Profiles in Improvement: Vinod K. Sahney, PhD, IHI Senior Fellow

Sahney_Vin.jpgVinod K. Sahney, PhD, retired from Blue Cross Blue Shield of Massachusetts in February 2010 after serving as Senior Vice President and Chief Strategy Officer for four years. As a Senior Fellow at the Institute for Healthcare Improvement (IHI), he is assisting in the strategic planning and development of IHI's leadership programming. Dr. Sahney was a founding member and previous Chair of the IHI Board of Directors. Prior to joining Blue Cross, he served as Senior Vice President at Henry Ford Health System for 25 years, including responsibilities for Strategic Planning, Marketing, Government Relations, Public Relations, Community Affairs, Quality Resource Group, Special Events, Management Services, Information Services, New Enterprise Development Corporation, the Center for Health Services Research, and the Center for Health Promotion and Disease Prevention.
Q: What are the highlights of your work in health care?
My PhD is in industrial and systems engineering. My very early work in the 1970s was process improvement at Henry Ford Hospital in Detroit, Michigan. I helped develop process improvement teams, beginning with what we called the Operations Improvement Group. This group of 15 (myself included) worked on admissions scheduling, operating rooms, emergency rooms, and supply chain. 
After that, I became a professor at the Harvard School of Public Health teaching operations management. One of the important events that happened during that time was the development of executive programs for senior leadership in health care improvement. Prior to this we were only teaching new graduates about improvement methods; but these individuals would not arrive to a higher level leadership role for many years. That changed in 1977 when we received a $5 million grant from the Health Resources and Services Administration (HRSA) Bureau of Health to develop an improvement program for senior leaders already in the field. We asked physicians and hospital CEOs to help us develop the curriculum, which relies heavily on case method courses. The Program for Chiefs of Clinical Services (PCCS) was a three-week course intended for health care providers at the executive level, focused on applying business management disciplines to the specialized practices of the health care sector. It has been running for 33 years now and is doing well.
After developing that program, I went back to Henry Ford as Chief Strategy Officer with oversight of several departments. However, my main job was to develop a strategy to turn the single Henry Ford Hospital into an integrated health care system. I was there for 25 years. During that time we developed one of the largest integrated health care systems in the country.   
My last position with Henry Ford in 2002 was to head the new 300-bed hospital from the ground up. That was quite the experience. The Henry Ford West Bloomfield Hospital opened in 2009. It’s just tremendous — what a new hospital should look like: no shared rooms, plasma screens on everything, and Internet everywhere. 
In 2006, I made the switch from the provider side to the insurer side of health care when I became the Chief Strategy Officer at Blue Cross Blue Shield in Massachusetts. During the four years I was there, my primary responsibility was to diversify the business so we could offer products to round up the client benefit package. This included expanding coverage to all areas of medical care, dental insurance, life insurance, short- and long-term disability, and more. 
I was also in charge of another 15-person process improvement group. This group led all project management improvements and implemented the changes needed. One of the big things we launched was the Lean Program. Looking at our processes, we examined how we could apply Lean principles to improve health care processes. 
The third area that reported to me at Blue Cross Blue Shield was the new business development team. Our primary function was to invest in start-up companies that engaged in business similar to ours.
Q: At what point did you begin working with IHI? 
During the entire span of my career, I was engaged with IHI because I was one of the founders. I have been on the IHI Board of Directors since the beginning. It has been a very nice combination of working in the field, having a foot in the academic world at Harvard, and serving on the IHI board. I met Don Berwick [former IHI President and CEO] when I was a professor at Harvard. I met Paul Batalden [founding IHI board member] at Healthcare Corporation of America (HCA) and David Gustafson [founding IHI board member] was my professor at the University of Wisconsin-Madison. The four of us, plus Jim Roberts [founding IHI board member] and Jim Schlosser [founding IHI board member], started meeting and then the idea came to us: “Maybe we should start an organization.” IHI was then incorporated in Michigan in 1991. 
Q: How does transitioning from a board member to a senior fellow change your role at IHI?
The biggest change will be the amount of time I spend here at IHI. As a board member, I was in the office a few times a year and served more as an advisor, reviewing projects. As an IHI Senior Fellow I will be spending about 20 percent of my time at IHI and have a more hands-on role with projects and programs, especially with leadership programs. For example, I have been working with Kathy Luther [Executive Director at IHI] to review the programs IHI offers for individual leadership development — educational programs for chief quality officers, chief medical officers, chief nursing officers, or CEOs.  After we conducted an inventory and systematically identified the gaps, we realized that IHI does not offer any programs for chief quality officers, so we started developing programming in that area. 
