Improvement Science Track

​​​​​​​​​​Ensuring that improvement science drives meaningful and far-reaching changes that truly improve health and health care is the aim of this topic track. Specific topics include:

  • Understanding systems and the human side of change
  • Using practical measurement approaches and rigorous evaluation
  • Testing changes and learning from improvement
  • Implementing and sustaining improvement
  • Spreading and scaling improvement across organizations and regions​
Session selection is open. View all Improvement Science sessions below or see the full program here. ​You can also view this year's 10 Forum tracks.​

Improvement Science Sessions

jQuery UI Accordion - Collapse content

Design and Evaluation of Improvement Initiatives

Design and Evaluation of Improvement Initiatives

Quality improvers increasingly are challenged to demonstrate that the results of their projects are attributable to the changes they implemented. This is particularly difficult when multifaceted interventions are introduced in complex health care systems. Evaluation is difficult because implementation approaches evolve over time. This session will use a mix of presentations and attendee participation to explore a rapid-cycle evaluation approach to learning from improvement initiatives. Participants will have the opportunity to design their own evaluation plan.

After this presentation, you will be able to:

  • Describe the core design components of an improvement initiative
  • Describe evaluation approaches suitable for improvement initiatives
  • Describe how to use evaluation findings to regularly pause, reflect on, and adapt improvement initiatives

Presenters: Gareth Parry, PhD, Senior Scientist, IHI; Amrita Dasgupta, MPH, Research Associate, IHI; Don Goldmann, MD, Chief Scientific and Medical Officer, IHI

Sustaining Improvement in Daily Work

Sustaining Improvement in Daily Work

Sustained improvement requires sustained attention to operational quality by those who work at the front lines of care. Drawing on IHI’s experience with pioneering quality improvement organizations, this session challenges participants to design a formal system to ensure their front-line teams sustain and improve highly reliable, safe, and efficient care, including daily huddles, visual boards, standard work, problem solving and escalation, regular monitoring, and integration with strategic organization goals. Brief presentations are interspersed with hands-on exercises.

After this presentation, you will be able to:

  • Distinguish between management for quality control, quality improvement, and quality assurance
  • Use IHI’s quality control framework to design a system for sustaining quality at the front line
  • Create a plan for testing and implementing a quality control system at your own organization

Presenters: Richard Scoville, PhD, Improvement Advisor, IHI; Kevin Little, PhD, IA, Informing Ecological Design, LLC; Jeffrey Rakover, MPP, Research Associate, IHI

A Writing Workshop to Help You Publish Your Work

A Writing Workshop to Help You Publish Your Work

his workshop offers two parallel coaching tracks developed to help you become a successfully published health care improvement author. The first track provides useful strategies if you are early in your writing. The second offers coaching that can help you improve your draft papers at any stage of development. In both tracks, we provide tailored techniques for effective improvement writing, steps to using SQUIRE 2.0 Publication Guidelines for a stronger manuscript, and strategies for successful journal submission.

After this presentation, you will be able to:

  • Identify improvement-based methods for your manuscript preparation
  • Employ SQUIRE 2.0 Publication Guidelines to craft a strong manuscript
  • Develop strategies to increase the probability of acceptance of your journal submission

Presenters: David Stevens, MD, Adjunct Professor, The Dartmouth Institute; Daisy Goodman, CNM, DNP, MPH, Instructor, Dartmouth Medical School; Greg Ogrinc, MD, MS, Senior Associate Dean, White River Junction VA Medical Center

The Practice of R-E-S-P-E-C-T: Find Out What It Means to You

The Practice of R-E-S-P-E-C-T: Find Out What It Means to You

Drive improvement by learning to shine a light on emotional harms from disrespect. Health care can inadvertently cause patients to experience both physical and emotional harm. Preventable emotional harms are caused by the experience of disrespect. Leveraging systems for identifying, assessing, and tracking preventable physical harm, we describe a novel approach to bringing the same rigor to episodes of disrespect with the intent of preventing future emotional harm. Engage in "The Practice of Respect."

