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“Tackling seemingly intractable challenges takes a healthy amount of courage. What are some of the factors that either enable or inhibit leaders and organizations to be courageous?”
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Saranya Loehrer: Moving QI Innovation Forward

By Saranya Loehrer | Wednesday, September 4, 2019

Saranya Loehrer, MD, MPH, is IHI’s Head of Innovation. In the following interview, she describes her health care journey and what she envisions for innovation and R&D.

Tell us about the journey that led you to health care and IHI.

My story is probably not unlike many first-generation Americans. I grew up in a small town in Wisconsin and spent many summers in India, where I would witness poverty, sickness, and inequities that were impossible for me to reconcile with my everyday experiences back home. This led to an early interest in human rights and social justice. After college I worked for Physicians for Human Rights (PHR), helping health professionals translate their clinical expertise into advocacy for scientifically sound global HIV/AIDS policies.

During my time at PHR, I had the pleasure of working with Nicholas Leydon. Fortuitously, as I was starting medical school, Nicholas was joining IHI to focus on its global work, which was in a nascent stage.

Where did medical school take you?

I went to Loyola University Chicago Stritch School of Medicine. Its Jesuit history has a lot of underpinnings around social justice and health, so it was a wonderful fit for me, yet I also experienced the profound disconnect between what you learn about delivering excellent care and the system within which you’re supposed to deliver it. When I expressed my frustration to Nicholas, he encouraged me to learn about quality improvement. At that time, improvement science wasn’t something most medical students, or physicians, I knew had exposure to. Fortunately, I found a mentor at Loyola who encouraged me.

The IHI Open School was fairly new and it became a wonderful resource for me. I took all the courses and started applying what I learned at a student-run free health clinic where I volunteered. I was hooked. Improvement science gave me a way to understand the etiology of our frustrations and tools to translate that into action.

After writing about some of this improvement work, I received the David Calkins Memorial Scholarship to come to the IHI National Forum. While there, I had the opportunity to meet Don Berwick (IHI President Emeritus and Senior Fellow), who generously spent some time mentoring me. I didn’t know what my path was going to look like, but I knew I wanted to do systems improvement. After taking my boards and earning my MD, I came to Boston to pursue an MPH, and began working with IHI. I gave myself about a year to determine whether I’d go back [to clinical training] and do residency. That was over nine years ago, and I haven’t looked back.

You didn’t follow a path to clinical work?

No, and that still feels like the right decision for me personally. When you walk into the IHI office in Boston, on the wall behind the reception desk, it says: "We will improve the lives of patients, the health of communities, and the joy of the health care workforce.” The focus on the workforce was meaningful for me because I saw people go to work every day trying to do the right thing for patients, for colleagues, for staff, but in systems that weren’t necessarily designed for them to succeed. And yet, they would come in every day and not only do their job — they would also try to make the system better. IHI understood that and wanted to help. That was powerful for me.

What is the Innovation process at IHI?

The Innovation team develops content and methods to advance IHI’s mission and serve the field at large. The first step is developing a set of questions to explore. We welcome suggestions from anywhere — internally or externally, from staff, partners, Board members, or simply conversations we are having in the field.

Once we agree upon a set of questions, there’s a formal process that is articulated in the IHI Innovation System white paper. It involves chartering the project, scanning the literature, and conducting interviews to find promising approaches, looking outside the field for insights, and developing a testable theory of change. Every 90 days we take stock of where we are with each project and determine whether to continue exploring an innovation, transition the work to another part of IHI, or “shelve” it.

I’m proud that the Innovation team has incubated and helped nurture some of IHI’s most important content, including the Triple Aim, Pursuing Equity , and Age-Friendly Health Systems, as well as methods like the Breakthrough Series Collaborative model.

What is your vision of the next steps for innovation?

I’m particularly curious about three areas. First, what is the right mix of questions for the Innovation team to pursue? Our innovation questions usually fall into three categories. Some are transformational questions that might not have been explored much, at least within health care. Others are adjacent questions. We might have done some work in this area, but we’re applying that knowledge differently, in new contexts or with new populations. Finally, some are core questions, examining incremental changes or improvements. We typically can take on about 20 new questions a year and are exploring the right balance across these categories.

Second, how can we expand and diversify our network, including individuals who help lead 90-day projects and organizations that serve as vital test beds to refine theories developed by the team?

Third, how can the Innovation team more intentionally support IHI’s global work? Three major reports came out last year, one by the National Academy of Science, Engineering, and Medicine, one by the Lancet Commission, and one by the WHO/World Bank/OECD. All three focused on health care quality in a global context and put a spotlight on the ways in which quality can be a killer or a savior. The findings indicated between 5 and 8 million deaths annually are due to poor quality care in low- and middle-income countries. Not access to care, which of course is important, but quality of delivered care.

Over the past decade IHI has developed, supported, and learned from incredible improvement work globally. How can our team be a better partner in that effort?

What is a question you are excited to dig into?

A perennial question that underpins all improvement work is around unwarranted variation. What contributes to the disconnect between prose and practice, between knowledge acquisition and knowledge application? That’s a question that we will always be interested in pursuing.

Something related that I’ve been thinking about centers on courage. Tackling seemingly intractable challenges takes a healthy amount of courage. What are some of the factors that either enable or inhibit leaders and organizations to be courageous?

Is there a beacon that you look to, an organization that does great innovation?

The potential for innovation is inherent everywhere; what varies is how it gets nurtured and applied. One highly innovative group I have the privilege to work closely with is the IHI Leadership Alliance, comprised of health care leaders throughout the US who are developing new ways to deliver on the full promise of the Triple Aim. From developing the Breaking the Rules movement, which has gone global, to addressing workforce safety, to ensuring all their employees make a living wage, this group has consistently inspired me in its demonstration of curiosity, creativity, and courage.

What is our biggest challenge in this work? What keeps you up at night?

Probably the same thing that keeps most improvers up at night: how do we help more people faster? How do we get improvement knowledge and skills into the hearts and minds of as many people as possible to help them make a difference?

Health is also personal. We have all experienced health challenges personally or with loved ones; we will all experience wellness and sickness in our lives. My spirited and joyful Ammamma (grandmother) passed away recently. I was fortunate to be with her the last week of her life when she was in hospice.

The tenderness with which the hospice clinicians and staff cared for her and for our whole family was a gift to us. The experience made clear to me it is possible for care to be delivered and received in a way that fulfills the highest aspirations of the healing professions. I will be forever grateful for the experience my family had, and forever unwilling to accept that in some ways we just got lucky. This is what care should — and can — look like for every person, every time.

Editor’s note: This interview has been edited for length and clarity. Please share your innovation ideas or questions in the User Comments section below.

You may also be interested in:

White paper: IHI Innovation System

Do You Have the Courage for Quality Improvement?

Leadership sessions are a part of IHI’s National Forum this December.

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