Health equity top priority for leader of Institute for Healthcare Improvement

Mate received a degree in American history from Brown University in Providence, Rhode Island, and earned his medical degree at Harvard Medical School in Boston.

After graduating from Brown, Mate worked at Boston-based Partners in Health. He also worked at the World Health Organization and Brigham and Women’s Hospital. Prior to being elevated to president and CEO at IHI, he was the organization’s chief innovation and education officer. He recently told HealthLeaders that he was inspired to pursue a career in medicine while working for Partners in Health with HIV/AIDS patients in Haiti and drug-resistant tuberculosis patients in Peru.

“I joined Partners in Health and got a chance to work with an interdisciplinary group of doctors, economists, and anthropologists. I observed the work that the physicians did in direct care, and it struck me as very powerful, compelling, and different from the work of those in public health and economics. All of the disciplines were important to the kind of impacts that we were seeing, but it was the clinicians in their direct care and what they could do at the individual level that I found incredibly compelling,” he says.

The career choice was in line with his upbringing. “Both of my parents are in the clinical arena. My dad is a pediatrician. My mom is a microbiologist—she works in a hospital laboratory,” Mate says.

Following are the highlights of Mate’s conversation with HealthLeaders.

“I love the fact that IHI does not view healthcare challenges as inevitable. It treats situations as solvable systems problems. I found that approach relevant whether I was in my practice environment or in sub-Saharan Africa working on a maternal and child health program. Regardless of the care setting, I found problems that were surfacing that were not just the pure clinical problems that were in front of us doing patient care—they were problems of the underlying system that was creating the clinical problems. Most people did not have the vocabulary for solving that systems problem, but IHI did.”

“IHI had an approach that felt compelling, and that is what drew me to IHI and made me want to work for the organization, first internationally, then as leading the research and education team.”

“The area that has been at the core for me is where health and social justice intersect. Today, that intersection is most evident in issues around health equity. There have been several examples in the work I have done, including the work that I did in Peru and Haiti with Partners in Health, and the work I did with IHI in sub-Saharan Africa.”

“Equity was included in the definition of quality that the Institute of Medicine put forward in the late 1990s and early 2000s. But we still have a massive opportunity to bridge the equity chasm much as we have been trying to bridge the quality chasm for years.”

“The big defect is to stop admiring the problem. We have had a lot of documentation of inequities and disparities in our systems for a long time. Not too long after we had To Err Is Human, we had Unequal Treatment in 2003. So, we have known these issues for a long time; but even today, we have more descriptive studies and analyses of what drives inequities and fewer intervention studies that talk about how to remediate inequities and close gaps.”

“So, for me, the big opportunity that we have in the equity work is to actually tackle inequities.”

“There is a big relationship between the inequities that we see and the safety challenges that we see. Some of the biggest opportunities in safety are also opportunities to remediate inequities or to close disparity gaps that we experience. A lot of the vulnerabilities of patients to injuries, infections, and readmissions are concentrated in the most vulnerable and under-resourced people in our communities—often in communities of color.”

“We have a framework for change at IHI that has three components—will, ideas, and execution.”

“For will, you must have the will and motivation to change. That will needs to exist at the senior leadership level such as the board of directors, but it also has to be driven in part by a sense that the status quo is untenable and that the future might be more attractive if you can chart a path to that future.”

“You also need to have fundamentally better ideas for what the future can be—that is the second dimension. So, you must have will and motivation, but will is not enough without ideas to change your system from what it is today to what it should be tomorrow.”

“The third area is execution. You need a disciplined approach to implementing change—whatever the change might be. The execution plan needs to be different based on the nature of the change. So, depending on the nature of the ideas and the will that is present, you might have a pilot program, or you might be ready to scale change widely. It takes different levels of execution depending on the will that is present and the belief you have in your ideas.”

“Leadership is increasingly important as we tackle some of the big challenges that we have around equity, racism, and major social problems.”

“Some of this work can be uncomfortable, and leaders should lean into that discomfort. There are some big challenges ahead, and they tend to be deeply rooted and systemic. These challenges will be uncomfortable and difficult to fix. You need to recognize that your biggest obstacles are people—the people who are voicing the most opposition to your change initiative are deeply passionate about what you are trying to change and have strong opinions because they are passionate about it, and you want to engage them in the process.”