We also realized that IHI does not offer programs for physician department chairs, and these clinical chairs are key to health care quality improvement since they are the CEOs of their departments. I am interviewing people in the field for their advice about what would be useful and to gauge interest in such a program. I’m also doing a lot of feasibility testing and asking the field experts what they think should be in the curriculum. 
Another project I’d like to focus on over the next three months is writing teaching case studies on improving clinical departments. I began the research for this work by visiting the surgical department at the Henry Ford Hospital. Over the course of three years, this surgical department instituted a series of successful improvement processes that pushed them from the 30th percentile to the 90th percentile on the national data. I visited the department to interview the key players and they provided me with all of their data and performance processes. I also want to get input from the physicians and department chairs on the departmental process improvements.  
A teaching case study like this would be widely applicable because it illustrates systematic changes for improvement can lead to success. It is important to use examples of process improvement programs that were developed and implemented over two to three years, achieved positive results, and used the improvement process (the PDSA cycle, etc.). I want to illustrate that it is the process that produces results, not magic! 
These case studies will also help create a shared learning database with standard teaching materials that will greatly add to the quality improvement teaching materials already available at IHI. Because IHI has such a broad teaching faculty, in different areas of the country and the world, we can sometimes lose consistency in our teaching materials. Developing case studies can help IHI be more consistent in its teaching approach. In addition to the surgical case, I hope to gather a variety of process improvements in different areas of medicine such as OB/GYN, chronic care, or diabetes. 
Q: Can you elaborate on some of the surgical department process improvements and how they benefitted Henry Ford?
The surgical department also provided me with the financial results of their improvement efforts that help make a business case for improvement. For example, when physicians bill insurance companies, they have to code what procedures were performed on their patients. Coding incorrectly leads to a loss of revenue that would ordinarily be paid by the insurance company. If a physician performed four procedures on a patient in the operating room and only codes for one procedure, for instance, then they might only get paid $2,000 instead of $3,000. But doctors don’t like to spend time coding. To make this process more efficient and physician-friendly, the surgical department developed a very specialized coding table that is broken down by specialty (e.g., a colorectal surgeon only sees certain procedures pertaining to colorectal surgeries), making it easier for physicians to check off the procedures performed. The department also provided detailed training to help doctors learn the new system, which has improved coding and thus positively impacted the department’s revenue.   
Q: Are there other long-term “dream projects” you hope to eventually work on at IHI?
My key role at IHI is to identify gaps in the programs IHI offers and fill them. For example, IHI really does not have many programs available for the chief executive officer, chief medical officer, chief financial officer, chief nursing officer, etc. This is another layer we need to consider. To begin closing this gap, I’m reviewing a program that premiered in and is sponsored out of England. It’s a global program that is only open to hospital CEOs from the United Kingdom, Europe, Australia, and the United States. I observed the program for a few days to see if IHI could develop something similar. IHI is developing potential models and evaluating costs at the moment. 
IHI is also doing some thinking around how CEOs learn. You have to really engage them, not lecture to them. You can do this best by using case methods where they work in small groups and teams. They would be much more receptive to this type of learning than a lecture in a large classroom. After this preliminary drafting, IHI will develop a rough curriculum, test it, see what worked, and do a PDSA cycle!
Q: Your background is in industrial and systems engineering. How did you get involved in health care? 
By chance. I was working on my PhD in engineering in 1966 and my professor was contacted by the CEO of the University of Wisconsin Hospital, who needed an engineer to help him improve. So my professor put me in touch with the CEO. Since Medicare and Medicaid programs were to be passed by Congress at the end of 1966, there was going to be a lot of money available for research under Medicare and Medicaid. He wanted me to write a proposal and get some grant money, and I began by talking to the doctors, per his suggestion.
When I met with the doctors they said, “We don’t know how to evaluate quality-efficient care. We don’t know why certain areas work better than other areas, so it would be great if you could do a research project on improving the quality of patient care.” I went back to the CEO of the hospital and said, “Looks like doctors really think we should focus on what makes good quality patient care.” The hospital consequently received a huge grant for this research project, for which I was project manager and worked on it for two years while finishing my PhD in engineering. 
Working with the chairman is what gave me an insight into the health care industry. In those days, almost nobody worked in health care except doctors and nurses, so I was a very early non-clinical worker. As the industry expanded, I found more and more opportunities to work in health care. So it was really a chance event and not something I planned. I enjoyed the working environment in health care much more than my prior experience working in a steel plant. 
It has also been a great joy in my life to work with IHI. I think a lot of the credit goes to Don Berwick [President Emeritus and Senior Fellow] and Maureen Bisognano [President Emerita and Senior Fellow], who have created an environment that’s exciting, seeing IHI through its growth and working on things that really matter. I’ve learned a great deal from people at IHI just by listening to them. IHI is constantly thinking about new ways of doing things, and creating and delivering programs. I’ve really enjoyed it all. 
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