Q&A: '2016 will be the year of change from the inside out,' IHI chief says

The Institute for Healthcare Improvement was launched in 1991 by Dr. Donald Berwick and colleagues with the aim of redesigning healthcare delivery into a system without errors, waste or unsustainable costs. This year, Derek Feeley, the former head of the National Health Service in Scotland, replaced Maureen Bisognano as CEO of IHI, whose reach now extends to dozens of countries across the globe. Modern Healthcare quality and safety reporter Sabriya Rice recently spoke with Feeley about the changes in healthcare and their impact on the organization. This is an edited transcript.

Modern Healthcare: What external factors affected the industry in 2015?

Feeley: In the last year, the impact of the Affordable Care Act really began to be felt. We're seeing growth in accountable care organizations. We're seeing the early stages of payment reform that are challenging to people, but are potentially amenable to triple-aim type solutions. Change was coming from the outside in. We're starting to see people having to think differently about health, about healthcare and about costs.

MH: How do you see the year ahead?

Feeley: 2016 will be the year for healthcare leaders in consultation with patients and families to take the helm. It is my fervent hope that 2016 will be the year of change from the inside out.

We're working with 40 or so healthcare organizations and IHI's leadership alliance. We believe that the right way to tackle these issues is for us, as a group of healthcare leaders, with our patients and families, to figure out how best to respond now. Let's set a path; let's begin to shine a light on some of the possible solutions. Let's be asset-based. What assets do we have at our disposal, and then how can we deploy those? Occasionally in healthcare, we've gotten stuck in a deficits mindset. This is really hard. It's so difficult. It's so challenging. You hear the adage about people having one foot on the dock and one foot in the canoe. This is the year where we're going to get in the canoe and we're really going to steer a path to calmer waters.

MH: What do you think are the biggest patient-safety challenges for leadership today, given the many competing factors that they're dealing with?

Feeley: Improvement needs to be focused in two areas.

First, there needs to be a set of what you might call cultural changes that facilitate a stronger safety culture where people feel it's safe to speak up, where people feel it's OK to challenge what they see as unsafe practice, where we create an environment where transparency is encouraged, (and) where we think about identifying variation.

The second priority is to create a learning system. How do we get the right set of measures? How do we equip our staff with the skills that they need? How can we underpin that with a leadership culture that's supportive?

MH: IHI is working with Dartmouth on a set of whole system measures. What are those measures?

Feeley: We have a set of whole system measures, which are largely grounded in prior practice. They've been beneficial. (But) things have changed. This is the right time for a new set of whole system measures that say something about improvements in health, that start to measure equity and disparities, that help us make meaningful improvement, and that will help people to think about value.

We want whole system measures designed to help institutions answer some very straightforward questions about where they stand relative to the best. If we can get a consistent set of measures, it's much easier to get an answer to that question. It also helps you understand where you have learning that you could share, and where you need to accrue some learning.

MH: When do you anticipate this being ready?

Feeley: They should be ready in the spring.

MH: Will this add to the burden of measurement for healthcare systems?

Feeley: We need to make sure that what we come up with replaces measures that are already in play. We're taking off the table measures that are no longer the most important things to inform us about our progress. I don't want to get into a situation where we just layer a new set of measures on top of existing measurement systems.

MH: You headed the National Health Service in Scotland. Are the issues you see here in the U.S. global?

Feeley: They are definitely global. Leaders all over the world are facing essentially the same set of issues: economic, demographic, epidemiological challenges, a set of customer expectations that are changing and a pace of change that has accelerated.

It's never easy just to lift and drop, but what we can do is learn and adapt and take what we understand about improvements in other domains back to the U.S. One of the things that the U.S. has done incredibly successfully over many, many years is export innovation. One of the things I would like to see now is the United States become an importer of ideas.

MH: What mark would you like to leave on IHI?

Feeley: The first is reaching many more people. There is so much improvement to be done that we need to figure out ways to get to more people—to build this army of improvers. We've got 5,000-plus people attending our annual Orlando meeting. We have another 10,000 people who attend our other forums across the world. We have over 250,000 students. In January, we launched our first MOOC, massive open online course, again, in an attempt to just reach more people.

Second thing is accelerating thinking about the triple aim. I think that's where U.S. healthcare is going. I think that's where that change from the outside in that we talked about earlier will lead us. And I want IHI to be a place that enables and facilitates that kind of thinking. We've got lots of experience now of how to achieve triple-aim results. I want us to accelerate the path toward health as well as healthcare.

My final aim is to move the idea of joy in work forward. We know there's a strong correlation between a highly motivated, engaged, dynamic group of staff and great outcomes for patients. So I would like us to be doing something really tangible and valuable around joy in work.