What are the different phases of a large-scale innovation project at IHI?

Kedar Mate, MD, Senior Vice President, IHI

I’ll tell you about a project we’re doing right now, which is around behavioral health integration. So we started with this idea of behavioral health integration at large. We were really interested in who is doing this well? We were agnostic as to where or in what setting. We wanted to just learn where comorbid behavioral and physical health was being addressed successfully. And we were studying that in primary care and community care settings and in acute care settings. So we started with this sort of broad question. And what we did initially was we built this sort of theory, which involved five layers of care: acute care, primary care, community care, family care, and self-care. Those were the five layers. And now we’ve stepped through those five layers and done innovation project after project looking at best practices in each of those five dimensions. Right now we’re working on acute care integration.

And we found across the country there aren’t a huge number but there are a few institutions out there that are doing some really incredible work on integrating behavioral care services with medical care services and surgical care services and intensive care services in different acute care institutions. We’re going to now take those ideas — those initial suggestions — we’ve pulled together a theory, which we’re starting to articulate now and we’ll design a prototype which we hope will be tested with a handful of institutions as we move forward — there’s a couple that are interested in working with us on this — and by testing it, we will then validate aspects of the theory or discard aspects of the theory and that will allow us, hopefully, to get to a useful model of behavioral health integration in acute care settings that’s not just a model of service delivery but also has components of the financing — how do you build a business case for this — as well as how you overcome the operation and clinical barriers to making integration happen.