WIHI - A Podcast from the Institute for Healthcare Improvement
WIHI: New Guidance for Governance of Health System Quality - What Trustees Should Know and Do

WIHI: New Guidance for Governance of Health System Quality - What Trustees Should Know and Do

January 18, 2019
  • Beth Daley Ullem, MBA, President, Quality and Safety First
  • Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI)
  • Ruth A. Mickelsen, JD, MPH, Senior Lecturer, University of Minnesota School of Public Health; Chair, HealthPartners Board of Directors​​​​

 How well do health care boards oversee health care quality? Trustee oversight of finances has a long track record, while accountability for health care quality is relatively new and features a steep learning curve. There are hundreds of quality metrics to understand along with dozens of initiatives to improve care. Indeed, board members often complain that they're handed so much information, it's hard to ask hard questions, let alone engage in oversight.

 Is there a better way for boards to fulfill their mandate of ensuring health systems live up to theirs on quality? Maybe so. The IHI Lucian Leape Institute​ has just released a white paper, that pairs a new online assessment tool with a new framework, to help boards and health care leaders work together to take a giant step forward with governance of quality. We explored those details and more on the January 17 WIHI: NEW Guidance for Governance of Health System Quality – What Trustees Should Know and Do.

Special Edition WIHI - Women in Action: Paving the Way for Better Care

Special Edition WIHI - Women in Action: Paving the Way for Better Care

December 18, 2018

Date: December 20, 2018

Featuring:
Mona Hanna-Attisha, Pediatric Public Health Whistleblower
Maureen Bisognano, President Emerita and Senior Fellow, Institute for Healthcare Improvement
Vania Deonizio, Healer of Forgotten Wounds
Celine Gounder, Storytelling Disease Detective

WIHI is pleased to present a Special Edition Podcast, Women in Action: Paving the Way for Better Care, featuring a panel of outstanding women who are creatively and effectively reshaping caregiving, and conversations about health and health care in the US and around the world. Whether itís blowing the whistle on the dangerous levels of lead in drinking water in Flint, Michigan, championing the healing powers of dance and movement in hospitals, or shining a human spotlight on disease outbreaks throughout the world, we learn from the panel that there are multiple ways to act and make a difference today.

WIHI recorded this keynote panel, moderated by Maureen Bisognano, on December 11, 2018, in Orlando, Florida, at the Institute for Healthcare Improvementís 30th Annual National Forum on Quality Improvement in Health Care.

You can learn more about Maureen Bisognano and the backgrounds of the keynote panelists ñ Mona Hanna- Attisha, Vania Deonizio, and Celine Gounder ñ here. [link to biosÖhave to figure out how to link to specific bios since theyíre spread out on the Forum web pages]

The podcast is one hour; we recommend that you have the presentation slides (posted on this page) handy for reference as youíre listening. Vania Deonizio also shared a video about Danciní Power during her remarks. Youíll find a link to the video just below.

WIHI: BUILDING THE WILL AND SKILL TO BE A CLINICAL IMPROVER

WIHI: BUILDING THE WILL AND SKILL TO BE A CLINICAL IMPROVER

November 9, 2018

November 8, 2018

 Featuring:

  • ​Brent C. James, MD, MStat, Clinical Professor (Affiliated), Department of Medicine, Stanford University School of Medicine; Senior Fellow, IHI; Former Chief Quality Officer, Intermountain Healthcare
  • Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement
  • Kavita P. Bhavan, MD, MHS, Associate Professor Infectious Diseases, UT Southwestern; Medical Director, Outpatient Parenteral Antimicrobial Therapy Clinic, Parkland Health & Hospital System

 Clinical and administrative leaders in health care know how difficult it is to shape one, unifying workplace culture. And while interdisciplinary team-based care is becoming more common in health systems, the range of people taking care of patients perform their jobs based on very different professional backgrounds and training.

 Can quality improvement (QI) break down these silos? Can it nurture a new kind of culture, where QI is the knowledge that unites clinicians in the common pursuit of better clinical decision making and encourages more clinicians to take the lead with improving care delivery? There’s evidence to suggest yes.

 Whether the issue is curbing overdiagnosis and overtreatment; reducing waste, costs, and patient suffering; or factoring in “what matters” to a patient when considering treatment options, clinicians who are improvers can lead the way. We explored this topic and more on the November 8 WIHI: Building the Will and Skill to Be a Clinical Improver.

