Leadership & Organizing to Improve Population Health

Orientation, Lecture 1: Explaining I-CAN

Jessica Perlo, MPH, Open School Community Manager, IHI
Donald Berwick, MD, MPP, Senior Fellow and President Emeritus, IHI

Hi. I’m Jessica Perlo, Community Manager of the IHI Open School. It’s my pleasure to talk to you today to tell you about the purpose and structure of the course and the I-CAN program. In this pre-program orientation, we’ll discuss the program goals, the faculty, and how you can get the most out of the learning experience. With help from the prerequisites, we will also provide some introductory education in population health and improvement science, which will create a good foundation for the next eight weeks of learning.

At the end of this brief lesson, you’ll be able to explain the purpose and design of the I-CAN mobilization effort. You’ll be able to describe the course program components, goals, and curriculum flow. And you’ll recognize the course faculty and how to get the most value out of the I-CAN program.

So what exactly is I-CAN? In addition to being an acronym for the IHI Open School Improvement Change Agent Network, it’s a new program to train health professional learners to become community organizers and leaders of population health improvement. This course, Leadership and Organizing to Improve Population Health, is intended to guide learners through projects to improve the health of their local populations. By joining this program, you will gain access to a community of like-minded individuals online; you’ll receive training through a special, eight-week, semi-synchronous online course that includes coaching from IHI faculty and other subject matter experts; and finally, and most importantly, you’ll be able to improve the health and health care of your communities.

We’ll dig into the course details in the next video, but for now I’m going to turn it over to Don Berwick, a physician and former President and CEO of IHI, to tell you why and how we designed the I-CAN project — and our theory of change.

Hi. I’m Don Berwick. I’m the Senior Fellow and President Emeritus at the Institute for Healthcare Improvement and the founding CEO. I ran IHI for 19 years. I’m really excited about the I-CAN project and I want to explain to you a little bit about the background.

The fundamental premise on which the Institute for Healthcare Improvement was founded is that there are methods in the world that would allow us to have complex systems of any type improve far faster than they will without those methods. I-CAN is an attempt to apply the methods of Improvement to a large-scale problem — in this case, the problem of population health. You, the members of the IHI Open School participating in I-CAN, are going to be equipped through this process with skills and knowledge that we believe will help make you a more effective participant and leader of improvement from now on and through the rest of your careers.

The skills that we’re bringing together in the I-CAN project come in three pots; the first is subject matter knowledge. If you’re going to know how to change a system, you need to understand that system. And that involves the knowledge from research and experience that’s relevant to that problem. If you want to be a surgeon, you better understand surgery. If you want to make airplanes, you have to understand airplanes. And if you’re going to improve population health, you better understand population health and what generates it. So, the first domain of knowledge is subject matter and, in that, you’ll be exposed to what we call a driver diagram. It’s a very systematic presentation of the influences on the health of a population as now understood through modern science, public health science, and clinical science — subject matter knowledge.

The second is the fundamental set of tools and knowledge for which IHI was originally formed to spread — and that’s the knowledge of improvement. When a system is complicated and there are a lot of interacting influences, there are specific methods and approaches — and areas of growth of knowledge — that we now know help individuals and leaders be more effective in making those changes, no matter what subject matter they’re working on. There are a lot of ways to describe the subject matter knowledge for improvement, but it was probably best codified by the great mind of the 20th century in improvement — one of the great leaders and teachers, Dr. W. Edwards Deming.

In the last part of his career, Deming said that the body of information and skills that can be brought to bear on the improvement of a system comes in four categories. He called those categories profound knowledge. He said you need to have knowledge of systems, how interacting influences work — what are all the different constellations of influences that lead to a particular outcome and what kind of changes in those influences can lead to better outcomes. He said knowledge of a system, how things work together.

The second, he said, was knowledge of variation. Systems speak. but they speak through, largely, variation. And by understanding how numbers are changing, how data are changing, how performance is changing over time, you can actually learn an awful lot about what influences are favorable and what are unfavorable. But to do that, you have to be a master of certain forms of statistics that you can learn if you’ve studied quality improvement.

The third area of knowledge Dr. Deming called psychology. He means here that in the work we do in improvement, we’re usually in human systems, where people are interacting with each other in groups or individually. And the way that people think, what motivates them, how they learn, how they resolve conflicts — this broad area of interpersonal psychology and relationship — has to be understood and mastered by leaders or participants who want improvement to occur. So that’s three of the four areas: knowledge of systems, knowledge of variation, and knowledge of psychology.

The fourth area is a little hard to understand, but he really meant knowledge of how knowledge grows. How do we learn? How does a kid learn to ride a bike? How did you learn to play chess? You don’t do it in one step; you do it by a whole series of what are really little micro-experiments. You have an idea that might be an improvement on the existing reality. You try the idea out. You reflect on what you did. And then you learn from that and go to your next idea. In the jargon of quality improvement, that’s called Plan, Do, Study, Act — PDSA cycles. But there’s nothing mysterious about it; it’s what a kid does when he’s learning to ride a bike. He gets on the bike, tries to push the pedal a certain way, either falls or doesn’t, and learns from that about how to ride the bike better and then goes to the next test.

Those are the four areas of knowledge, codified by Deming around knowledge of improvement. And if you’re working with the IHI Open School, you’ll learn and master those, as well.

The third is the newest at the Institute of Healthcare Improvement, which was really brought to us by Marshall Ganz and other theorists about the modern approach to leadership. How can we work together to motivate ourselves and others with skills to take knowledge into action, to actually make changes in the real world? That’s a very complex endeavor— understanding modern approaches to mobilization and leadership — but that’s core to the thinking now within IHI and certainly in I-CAN. What we really want to do in I-CAN is bring these three areas of skill — knowledge about population health, knowledge about improvement, and knowledge about mobilization — and work together into one constellation of activities and one reservoir of support to you, the students, so you can take this knowledge, combine it, and together, as a force for change, not just on your campus, but hopefully in the world, help make health and health care better. That’s the theory behind the I-CAN project.

It’s a cumulative project itself; we don’t know how to do this. We’ve never done it before. So the model behind I-CAN is to start small with our own PDSA cycle. Take a smaller number of students and their faculty on campuses around the world, get to work on population health in a several-month period, and see if we can learn about how that idea about mobilizing to action actually works. Based on that, expand participation to a larger group of students — several thousand, we hope. And finally, in the third wave of I-CAN, over an 18-month period, or a two-year period, really expand to global scale. Our target’s very ambitious — it’s thirty thousand young people knitted together in mobilization around the world through the IHI Open School and the I-CAN project to achieve real changes in population health. We’re going to learn together. Welcome to the process and have fun learning.