New IHI Chief Executive: ‘There is No Quality Without Equity’

Mate recently shared his perspectives on healthcare improvement and leading IHI with HealthLeaders. The following is a lightly edited transcript of that conversation.

HealthLeaders: How has the coronavirus pandemic exposed areas for improvement in healthcare?

Kedar Mate: COVID-19 has pried its dirty, despicable fingers into every nook and cranny of our health system that is weak. It has exposed all of the flaws and defects.

First and foremost, there are equity considerations. COVID-19 has dramatically affected populations differently in parts of the country and in racial groups. Black and brown people are—broadly speaking—more affected by COVID and they are experiencing a higher death rate.

COVID has also exposed challenges around the care continuum. Whether it be related to ambulatory care and the fragility of that system, or the acute system that is heavily dependent not only on ambulatory care but also the postacute system, which has been hard-hit by the condition. Overall, the care continuum has been significantly affected by the pandemic as we have seen the virus challenge us to generate a more integrated and cohesive system.

Lastly, we have seen how COVID has exposed the challenge of integration of healthcare and public health. It has exposed how much we have underinvested in public health for more than a decade.

HL: What is your vision for IHI?

Mate: The vision of the institute is and remains that everyone gets the best care possible. Our mission to improve health and healthcare worldwide remains.

We realize that mission and vision through a handful of major areas of focus.

One is on safe care. We will increasingly be paying attention to how to improve patient safety and the safety of our families and communities. Now more than ever, patient safety is just not about what happens in an acute care hospital but what happens across the continuum of care.

Two is around value—how do you reduce waste and drive improvement in clinical outcomes? This is an important time to be focused on this area. The pandemic has wreaked havoc on our health systems.

Third, the experience with caregivers and staff is also important. IHI has been invested in improving joy among the clinical staff for quite some time. With all that we have experienced with COVID, joy in work is more important than ever. Building resilience in our staff throughout an organization feels extremely important today.

We have to do all of this with an intentional attention to equity. We need to focus on safety, value, and experience with an underpinning of attention to inequities that are present, and the goal is achieving more equitable outcomes. … There is no quality without equity.

HL: What are two or three of the top healthcare improvement initiatives at IHI?

The first one, which I have been involved with and admire, is our work on Age-Friendly Health Systems. Over the past few years, we have created—with support from the John A. Hartford Foundation—a definition of what it means to become an Age-Friendly Health System, and we have been spreading that definition systematically throughout this country and beyond our borders. There are now more than 750 health systems that are participating, and the number keeps growing each day.

One immediate consequence of COVID has been the need for focusing the Age-Friendly Health System’s attention not only on acute care but also nursing homes to try to stem the challenge of how COVID is affecting nursing homes.

Through the Age-Friendly program, we have quickly stood up a nursing home rapid response network. Every day, the network features a 20-minute huddle for as many nursing homes in the country that we can reach. It has generated knowledge about better practices to take care of older adults who live in nursing homes and for the staff who work in nursing homes every day.

A second major initiative we are working on is in the area of maternity care—a project called Better Maternal Outcomes. This project links to our pursuit of equity. We are trying to improve the experience and outcomes of black mothers, who have historically had a differential rate of adverse birth outcomes. Our work has taken that history as a starting point focused on the challenge of improving the experience of black and brown women to ensure their health outcomes are as good as they can be.

Lastly, we started work recently on pancreatic cancer, with the 1440 Foundation. This is exciting work for us, where we are turning our attention to quality- and safety-focused activities to try to improve outcomes for patients with pancreatic cancer. We are starting with pancreatic cancer, which has a high degree of clinical variation and need for better multidisciplinary care to improve outcomes.

HL: What are the primary opportunities for healthcare improvement associated with telehealth?

Mate: Every new technology introduces both risks and the promise of improving outcomes. We have to try to balance that scale more toward the promise of the technology. With the rapid expansion of telehealth, what you have seen is an enormous opportunity because it creates greater access and greater opportunities to apply the best clinical science and knowledge.

There are a number of opportunities for improvement. First is about process. How do we triage appropriately for each modality? What is appropriate for the phone? What is appropriate for video? What do we handle in-person?

There is a risk that moving to more virtual modes of clinical delivery could introduce more risk of diagnostic or therapeutic error. We need opportunities to further calibrate the application of these technical platforms to ensure that we are getting the best possible outcomes for patients and families.

Lastly, while telehealth has the potential to both expand access and address workforce shortages, there are some new challenges about how the information gets shared efficiently, how you communicate from one provider to the next, and how information might not flow seamlessly between your telehealth provider and your primary care doctor or specialist.

HL: Give examples of prime opportunities to improve patient safety.

Mate: IHI recently published a paper about how technologies that have been put in place in the electronic health record have started to generate improvements in computerized physician order entry. There have been improvements over the past decade but there are still important gaps in how those technologies are working.

There is an enormous opportunity for us to further improve infection prevention and control. If nothing else, the COVID pandemic has shown the need for greater attention to our infection prevention and control protocols, and the ways to work on them to ensure that we are ready for pandemic-like moments in the future.

Lastly, our entire safety enterprise needs to tackle safety challenges and adverse events through the application of an equity lens. The more I see morbidity and mortality reports with the equity lens being applied, the more revealing they are becoming of the challenges and defects that we have in our systems that allow for opportunities for improvement.

There is an incredible opportunity to improve the overall safety experience by applying an equity lens to our safety practice and our methods, so we are not only identifying the defects but also understanding the biases.