After this presentation, you will be able to:

  • Identify a framework for capturing, assessing, and tracking emotional harms from disrespect that utilizes existing institutional resources and processes
  • Describe how the framework for learning from adverse events informs the design and implementation of initiatives to improve the patient and family experience by reviewing case examples
  • Explore a roadmap toward a more reliable practice of respect, including the necessary organizational elements: engaged leaders, a safe work environment, peer support, interprofessional respect, patient and family engagement, and proactive communication after adverse events

Presenters: Lauge Sokol-Hessner, MD, Associate Director, Inpatient Quality, Beth Israel Deaconess Medical Center; Patricia Folcarelli, RN, PhD, Interim Vice President, Health Care Quality, Beth Israel Deaconess Medical Center; Barbara Sarnoff Lee, LICSW, Senior Director, Social Work and Patient Family Engagement, Beth Israel Deaconess Medical Center; Frank Federico, RPh, Vice President and Senior Patient Safety Expert, IHI

Sustainability: Who’s Got the Answer?

Sustainability: Who’s Got the Answer?

Why do some solutions to challenging patient safety problems stick and others drift away over time? How many times have we heard “we don't need more solutions, we need to execute better on the ones we already have”? The session will present multiple case studies of problems with known solution sets. Participants will discuss strategies to increase sustainability, key factors in success and failure, and known traps. Participants are encouraged to bring their own current change packages.

After this presentation, you will be able to:

  • Directly apply principles of sustainability to your current improvement work, looking for strength of sustainability and potential weaknesses
  • Identify key components of sustainable programs
  • Find opportunities to strengthen likelihood of long term sustainability of their existing improvement efforts

Presenters: Alide Chase, MSN, Consultant; Uma Kotagal, MBBS, MSc, Senior Executive Leader, Cincinnati Children's Hospital Medical Center; Patti Harvey, RN, MPH, CPHQ, Senior Vice President, NHPHQ and Executive Director, CMI, Kaiser Permanente

What Are We Trying to Improve? Good Question!

What Are We Trying to Improve? Good Question!

Your hospital has a specific problem that needs to be fixed. Over the last couple of years, committees have tried to solve the issue without success. With your improvement knowledge, you will work with a small group to solve the problem. This session will provide an interactive case to serve as a refresher of improvement science and provide a framework and materials for utilizing the training scenario in your own organization.

After this presentation, you will be able to:

  • Apply core improvement concepts and tools to a simulated improvement project
  • Demonstrate how concepts and tools fit together in an improvement project by focusing on the right questions and not the tools
  • Provide an improvement learning approach and materials that can be utilized at your home organization

Presenters: Koby Clements, MBA, Deputy Director, Center for Health Care Quality, University of Missouri Health Care; Eric Franks, Quality Management Coordinator, University of Missouri Health Care; Morgan Davis, MHA, Quality Management Coordinator, University of Missouri Health Care

Using Research to Plan Quality Improvement: The Good, The Bad, and The Ugly

Using Research to Plan Quality Improvement: The Good, The Bad, and The Ugly

If you’ve ever planned a quality improvement (QI) project and wondered “what is the evidence that this works?” then this session is for you. So-called “evidence-based” programs may not live up to their promise if the research literature wasn’t searched thoroughly, reviewed systematically, and critiqued for its limitations. In this session, you will learn how to objectively weigh evidence and differentiate between low- and high-quality studies so that you can focus precious resources on QI projects that have a strong evidence-based foundation.

After this presentation, you will be able to:

  • Develop an understanding of how peer-reviewed research fits into the plan phase of Plan-Do-Study-Act (PDSA)
  • Build a strong evidence-based foundation for your QI work
  • Identify common pitfalls in how research studies are used to plan QI
  • Implement rapid review methods to identify and select high-quality studies

Presenters: Helen Wu, PhD, MS, Senior Manager, Evidence Services, Kaiser Permanente's Care Management Institute; Brittany Carter, Evidence Services Consultant, Kaiser Permanente's Care Management Institute; Craig Robbins, MD, MPH, Medical Director, Center for Clinical Information Services, Kaiser Permanente

Learning Statistical Thinking Through Games

Learning Statistical Thinking Through Games

Teaching statistical improvement concepts need not be boring or didactic. Some of the last century’s greatest quality ambassadors developed games to help improvement leaders experience first-hand important concepts such as common versus special cause variation, experimentation, variation reduction, and process tampering. This workshop runs several of these classic games to help attendees experience and internalize “thinking like a statistician” in a pragmatic way, including Deming’s red bead game, Nelson’s funnel experiment, Box’s helicopter exercise, and others.

