and the “Why”


In his keynote presentation about AI for QI, Peter Lee from Microsoft explained that the highest value AI can add in healthcare today is as an aid to clinicians, not replacing them. Tasks like transcription, supporting communication and drafting notes are perfect for it. (you can read all about it - Anastassia Gliadkovskaya covered the session in a Fierce Healthcare article).


Lee’s session provided a glimpse of the “How” to Dr. Kedar Mate’s earlier keynote, that focused on the “Why”. 


Dr. Mate talked about clinicians’ frustration with a broken healthcare system. Most started their career with a passion to help patients. But after years in a system that seems to work against them – they are tired and morally injured. Helping them re-engage and find their purpose is key to improving healthcare. 


Mate shared the concept of Ikigai: the purpose, the “why”. He talked about finding the sweet spot: the intersection between what we love to do, what we’re good at, what the world needs, and what we can get paid to do.


His call to the large audience of healthcare leaders in the room: help clinicians find joy by re-connecting with their purpose.




Dr. Mate’s keyote address


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