WIHI: Lowering Readmissions, Reducing Disparities

WIHI: Lowering Readmissions, Reducing Disparities

October 26, 2018

Date: October 25, 2018

 Featuring:

 Andrea Tull, PhD, Director of Reporting and Analytics, Edward P. Lawrence Center for Quality & Safety, Massachusetts General Hospital (MGH)  

Aswita Tan-McGrory, MBA, MSPH, Deputy Director, The Disparities Solutions Center

Initiatives to reduce avoidable readmissions are the norm in US health systems today, particularly because Medicare fines hospitals with higher-than-expected rates. Health care leaders also recognize that when patients are readmitted to the hospital within 30 days of discharge, it usually indicates that processes are not what they should be.

In addition, health care organizations have come to appreciate that non-clinical issues, often referred to as social determinants of health, have a great bearing on rehospitalizations — everything from poor housing to unstable income to food insecurity. Collecting data to better assess the impact and better address these determinants to prevent readmissions is ongoing. We gained gain some valuable insights into the efforts of a major health care system in Massachuestts and their learning curve on the October 25 WIHI: Lowering Readmissions, Reducing Disparities. 

WIHI: The How and Why of Deprescribing

WIHI: The How and Why of Deprescribing

September 14, 2018

Date: September 13, 2018

Featuring:

  • Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP, Executive Director, Peter Lamy Center on Drug Therapy and Aging; Professor, University of Maryland School of Pharmacy 
  • Florian Daragjati, PharmD, BCPS, Director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention
  • Lynn Deguzman, PharmD, BCGP, Regional Clinical Operations Manager, Kaiser Permanente
  • Leslie J. Pelton, MPA, Senior Director, Institute for Healthcare Improvement
  • Leanne Phillips, PharmD, BCPS, Clinical Pharmacy Coordinator, St. Vincent’s East, Ascension

The ground is shifting for prescription medication in the US and Canada, and in other countries, too. There’s much talk and publicity about weaning people off drugs, or what is referred to as “deprescribing”: a process that entails taking patients off some of their medications or tapering down the dosages.

The underlying reasons for deprescribing include concerns about polypharmacy, especially the impact on older and frail adults; antibiotic resistance caused by inappropriate and excessive use; and the ongoing opioid epidemic connected to years of overprescribing highly addictive medicines for pain.

A growing number of health care organizations are working with IHI on how to safely implement deprescribing. Learn about their experiences and the future of this work on the September 13 episode of WIHI, The How and Why of Deprescribing,

WIHI: Connecting Patient Experience to Strategic Aims

WIHI: Connecting Patient Experience to Strategic Aims

August 9, 2018

Date: August 9, 2018

 

Featuring:

  • Barbara Balik, RN, EdD, Co-Founder, Aefina Partners, and Senior Faculty, Institute for Healthcare Improvement (IHI)
  • Kris White, MBA, RN, Co-Founder, Aefina Partners, and Faculty, IHI
  • Helen Macfie, PharmD, FABC, Chief Transformation Officer, MemorialCare

 

Most hospitals are understandably preoccupied with patient experience scores. High-performing organizations worry when their scores plateau, and those with mediocre scores wonder why their attention to better "customer service" hasn't improved the numbers. Up and down the rankings, there's discussion about patients as unreliable informants, flawed survey instruments, low survey response rates, and institutions being judged unfairly by these scores.

 

A decade into publicly reported patient experience data for US hospitals (most notably with HCAHPS​), experts say that health systems are working on patient experience too much in isolation, separate from other organizational strategic aims. If you're tired of the same old discussion about patient experience scores, we hope you'll listen the new ideas and best practices presented on the August 9 WIHI: Connecting Patient Experience to Culture and Strategic Aims.

 

WIHI: How to Build Better Behavioral Health in the Emergency Department

WIHI: How to Build Better Behavioral Health in the Emergency Department

July 13, 2018

Scott Zeller, MD, Vice President of Acute Psychiatry, Vituity

Robin Henderson, PsyD, Chief Executive, Behavioral Health, Providence Medical Group Oregon and Clinical Liaison, Well Being Trust

Vera Feuer, MD, Director of Pediatric Emergency Psychiatry, Northwell Health

Mara Laderman, MPH, Director for Innovation, Institute for Healthcare Improvement (IHI)​

 

​For all that emergency departments (EDs) do to stabilize individuals and save lives, they’ve never been the ideal place for patients whose crises are related to behavioral health. EDs are designed to address the most urgent, sometimes life-threatening problems, and then discharge or transfer patients to the appropriate next level of care. If a psychiatric or addiction-related admission is needed, however, there may not be any beds. This often leads to boarding patients in the ED or adjacent hallways for hours, sometimes days. ​

 

In the US, many blame an underfunded mental health system for the shortage of inpatient beds and an inadequate supply of outpatient services that might help patients avoid going to the hospital altogether. Emergency department staff aren't any happier with the status quo. They have begun to look at how EDs might improve the overall care experience for behavioral health patients and contribute to continuity of care.

