By Jay Kumar
In his keynote address at the Institute for Healthcare Improvement (IHI) Forum, IHI CEO Kedar Mate, MD, urged attendees to look for patient safety solutions that not only help marginalized populations but benefit the public at large.
The conference, which normally takes place in Orlando, is being held virtually this year. Mate, who was named the organization’s CEO in June, said the search for ways to build a better healthcare system should embrace the concept of targeted universalism, which is an inclusive way to implement interventions. A prime example of targeted universalism is the curb cut, which was initially created to provide public streets accessible to wheelchair users, but now benefits a wide variety of people for various reasons.
“Targeted universalism seems ready made for today’s moment and today’s challenges,” Mate said. Other examples include seatbelts, which originally created for children; smoking laws, which were enacted to help flight attendants on airplanes; and closed captioning, which was designed to help the hearing impaired.
“In fact, by focusing on the most marginalized and excluded, we just might create a system that is better for all of us,” he noted.
The spirit of collaboration needs to be encouraged, said Mate.
“Our societies are becoming increasingly polarized, and this polarization is obscuring the value of collaboration, when the present global moment that we are in demands exactly that,” he said. “It has reduced decision making to either/or constructs where someone has to lose instead of seeing the opposite that might be present in both/and solutions…Consider the curb cut as a way of seeing through that polarization.”
An important challenge for the healthcare industry is to create a more equitable health system, Mate said. Organizations should take the following steps to ensure health equity:
- Make health equity a strategic priority
- Build infrastructure to support health equity
- Address the multiple determinants of health
- Eliminate racism and other forms of oppression
- Partner with the community to improve health equity
IHI launched a collaboration called Age-Friendly Health Systems that developed a framework called the “4 Ms” to create age-friendly health systems:
- Knowing and understanding what MATTERS to older adults
- Improving MEDICATION use
- Increasing MOBILITY
- Improving MENTATION (i.e., preventing, identifying, treating, and managing dementia, depression, and delirium)
“These interventions have had profound effects on older adults, reductions in polypharmacy, delirium incidents, and length of stay for our oldest adults,” Mate said. “Meaning less time to de-condition and more time at home with family and friends.”
In 2017, the IHI set the goal of having 1,000 health systems adopt age-friendly initiatives. Mate said as of this week, 1,195 care locations are recognized as age-friendly health systems. In addition, Providence Health added a fifth “M,” malnutrition, which had the added benefit of helping all patients, not just the elderly ones, he said.
“In healthcare, ignoring the disadvantaged and the systems that perpetuate these disadvantages will not only in the health of individuals but in the health of entire nations,” Mate noted. “We are living this now with COVID-19.”
Mate listed several “curb cuts for a better world” that he would like to see implemented:
- Address the inequities right from the start.
- Invest in public health.
- Fix our long-term care environments. “Our nursing homes need our support right now, not our mistrust and suspicions.”
- “De-carcerate” by reducing the prison population where possible.
- Expand community health.
- Improve prison health.
To find their own curb cuts, Mate said health organizations need to name their universal goals, pick a measure that’s important to them and stratify their data, and stay physically and psychologically safe.
“We need ‘psychological PPE’ to promote mental health and well-being,” he added.
Jay Kumar is editor-in-chief of PSQH.