After this presentation, you will be able to:

  • Understand key concepts of special cause variation, process tampering, and variation reduction
  • Experience the value of control charts and designed experiments
  • Describe key statistical thinking concepts important to health care management and improvement

Presenters: James Benneyan, PhD, Director; Shannon Provost, PhD, Visiting Professor, University of Texas at Austin

Learning to Coach and Coaching to Improve

Learning to Coach and Coaching to Improve

High-performing teams usually attribute much of their success to their coach. Yet many improvement teams are left on their own without a coach or facilitator. As a result, they often lose energy and direction. A coach is not part of the team as a player but joins as an objective guide to help the team in both achieving goals and building capacity. This session will review the essential role and skills needed to be an effective coach. Exercises and coaching scenarios will be used to apply your coaching skills to typical team challenges.

After this presentation, you will be able to:

  • Describe the critical role of improvement coaches within an organization
  • Understand that coaches need to build skills not only in quality improvement methods and tools but more importantly in managing the human side of change
  • Identify and practice key coaching skills such as facilitating effective meetings, using team decision-making tools, understanding different working styles, and building effective measurement systems

Presenter: Phyllis Virgil, MHA, ASQ CSSBB, Improvement Advisor, PMV Consulting; Karen Baldoza, MSW, Executive Director, IHI; Lauren Macy, Project Manager, IHI

Back to Basics: Building Essential Quality Improvement Skills

Back to Basics: Building Essential Quality Improvement Skills

Built around the Model for Improvement (MFI), the IHI Quick Course called “Back to Basics: Building Essential QI Skills” demonstrates how to link the three questions about aim, measurement, and change concepts to the sequence for success. This course will provide a refresher for those who are stalled in their improvement efforts and a jump-start for those who are new to the quality improvement journey.

After this presentation, you will be able to:

  • Describe the elements of the Model for Improvement
  • Identify the necessary elements to develop an aim statement and identify a family of measures
  • Develop high-leverage change ideas and effective plan-do-study-act cycles

Presenters: Christina Gunther-Murphy, MBA, Executive Director and Improvement Advisor, IHI; Michael Posencheg, MD, Associate Chief Medical Officer, Value Improvement, University of Pennsylvania Hospital

Measuring for Improvement: Useful Tools and Methods

Measuring for Improvement: Useful Tools and Methods

This workshop uses a hands-on approach to introduce you to the tools and methods to develop and implement a strong measurement strategy for your quality improvement projects. Lessons for developing a family of measures, operational definitions, a data collection and analysis plan, and for using run charts to look at data over time will be shared.

After this presentation, you will be able to:

  • Identify the uses of data for improvement
  • Identify the key elements of a measurement strategy
  • Develop an understanding of why looking at data over time is crucial to driving improvement

Presenters: Jafet Arrieta, MD, MMSc, Faculty, IHI; Sue Butts-Dion, Improvement Advisor, Butts-Dion Consulting; Robert Lloyd, PhD, Vice President, IHI

Worth 1000 Words: Telling a Story with Data

Worth 1000 Words: Telling a Story with Data

This session presents a case study about designing a new patient safety scorecard for a 50-hospital health care system. Challenges to be discussed include: How do you build clear visualizations that are simple to use but rich in content? What is the “Goldilocks” amount of information to include? How do you distinguish signal from noise? How do you win over multiple hospitals to adopt a single reporting platform? How do you get these visualizations in front of the right providers?

After this presentation, you will be able to:

  • Consider the challenges of representing patient safety data
  • Develop an approach to designing strong data visualizations

Presenter: Ari Robicsek, MD, Chief Medical Analytics Officer, Providence Health & Services

Health Care Integrated Delivery Network: The Future of Integration Science

Health Care Integrated Delivery Network: The Future of Integration Science

Capability Maturity Model Integration (CMMI) was developed by Carnegie Mellon University and is required by many Department of Defense contracts. An example of using CMMI in health care will be shown. An account of how it was deployed on projects throughout Health First in Melbourne, FL, and the resulting metrics will be provided. A parallel can then be drawn to other health care organizations to increase their consistency and thus provide a larger return on investment.