 

Promising new practices are being tested in nine hospitals participating in Integrating Behavioral Health in the Emergency Department and Upstream​, an initiative led by IHI in partnership with Well Being Trust​. Improvements these hospital EDs are testing include creating new lines of communication and care coordination, including post-discharge follow-up, with community-based services; standardizing and streamlining processes from intake to discharge for a range of mental health and substance abuse issues; working with both patients and their family members on self-management skills; and educating ED staff on behaviors consistent with a trauma-informed and empathetic culture.

 

We dicsussed these tests and innovations on the July 12 episode of WIHI: How to Build a Better Behavioral Health in the Emergency Department

WIHI: Addiction Treatment Demystified: Proven, Practical Steps for Complex Care.​​

WIHI: Addiction Treatment Demystified: Proven, Practical Steps for Complex Care.​​

June 22, 2018
  • Corey Waller, MD, MS, FACEP, DFASAM, Addiction, Pain, Emergency Medicine Specialist; Managing Partner, Complex Care Consulting, LLC; Chair, Legislative Advocacy Committee for the American Society of Addiction Medicine (ASAM)
  • Catherine Mather, MA, Director, Institute for Healthcare Improvement (IHI)

 

About 5 percent of patients in the US are individuals with complex needs. Many show up at hospital emergency departments with a combination of physical, socioeconomic, and behavioral health issues — only to return, again and again, sometimes in worse condition, because the current system isn't set up to address a multitude of problems. The burgeoning field of "complex care" is trying to break the cycle with new interventions and stronger connections to supportive services.  .

But addiction, a common thread among the complex patient population, is often dealt with differently. While the recent opioid epidemic has forced health care providers to change some of their prescription practices and to become more knowledgeable about substance use disorders in general, patients themselves are still typically 'referred out' for treatment — to a much less integrated and accessible system, already stretched to its limits.​

What could the health care system offer that it's not offering now? We explored that and more on the June 21 episode of WIHI: Addiction Treatment Demystified: Proven, Practical Steps for Complex Care.​​

WIHI: Strategic Pathways to Population Health

WIHI: Strategic Pathways to Population Health

June 8, 2018
  • Saranya Loehrer, MD, MPH, Head of the North America Region, Institute for Healthcare Improvement (IHI)
  • Christina Lundquist, BA, MHS, Vice President of Operations, Rainbow Babies and Children's Hospital and MacDonald Women's Hospital at University Hospitals (UH) Health System
  • Lora Council, MD, MPH, Senior Medical Director for Primary Care, Cambridge Health Alliance ​

 

Health systems face numerous challenges in their efforts to improve population health. Among them, multiple entry points, such as initiating better care management for all patients with chronic asthma, widespread depression screening, or working with the community to address food insecurity. Each initiative is valuable yet, taken together, don't necessarily add up to a comprehensive population health strategy. Is there a logic to what to do first, then second, and so on? How do you know you're on the right track?

 

There are no simple answers, but there has been enough experience with population health in the US and elsewhere that several groups, including IHI, have come up with four portfolios of work to help organizations become more strategic about their efforts. With the help of new resources​, we discussed these four "pathways" and with two health systems that are deeply engaged in improving population health on the June 7 episode of WIHI: Strategic Pathways to Population Health.

WIHI: Giving Patients and Families the Tools to be Health Care Improvers

WIHI: Giving Patients and Families the Tools to be Health Care Improvers

May 18, 2018

Amar Shah, Consultant Forensic Psychiatrist & Chief Quality Officer, East London NHS Foundation Trust

​Lindsey Bourne, Director of Education, PFCCpartners

Barbara Grey, Director SLaM Partners & Quality Improvement (QI), South London and Maudsley NHS Foundation Trust

Sarah Davenport, Service User Consultant, South London and Maudsley NHS Foundation Trust

​Gabrielle Richards, Head of Inclusion, Recovery, Occupational Therapy, and Allied Health Professionals, South London and Maudsley NHS Foundation Trust​

 

Patients and families are playing a greater role in health care quality improvement. Over the last decade participation has grown to include serving on Patient and Family Advisory Committees, or PFACs; regularly meeting with hospital board safety and quality committees; joining co-design and co-production initiatives; and speaking or leading sessions at QI conferences.

 Along the way, there's been some exposure to QI principles and methods, but now some organizations believe it's essential for patients and families to have training in basic improvement to enhance their influence and involvement. On the May 17 episode of WIHI, Giving Patients and Families the Tools to Be Health Care Improvers, we discussed getting improvement basics into the hands of patients and their families with East London NHS Foundation Trust and South London and Maudsley Trust and how "service users" have become involved in nearly half the improvement projects happening at their organizations.