Q&A: Mara Laderman, Senior Director, Innovation, at the Institute for Healthcare Improvement (IHI)

RamaOnHealthcare June 19, 2024

IHI Innovation System: Creating Solutions Through Rapid Cycle Learning & Testing

Today, RamaOnHealthcare talks with Mara Laderman, a Senior Director of Innovation at the Institute for Healthcare Improvement (IHI).

Mara Laderman, Senior Director, Innovation, at the Institute for Healthcare Improvement

RamaOnHealthcare (ROH): Today, RamaOnHealthcare talks with Mara Laderman, a Senior Director of Innovation at the Institute for Healthcare Improvement (IHI) and discusses IHI’s 90-Day Learning Cycle approach to Innovation. Mara, can you give us an overview of this approach?

Mara Laderman (ML): IHI’s 90-Day Learning Cycle approach is a method for rapidly researching and evaluating new ideas to address different problems in health and health care improvement. For each topic, we spend 90 days examining the problem and developing an evidence-based and testable approach to solving it. We typically work on four to six different topics every 90 days, and each cycle follows a similar structure.

That structure starts with 30 to 45 days of exploring the problem. We conduct literature reviews to understand what’s been published about the area we’re researching. This involves peer-reviewed studies, gray or non-peer reviewed reports from places like government agencies, and consulting firms. We also conduct a lot of expert interviews with people who are working on different aspects of the problem. This might include researchers, policymakers, health system leaders, clinicians, or people working at the point of care. It could also include people with lived experience, patients, and family members. It really depends on the topic, but we try and get a lot of different perspectives. There isn’t always a lot that’s been published about the topic we’re focusing on, so those expert interviews are particularly important for understanding the different ways of looking at a problem and then trying to understand what different solutions might be.

The next phase of the cycle takes about a month or so. This is when we synthesize what we’ve learned from the literature review and expert interviews. We ask ourselves questions like, What are some of the common themes that we’re hearing? Are there any kind of core principles that seem to be emerging? Are there similarities that are coming through? From there, we start to put together some kind of conceptual model, a framework, or a theory of change to help us try and understand what the key drivers are to addressing the problem that we’re trying to solve. If we’re able to, we develop some more specific change ideas and strategies that organizations might be able to test.

In the last 30 days or so, we vet aspects of our draft conceptual model or framework or theory of change with the people that we interviewed, people in the field, and IHI partners. We write up what we learned and determine how best to deliver that information to people who need it internally and externally.

ROH: How do you find creative solutions to pressing challenges in health care today?

ML: We do this in a couple of different ways. The first way is through the expert interviews that we conduct. That’s where we find a lot of rich information on new things that people are trying. Often, we find that people who are experimenting and running new tests of change at their organizations aren’t writing up their experience. They’re not publishing peer-reviewed articles, but they’re doing really interesting work and we’re able to learn about that through word of mouth from people in IHI’s orbit.

The second way we find creative solutions is by looking outside of health care. We look to analogous industries to try and understand how they have attempted to solve a similar problem. For example, if we’re looking at a problem with flow or operational efficiency, we might want to look at the fast-food industry. Not to suggest that fast food and health care have a lot in common, but if they’re trying to move people through a line quickly, there might be something to learn from the line at Chipotle or the line at Sweetgreen that could be applied in a different way to a health care setting. Looking at analogous industries is often a good place for us to start to come up with some new and creative ideas.

Finally, we’ll brainstorm as a team to determine if there is a new way to think about something that came up in our literature review or expert interviews. When we understand what has been done in the past, we can learn from the successes and failures and consider whether there might be a new creative way to approach the problem.

ROH: What are some interesting health care challenges you have recently explored or are planning to explore through the Learning Cycle process?

ML: Since the IHI innovation team was founded in 2006, our team has worked on hundreds of 90-day Learning Cycles, covering a range of different topics. I’ll talk briefly about two recent projects that are particularly interesting and timely: one looking at the role of AI in health care, and another about the role health care organizations can play in decarbonization.