After this presentation, you will be able to:

  • Create awareness of CMMI in health care
  • Convey the results of implementing CMMI at Health First
  • Explain how CMMI complements Lean and Six Sigma

Presenter: Wendy Romeu, PMP, CPIM, President, Alluvionic

Running Successful Collaboratives Around the Globe

Running Successful Collaboratives Around the Globe

The urgency of rapid and sustainable change is great in health care. IHI's Breakthrough Series (BTS) Collaboratives are a powerful tool for spreading improvements when established design principles are used and common pitfalls avoided. This interactive session covers topic selection, change packages and measurement systems, engaging teams, and running robust learning sessions and action periods. Examples will focus on adaptations to the model around the globe.

After this presentation, you will be able to:

  • Apply established design principles for successful BTS collaboratives
  • Diagnose and address common challenges in using the BTS method

Presenters: Kelly McCutcheon Adams, LICSW, Director, IHI; Sue Butts-Dion, Improvement Advisor, Butts-Dion Consulting

Building a Strong Quality Improvement Culture Within the Triple Aim

Building a Strong Quality Improvement Culture Within the Triple Aim

Within a population health and care management program, teams formed and built a quality improvement (QI) culture from the ground up by collaborating with a QI coach. They now use QI methods to leverage key partnerships and drive outcome improvements. Faculty will share strategies for enculturating QI, convening competing entities, building trust, identifying mutual metrics, and rebounding from failures. Successes and missteps will be analyzed to provide you a roadmap for future work.

After this presentation, you will be able to:

  • Begin evaluating your own organization’s QI culture using assessment tools
  • Identify investment strategies and create an action plan for building QI culture and utilizing coaching
  • Recognize barriers to successful collaboration and plan solutions

Presenters: Mary Webster, MSN, RN, CCM, CPHQ, Quality Improvement Coach, Carolinas Medical Center; Anita Schambach, RN, MHS, Assistant Vice President, Ambulatory Services, Carolinas HealthCare System

Program Design: Integrating Research and Evaluation

Program Design: Integrating Research and Evaluation

Integrated monitoring, evaluation, and operational research in program design is crucial to understanding impact and is of utmost importance to key stakeholders. It allows for data-responsiveness throughout implementation, critical appraisal of intervention performance, and potential for spread and scale. Drawing from IHI’s experience designing and implementing a complex program aimed at improving health outcomes for mothers and newborns in Ethiopia, this session will explore ways to effectively integrate these elements to enable a robust learning agenda.

After this presentation, you will be able to:

  • Distinguish between a monitoring and evaluation plan and an operational research agenda
  • Describe how a strong monitoring and evaluation plan facilitates adaptive program design
  • Explain how integration of operational research into program design strengthens formal evaluation and positions the program to influence policy

Presenters: Hema Magge, MD, MS, Country Director, Ethiopia, IHI; Abiyou Kiflie, MD, MPH, Deputy Country Director, Ethiopia, IHI; Kavita Singh, PhD, Research Associate Professor; Gareth Parry, PhD, Senior Scientist, IHI

Closing the Referral Loop: Improving Communication

Closing the Referral Loop: Improving Communication

More than 105 million referrals of Medicare beneficiaries are made between primary care and specialist physicians in the US every year. PCPI and The Wright Center sponsored the Closing the Referral Loop (CRL) pilot project, which involved 12 dyads of primary care and specialist physicians. Using the IHI Collaborative model, the number of closed referrals increased from 40 percent to 70 percent. This session will present the CRL toolkit and discuss how it can be used to improve ambulatory referral management across the nation.

After this presentation, you will be able to:

  • Discuss the importance of care compacts between primary care and specialist physicians
  • Define referral types, time frames, expectations, and measures
  • Describe workflow, operational, and system changes, including how to address a lack of electronic health record interoperability to facilitate closing the referral loop

Presenters: Stephen Davidow, MBA-HCM, CPHQ, APR, Director, Quality Improvement, PCPI Foundation; Jignesh Sheth, Clinical faculty, Scranton Temple Residency Program; Tiffany Elkins, BSBA, EMR Specialist, The Wright Center

Care Transition Strategies to Reduce Readmissions

Care Transition Strategies to Reduce Readmissions

A group of hospitals collectively reduced readmissions by 32 percent in less than 8 years by enhancing performance through transparent data sharing, benchmarking, and sharing best practices with each other. In this session, learn about how one of these hospitals, Hackensack University Medical Center, has established effective transitions of care strategies that prioritize readmissions reduction in high-risk patients. Learn care transition best practices to identify high-risk patients, establish readmission risk assessments, hardwire readmission reduction using technology, and sustain results.

