Last week I attended the 22nd Annual National Forum on Quality Improvement in Health Care, hosted by the Institute for Healthcare Improvement (IHI) in Orlando, Florida. I first visited IHI’s HQ in Boston soon after I began my Harkness Fellowship, in July 2010. I was excited to visit the organization, after hearing and reading so much about it over the last few years working within the NHS. The office environment reflects the culture of the organization. There are no walls. Literally. It is open-plan, with central communal areas supplying comfy sofas and sodas. Inspiring quotes adorn pillars and ceilings. One of my favorites is from Margaret Mead:


A small group of thoughtful people can change the world. Indeed, it's the only thing that ever has.

This quote is an appropriate one for IHI. The organization has unarguably had a transformational global impact improving the quality of healthcare and demonstrably saving lives. Since being founded in 1991, IHI has worked with 55 countries, involving 25,000 organizations. More than 40,000 students and trainees have registered with IHI’s Open School, through a network of 260 Chapters across 35 countries. In excess of 6,000 people attended last week’s IHI Forum, which in itself is testament to IHI’s remarkable organizational capabilities.


Harvard Professor and Pediatrician Don Berwick is the Founder of IHI. Don Berwick was also CEO until this summer, when he was appointed to a new challenging role as President Obama’s Administrator for Medicare and Medicaid Services. The last year has been seminal for IHI. Not just because of the sweeping changes to the American health care system – described in previous blogs – but also because Maureen Bisognano took over as President and CEO of IHI.


As IHI’s new CEO, Maureen gave an inspirational and empowering opening plenary session at the International Forum. She spoke about the concept of minimally invasive medicine: “When we can’t lessen the burden of illness, we can lessen the burden of treatment”. Maureen’s talk was peppered with personal anecdotes and real-life examples of health improvement to achieve IHI’s Triple Aim: to improve the health of the population; to enhance the patient experience of care and to reduce the per capita cost of care.  Maureen Bisognano highlighted practical examples such as the “walking bus” to address childhood obesity, as well as system approaches like the weekly critical flow failures published by Cincinnati Children’s Hospital Medical Centre, Ohio.


This year, IHI’s Forum was co-hosted by Elliot Fisher, also one of my mentors this year. In addition to his work leading the Dartmouth Atlas of Unwarranted Variation, Professor Elliott Fisher is credited with coining the concept of “Accountable Care Organizations”, known as “ACOs”, a “buzz word” currently dominating US health policy discussions and minds. To qualify as ACOs, US health care organizations must voluntarily demonstrate that they have clearly defined aims, are undertaking detailed performance measurement, are truly integrated and that financial incentives are aligned with their aims. Aspirations surely transferable and relevant for NHS providers? Indeed, the goal of ACOs which is to pay providers in a way that does not encourage supplier induced demand but rewards organizations to deliver high quality care is clearly a critical goal for GP consortia in the UK as they take over managing budgets.


Other impressive keynote speakers at the Forum included Kathleen Sebelius, Secretary of the Department of Health and Human Services (HHS), who praised and encouraged the work of all those working with and for IHI, saying that its work demonstrated that “you couldn’t keep good ideas down”.


The final keynote of the Forum was given by the popular global affairs reporter T.R.Reid, who spoke about his latest book “The Healing of America” (recommended reading). The book, and talk, contained perspectives on international health care systems from both personal experience and organizational viewpoints. In conclusion, T. R. Reid challenges the ethical position of denying access to health care for all citizens, even after health reform has been fully implemented. However, while the American health care system may be imperfect, other health systems also have their flaws.


In America, both the size and the market approach to health care have predictably led to variation and innovation in delivery and payment mechanisms. Spending a year in the US as a Harkness Fellow therefore is a unique opportunity to learn about this system, to learn from organizations like IHI and from senior health policy leaders such as Professor Elliott Fisher. For that, I am hugely grateful to the Commonwealth Fund and the Nuffield Trust.


Wishing a Happy Christmas to all back home!