The word “innovation” can refer to different things in health care. What does it mean at the Institute for Healthcare Improvement (IHI)?

At IHI, our innovation team develops solutions to key challenges in health care delivery — where none exist, or where the solutions are not broadly understood — which can be taken up broadly in the field.

Since 2006, IHI’s innovation team has run nearly 350 90-day cycles on topics ranging from developing the Triple Aim to Whole System Quality to improving health equity. We partner with willing practitioners, researchers, experts, patients, and communities to identify, develop, and test new solutions where necessary.

Anyone at IHI can submit an idea for the innovation team to consider. These ideas come from senior leaders who are hearing needs and opportunities for innovation in the field, project team members who learn about pain points from front-line staff, IHI’s Strategic Partners, board members, and more. Using a set of criteria as our guide, we identify five to seven topics per “wave.” Some of these are continuations from the prior quarter that need more research and testing, and others are brand new topics.

For each topic, the research team spends the first week or two scoping and refining the research questions. Some of the topics start off sounding like dissertation topics, something that a researcher could spend a career exploring. It’s important that our research questions are specific, actionable, and feasible to answer within the 90-day timeframe.

A good example of this scoping process comes from our ongoing work on climate change. This project began as an exploration of how health care organizations can address the climate crisis. Through conversations with IHI leaders and several external experts, the research team refined this question to focus on how health systems can effectively reduce their carbon footprint and become more climate resilient through health care delivery. While still a big topic, this question is one that is less covered by existing work in the field and was specific enough to be tackled in 90 days.   

After scoping and refining the research questions, we start an environmental scan. This includes reviewing both peer-reviewed and grey literature, exploring industries outside of health care for analogous examples, and conducting interviews with a range of experts. These experts include leaders, front-line staff, academics, policymakers, community stakeholders, and individuals with lived experience. This scan identifies known best practices to address the problem, exemplar organizations from whom we can learn, and barriers and opportunities. It helps identify gaps and ways IHI might help support organizations facing similar challenges.

Our motto is to learn as much as we can as quickly as we can, and not more than that. Our goal is not to conduct a systematic review or a meta-analysis. Once we start hearing the same themes repeatedly, we can feel confident that we have gathered sufficient information from the scan to proceed to theory-building.

We take the themes from the scan and start to build an initial theory of change, which often takes the form of a driver diagram. This theory includes the key levers to achieve the objective of interest, and frequently includes a barrier analysis of common pitfalls and opportunities to overcome them. This theory often forms the basis for a new concept design that is vetted and refined with partners and a subset of experts in the field for face validity testing.

Once we have a more refined design, we summarize our learning and take the theory into the field for testing. As described in the IHI Innovation System white paper, some of our projects continue for another 90 days. Some move directly to the field through an educational course or work with a partner. Others are held for a time if the field is not yet ready, and some fail. Failure is important in innovation. We can’t expect all our ideas to take hold; being allowed to fail allows our team to be creative.

This fall, our team will be working on six projects:

• Climate Action in Care Delivery
• The Next Generation of Patient Safety
• Content Development for Effective Chief Equity Officers
• Optimal Quality Office Design
• Anti-Racist Improvement Methods
• Behavioral Health Care Access

IHI developed an innovation system within our improvement organization because we believe that today’s health care environment needs both improvement and innovation. We look forward to sharing what we learn from our efforts with the IHI community.

Mara Laderman, MSPH, is IHI Senior Director, Innovation.

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Join the IHI innovation team at the virtual IHI Forum 2021 on Monday, December 6, for What's New from IHI Innovation? At this session, the team will lead rapid fire presentations about some of IHI's most exciting work from the past year, including: A Framework for Anti-Racist Research, Climate Action in Health Care Delivery, Technology Implementation, and Virtual Delivery of QI Methods.

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