After this presentation, you will be able to:

  • Develop an understanding of practical measurement approaches and rigorous evaluation to identify gaps in care
  • Learn how to test interventions to reduce readmissions in high-risk patients, track results. and identify improvement areas
  • Access proven methods to implement and sustain improvement

Presenters: Jenny Bernard, Transitions of Care Advanced Practice Nurse, Hackensack University Medical Center; Jeanette Previdi, RN, Patient Safety and Quality Advisor, Hackensack University Medical Center; Madeleine Biondolillo, MD, Vice President of Quality and Safety, Premier

Data Transparency + “Choosing Wisely” = Success

Data Transparency + “Choosing Wisely” = Success

Partnering with providers is critical in optimizing value-based health care. But identifying valuable analytics to improve care is challenging. particularly in an era of excessive data. Hear about the three-year partnership between a large medical center and hospitalist team to successfully use a data-driven, fully transparent, no-blame approach to drive quality care and appropriate utilization. We will outline key steps of the process, use of evidence-based guidelines, and ultimate design of a provider dashboard and education framework.

After this presentation, you will be able to:

  • Identify key components of designing a successful, data-driven approach to improving care, including the use of evidence-based guidelines to develop a value opportunity framework
  • Hear real-world examples of areas of opportunity and tactics used to improve
  • Discuss factors of success and key lessons that can be used in your organization to drive quality, including the systems and processes needed to support leaders and front-line staff in valuable change efforts

Presenters: Karin Larson-Pollock, MD, MBA, FACHE, Senior Director, Value Analytics and Care Systems, Providence Regional Medical Center Everett; Autumn Moser, MD, Medical Director, Medical Hospitalist Team

What We Measure When We Measure Quality

What We Measure When We Measure Quality

Joseph Juran identified a “trilogy” of necessary quality management functions: control, improvement, and planning. A successful quality measurement program requires integrated, balanced measures in all these areas. In this session, we review Juran’s trilogy and discuss the optimal properties of measures of each type with examples. We present practical tools for documenting improvement measures and describe a recommended process for measure creation in typical improvement settings.

After this presentation, you will be able to:

  • Distinguish between quality improvement, quality control, and quality planning
  • Describe the properties of useful quality measures and the questions they are designed to answer
  • Create a comprehensive quality measurement plan with input from content experts, improvement specialists, and information technology personnel

Presenters: Gareth Parry, PhD, Senior Scientist, IHI; Richard Scoville, PhD, Improvement Advisor, IHI

Clinical Operations in a Service Line Model

Clinical Operations in a Service Line Model

Northwell Health's Emergency Medicine Service Line (EMSL) spans the greater New York area with 16 diverse emergency departments. Where other service lines might struggle effecting change at so many sites, the EMSL has a secret weapon: The Clinical Operations Team. ClinOps is an interdisciplinary team responsible for site-level process improvement focused on efficient workflow redesign through staff engagement. This workshop will present the improvement science methodologies that ClinOps employs to lead effective and sustainable change.

After this presentation, you will be able to:

  • Identify improvement science strategies and their appropriate context
  • Determine opportunities for process improvement within existing workflows
  • Develop a connection between sustainable workflow redesign and culture change

Presenters: John D'Angelo, MD, FACEP, Senior Vice President, Emergency Medicine Service Line, Northwell Health; Kate O'Neill, RN, MSN, Director, Northwell Health

Keeping Our Promise: Xcelerating Learning & Spread

Keeping Our Promise: Xcelerating Learning & Spread

Why do so many pilot projects have little impact when adopted more broadly? Can problems be approached from a different perspective where the design produces information to judge potential success at scale? Kaiser Permanente leaders will share experiences developing and implementing Xcelerating Learning & Spread (XLS), an organizational approach to learning and spread at scale and integrating design/innovation with improvement skills. Recognized as one of the highest-quality care delivery systems, KP developed and implemented a strategy to harness the power of learning through people, leadership, networks, and an ability to adapt for local need. This session will review a framework for problem solving in a workshop format. Participants will learn how to apply the framework and discuss potential use in home care delivery settings.

