WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Disability Competent Care

Date: June 11, 2015

Featuring:

•  Gilbert Salinas, MPA, Chief Clinical Officer, Rancho Los Amigos National Rehabilitation Center
• Christopher Duff, MDiv, Executive Director, Disability Practice and Policy Consultant
• Regina Estela, MPA, Chief Operating Officer, Independence Care System
• Rachael Stacom, MS, AnP-BC, MSCN, Senior Vice President, Care Management, Independence Care System
• Rebecca Bills, MSW, LICSW, Clinical Manager, Medica Health Plan

A lot of progress has been made the past several decades for people with disabilities. But, there are still barriers and biases that prevent disabled individuals from leading full lives and fully accessing health care. For those with physical disabilities, once you get beyond basic accommodations such as parking spots, ramps, and wide corridors, myriad processes at hospitals and office practices don’t always factor in how someone, say confined to a wheelchair, may need to navigate much of it differently — with more time allotted to see a provider, access to multiple providers in one visit as opposed to multiple appointments, and greater attention to the special burden of waits and delays.

 

The good news is that these sorts of issues are now being more regularly identified and targeted for improvement. Disability community advocates, health systems, health plans, consultants, and government agencies have been looking hard at what constitutes disability competent care. We found out who's helping to raise the bar on best practice in health care for people with physical disabilities on this WIHI.  

WIHI: Now What? Best Practices for Newly Diagnosed Cancer Patients

Date: May 21, 2015

Featuring:

• Leonard L. Berry, PhD, University Distinguished Professor of Marketing, Mays Business School, Texas A&M; IHI Senior Fellow
• Pat Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement
• Jeffrey Landercasper, MD, FACS, Gundersen Health System
• Robert Anthony Chapman, MD, Senior Staff Physician, Medical Oncology, Henry Ford Hospital

When someone is first diagnosed with cancer, those first few days and weeks can be terribly disorienting. Even when health care professionals and staff try to provide clear information about next steps, the person who’s supposed to be taking everything in may be severely distracted. This can be true no matter what type of cancer; but when the news is especially frightening, we can all appreciate why, for some patients, nothing computes. Are there particular ways the health care system can behave, best practices that can be deployed, to ease this initial, hard part of the cancer journey? Yes, say a growing number of cancer treatment providers and patients and observers.
 
We have well-known marketing and health care service expert Leonard Berry to thank for helping us shape and anchor this WIHI; Len has spent the past year interviewing more than 350 patients, family members, oncologists, and others to get to the heart of current problems and missteps when it comes to supporting those who are newly diagnosed with cancer. As Len puts it, “A cancer diagnosis is a fireball that turns a patient’s and family’s lives upside down. How can we improve the overall experience? What are the possibilities to ease the path in these first, highly emotional days?” 

WIHI: Leaning In: Oregon's Coordinated Care Organizations

Date: May 7, 2015

Featuring:

• Chris DeMars, MPH, Director, Systems Innovation, Oregon Health Authority- Transformation Center
• Ronald Stock, MD, MA, Director of Clinical Innovation, Oregon Health Authority-Transformation Center
• Trissa Torres, MD, MSPH, FACPM, Senior Vice President, IHI

Far from the epicenter of Washington, DC, and the federal government’s efforts to expand health insurance coverage and usher in health care delivery and payment reform, states are moving ahead with amazing innovations of their own these days. Medicaid waivers, which offer states running room to experiment with public dollars, are one big reason. And one big example of what’s possible is unfolding in Oregon.

No stranger to trail-blazing with transformative ideas and initiatives, Oregon’s latest efforts to provide better care and value to nearly one million Medicaid recipients the focus of this WIHI. The groundwork and the enabling policies and legislation for Coordinated Care Organizations (CCOs) have been several years in the making, and the careful shaping of the program is leading to some impressive results.

You'll hear about the money, the care, the innovative use of community health workers, and just how 16 CCOs across Oregon function as one system on this great episode of WIHI.

 

WIHI: Reducing Risks and Defects with Help from the Front Lines

Date: April 23, 2015

Featuring:

• Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement
• Steven J. Spear, PhD, MS, Senior Lecturer, MIT Sloan School of Management; Senior Fellow, IHI
• Alexia Green, PhD, RN, FAAN, Professor and Dean Emerita, Texas Tech University Health Sciences Center
• Roger Resar, MD, The Mayo Clinic Health System; Senior Fellow, IHI

As health care quality improvement has matured, it’s common to hear the phrase, “Quality is everyone’s responsibility.” But what does that mean more precisely, and how does the concept apply day-to-day? How feasible is it for those on the front lines of delivering care to not just detect defects in systems and processes, but also solve many of them, right then and there? It turns out this is quite doable, especially if frontline staff and providers are empowered to do far more than patch up problems AND if they can count on operational guidance and leadership from others, including middle managers.

The goal is first and foremost to reduce harm to patients and improve safety, but in the process it’s also about raising joy in work and frontline confidence to address problems as they emerge and create replicable solutions as part of daily work. Learn how to "See, Solve, Share, and Lead" on this valuable WIHI episode.