On the topic of AI, our team has been exploring generative AI and its impact on different facets of health care, including patient safety and quality improvement. We’ve examined opportunities for AI to help facilitate patient safety improvements, and we’re looking at the potential risks and pitfalls of health systems using AI in different ways. We’ve also looked at AI and quality improvement and improvement science, trying to understand how quality improvement professionals can use generative AI to help support their improvement work. Now we’re developing recommendations for how both clinicians and health system leaders might think about using AI to do improvement work in new and better ways.

In addition to AI, we have been working for the past year or so on decarbonization in health care and how health systems can reduce their carbon footprint relative to care delivery. So far, that work has resulted in a primer published in collaboration with the AHRQ called, Reducing Healthcare Carbon Emissions: A Primer on Measures and Actions for Healthcare Organizations to Mitigate Climate Change. Related work is being tested by several health systems that took part in our Decarbonization Care Learning Community, where they implemented and tested strategies to reduce their use of products and processes that we know contribute to greenhouse gas emissions.

Our innovation work can really run the gamut, but we work across all facets of IHI’s priority areas, from patient safety to population health to advancing the science of improvement to improving health equity.

ROH: What happens after the 90-day Learning Cycle is completed?

ML: After the initial 90-day cycle there are several possible next steps. The first option is that we do another 90-day cycle. Often, we’re not done looking at a certain issue after 90 days, but we want to be very intentional in how we approach structuring additional research. After all, the 90-day cycle was founded, in part, on the idea that a research project can go on for any amount of time that you give to it, so we want to be disciplined and focused in the 90 days to ensure we can be rapid and agile. About half the time, we will charter another cycle, typically so we can spend more time developing our theory, working on our conceptual model, and making something that is actionable and usable.

Another possibility is that we work on testing our theory with a partner in the field. This gives us a chance to test and refine our ideas and improve our degree of belief that those changes will result in an improvement.

Alternatively, a 90-day cycle could lead directly into a program. IHI runs educational programs and trainings for a variety of health care professionals, and sometimes we have enough of an understanding of the topic and what individuals need to learn to go right into program development. In that case, we’ll work with our education team to create an in-person or virtual offering to teach people about the problem and the solution that we’ve developed.

In many cases, we publish our work in order to put new ideas out into the field.

Of course, not every cycle results in a next step. I’d say for approximately 10% of projects, we start working on something and find that there isn’t as much there as we thought there would be. If that happens, we’ll stop and acknowledge it wasn’t working. It’s essential to have that willingness to fail and to see things not necessarily go somewhere. That’s part of how we stay on the cutting edge, because if there is a fear of failure then we might not be able to be as creative or innovative as we could be otherwise.

ROH: Is there anything else you’d like to add?

ML: The approach to innovation that we use differs quite substantially from academic research. That’s not to say that one is better than the other in any way, it’s just a different way of approaching a research question. We try and be as action-oriented as possible, understand the problem in as many ways as we can, and understand what individuals and organizations are doing to address the issue. It’s a different way of approaching research that is unique from other ways research happens, particularly in medicine and health care. To learn more about our innovation approach, you can download our IHI Innovation System white paper on IHI.org.

About Mara Laderman

As an IHI Senior Director of Innovation, Mara Laderman provides operational leadership for IHI’s Innovation System. In this role, she leads innovation projects, manages a team of researchers, and works closely with organizational leaders to develop and sustain a robust pipeline of innovation projects that aim to develop new approaches to address pressing problems in health and health care improvement. In addition, she leads IHI’s portfolios of work in behavioral health and the opioid crisis, directing research initiatives, working closely with health care and community partners, and developing programming focused on better meeting individuals’ mental health and substance use needs across health care and community settings. Prior to IHI, Ms. Laderman managed a large psychiatric epidemiology study at the Center for Multicultural Mental Health Research in Boston, MA.