People who work in glass offices. . .

Write all over the walls.


At least is the case at the Institute for Healthcare Improvement.


To set foot inside the IHI offices is to perceive, no doubt with dumbfounded expression in my case, what it means to truly practice what you preach. More on this in a moment (for those who absolutely can't wait - they have a virtual tour, of course. First, some background:

This week, I'm working with six friends - until yesterday, I might have written "other students interested in health care improvement," but a day of work and an evening on the town quickly cemented the upgrade - on a broad roll-out of the WHO Surgical Checklist to medical students worldwide.

To those new to the Checklist, it is a 19-item set of basic and essential safety questions which, when answered together by all members of a surgical team, ensures dramatic reductions in preventable harm. To be sure, the checklist succeeds, in part, like the pilot's checklists that inspired it's use. It guarantees that all required steps are taken to get patients (or passengers) through safely. I believe that the checklist is so effective because it also helps turn a group of coworkers into a true "team." That is, it makes clear the identities and roles of everyone in the operating room, raising the level of situational awareness. The gentleman resting peacefully on the table is not just the next patient to a scrub technician or medical student in the room, but rather, Mr. Jones, who is having his gallblader removed, and will probably do well throughout surgery but does have an allergy to Keflex. By investing every team member in the shared goal of safety, the Checklist produces lifesaving results. Impressive, considering it costs pennies to use.


Getting this piece of paper into the hands of every student who is or will one day be in an operating room - PA, RN, NP, MD, and PharmD, is our goal, and what brought me to the glass-lined, offices above the posh Charles Hotel, which house the idea factory known as the IHI.


The IHI offices are remarkable in many ways - the free diet coke certainly had one team member floored - mainly, because walking within them, you become absolutely sure that every element of their design has been both 1) planned, and 2) made better than a previous version at some point. There was one notable exception which bears mention, a design flaw on the front door handles, which I observed being - predictably - pulled rather than pushed by another of my teammates. A classic example in the science of human factors, perhaps the vertical door push is retained for its teaching value.

OK, back to the office. Amazing. Walking in, I Immediately noticed the IHI's mission and core values inscribed on the walls. "No needless deaths." A poignant motivator for everyone who passes by. High on the walls, one finds quotes from history's leaders in innovators: "Sometimes it's fun to do the impossible," or the more curt, "Hope is not a plan." Down the central corridor, the six aims of the IOM report, Crossing the Quality Chasm (report here, aims here) line the hallway's load-bearing posts - they are literally the pillars of the IHI!!

Another inspiring translation of mission into structure is visible in the offices - or, more correctly, invisible: The walls are all glass. Remember transparency, "going naked?" Well, the IHI is a place where you can see what everyone is doing at all times. There are no secret meetings here. Often, employees are walking into the otherwise unremarkable office shared by the CEO and COO and three others to grab a piece of candy. Nearly always, at least in my observation, they're smiling.

In its constant efforts to improve everything, its flat corporate culture, its and its conspicuous openness and transparency, the IHI is the epitome of the attitudes it seeks to impart to the health care professions. Visiting the IHI has been a revelation. This place is filled with an incredible energy and enthusiasm. This must be what it was like to be at Bell Labs in the 60s, or Google at the millenium. They even have a fun committee.

Practice what you preach, and please, preach often.

-Dan H.