After this presentation, you will be able to:

  • Understand the design and value of XLS, a framework that aligns the science of learning and improvement with decision making for larger scale adoption
  • Discuss how to use data to make effective decisions about adopting and investing in programs
  • Understand how to align executive decisions and discussions

Presenters: Lisa Schilling, RN, MPH, Vice President, Quality and Care Delivery Effectiveness, Kaiser Permanente; Jason Jones, PhD, Vice President, Information Support for Care Transformation, Kaiser Permanente; Patti Harvey, RN, MPH, CPHQ, Senior Vice President, NHPHQ and Executive Director, CMI, Kaiser Permanente

An Alternative to Red-Yellow-Green Board Reports

An Alternative to Red-Yellow-Green Board Reports

Quality improvement specialists are well schooled in systems-based time-series measurement using control charts. But at the top of the organization, traditional scorecards and “stoplight” dashboards persist, and they can lead to arbitrary decision making and the illusion of control. Methodist Health System created a cascade of time-series measures that allows our board to understand the overall health of key processes while still tracking performance to goal. This session provides the rationale and methods for our board reporting system.

After this presentation, you will be able to:

  • Develop data displays preserving systems-based data analysis and improvement science at a senior leadership level
  • Develop a systems-based approach for selecting and prioritizing key strategic metrics at your organization
  • Identify key “bad habits” of performance measurement tools and how they negatively impact senior leaders’ ability to make decisions

Presenters: Dan Watson, MBA, Director, Clinical Decision Support, Methodist Health Systems; Valerie Craig, RN, MSN, MAOM, Vice President, Clinical Effectiveness and Patient Safety, Methodist Health Systems; Richard Scoville, PhD, Improvement Advisor, IHI

Practical Tools for Managing Improvement Projects

Practical Tools for Managing Improvement Projects

Project management that can effectively drive improvement projects to results requires distinct skills that integrate improvement methods and tools with those typical in project management. In this session, we will present key principles to strengthen the management of your improvement efforts as well as tactical tools and examples to make these principles come to life. These tools will help you lead more successful, sustainable projects.

After this presentation, you will be able to:

  • Describe key strategies of more effectively managing improvement projects
  • Identify a few tools, including aspects of coaching, that will help you better manage your improvement projects
  • Apply these strategies and tools to strengthen your own improvement work

Presenters: Karen Baldoza, MSW, Executive Director, IHI; Christina Gunther-Murphy, MBA, Executive Director and Improvement Advisor, IHI

Delivering High-Quality Primary Care

Delivering High-Quality Primary Care

A one-year pilot in three cities across the US has helped researchers identify activities that accelerate practice transformation, which has resulted in a set of “foundational modules” for a practice transformation curriculum that can be scaled and replicated. Participating practices have improved staff engagement, workflows, and quality scores. The speakers will introduce these foundational modules and discuss how they can be used to replicate and implement high-performance primary care across practices.

After this presentation, you will be able to:

  • Learn how foundational activities, like improving patient access and delegating administrative and clinical tasks, can help unlock the joy of practicing medicine and allow care teams to focus on patients the way they hoped for when they started their training.
  • Understand how primary care practices can create and maintain practice level ownership and engagement for transformation
  • Understand how these modules set up practices to take on more complex care delivery changes, and how they begin cementing a culture of continuous improvement
  • Develop and test an evidence-driven curriculum in primary care practices

Presenters: Julia Murphy, MSc, Director, Dissemination, Peterson Center on Healthcare; David Dorr, MD, MS, Professor and Vice Chair in Informatics, Oregon Health and Science University

Designing and Managing an Improvement Initiative

Designing and Managing an Improvement Initiative

Applying improvement methods readily leads to great plans for improvement initiatives. Applying this plan requires colleagues reaching a common understanding. This session provides practical tools for putting an improvement plan into action. You will learn how these tools align with five core design components: setting an aim, defining a change theory and a strategy for execution, identifying a measurement feedback system, and creating a plan to share learning.

After this presentation, you will be able to:

  • Develop a practical plan for designing an improvement initiative
  • Apply practical tools for managing an improvement initiative
  • Develop a practical plan for sharing key learning from your improvement initiative

Presenters: Gareth Parry, PhD, Senior Scientist, IHI; Robert Lloyd, PhD, Vice President, IHI