WIHI: All Hands on Deck to Reduce C. Difficile

Date: April 9, 2015

Featuring:

• Dale Gerding, MD, Professor of Medicine, Loyola University Chicago Stritch School of Medicine; Research Physician, Edward Hines Jr. VA Hospital
• Jason Leitch, PhD, MPH, National Clinical Director, Healthcare Quality, Scottish Government
• Alan Whippy, MD, Medical Director of Quality and Patient Safety, Permanente Medical Group, Northern California
• Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement

What was your reaction when you heard the news that Clostridium difficile (C. diff) infected far more people in 2011 than first reported by the US Centers for Disease Control and Prevention (CDC)? Writing in the New England Journal of Medicine at the end of February, the CDC updated its own prior calculations to report that the burden of infection in 2011 was 80% higher than previously stated. In total an estimated 453,000 people were afflicted with C. diff in 2011; C. diff was a factor in some 29,000 deaths.

 

Our reaction here was, among other things, to schedule a WIHI and to touch down with some people who can help us make sense of the numbers and the health care and community settings contributing to them. And, more importantly, to check in on where progress is being made to reduce instances of C. diff and where much more aggressive work needs to be done. While there are indications that hospital-onset C. diff is declining in the US, no one is satisfied with the pace of change.

 

WIHI host Madge Kaplan assembled a solid panel to discuss the issues. Dale Gerding walks us through the latest epidemiological research on C. diff, proven reduction strategies, ongoing challenges with antibiotic stewardship, and where trend lines are moving in the right direction. Jason Leitch gives us the view from the UK, and Scotland in particular, where concerted interventions have led to an 82% decline in cases of C. diff in hospitals among people over 65. Alan Whippy tells us about important work at Kaiser Permanente, where significant progress has been made, too, and adherence to best practices is crucial so problems can't creep back in. And, IHI's Don Goldmann helps us appreciate why it's important to stay focused on acute care settings, even as we grow appreciate the value of prevention and detection of C. diff across the continuum of care and the community.

WIHI: The Managers and Management We Need to Improve Care

Date: March 26, 2015

Featuring:  

• David Munch, MD, Senior Vice President and Chief Clinical Officer, Healthcare Performance Partners
• Stephanie Calcasola, MSN, RN-BC, Director of Quality and Medical Management, Baystate Medical Center
• Kedar Mate, MD, Senior Vice President, Institute for Healthcare Improvement (IHI)

No one’s capabilities and talent should be wasted when it comes to improving health and health care for those we serve. We know you agree. Health care leaders have an incredibly important role to play in driving improvement initiatives in their organizations. So do people on the frontlines of care. What we aren’t as articulate about is the role that middle managers play. You know, the people with the job titles of House Supervisor or Shift Supervisor or Team Lead or Manager of the PACU (Post Anesthesia Care Unit). A growing number of experts say we can’t afford to ignore how people in these jobs are essential to improvement, too. 
 
WIHI host Madge Kaplan is joined by one of those experts, Dr. David Munch, who led the discussion on this WIHI. IHI’s senior innovation and improvement capability expert, Dr. Kedar Mate, and Baystate Medical Center’s Stephanie Calcasola, also helped us look at what middle managers do, now, on behalf of quality improvement – and what they could do more of, if their contributions and unique positioning in the organization were better utilized and understood. Especially when it comes to making improvement endeavors operational and sustainable.

WIHI: Bundles and Buy-In for Value-Based Care

Date: March 12, 2015

Featuring:

• Mark P. Jarrett, MD, MBA, Chief Quality Officer, Sr. Vice President & Associate Chief Medical Officer, North Shore-LIJ Health System
• Susan Browning, MPH, FACHE, Vice President, Neurosciences, Head & Neck Surgery/ENT and Ophthalmology, North Shore-LIJ Health System
• Katharine Luther, RN, MPM, Vice President, Institute for Healthcare Improvement
• Mark Hiller, MBA, Vice President for Innovative Solutions & Leader, Premier Bundled Payment Collaborative, Premier
• Alice Ehresman, RN, Healthcare Quality Specialist, Baystate Health

 

Are your care teams ready for value-based payments? Does everyone understand the relationship between better patient care and potential savings? Are there some new skill sets and mindsets required of doctors and nurses and support staff that need to be called out and called for, rather than just taking everyone’s buy-in and readiness for granted?

 

There is more than a few questions to answer, and there’s no question that public and private payers in the US are moving towards more global payment arrangements with health care providers. But the picture of how health care delivery systems take up the challenge is still coming into focus. Forming or becoming part of an accountable care organization (ACO) has been one dominant response. And a growing number of health care organizations are redesigning common patient care procedures in order to enter into agreements that reward value over volume, and that tie payment to successful deployment of specific bundles of care.
 
It’s tempting to think of all this rejiggering as resting heavily on a hospital’s or office practice’s CFO or whoever draws up contracts with payers. But there’s so much more to it. We assembled a terrific panel, with leaders from pioneering health systems like North Shore-LIJ and Baystate Medical Center, to guide us through the challenges and triumphs in this new phase for health care payment and delivery.

WIHI: Topping the Charts in Pediatrics and Adverse Events Reporting

​Date: February 26, 2015

Featuring:

• Adebisi Alli, DO, MS, Chief Resident in Quality & Patient Safety, Department of Internal Medicine, Banner-University Medical Center, Phoenix VA Healthcare System
• Gareth Parry, MSc, PhD, Senior Scientist, Institute for Healthcare Improvement (IHI)
• Lori Rutman, MD, MPH, Attending Physician, Division of Pediatric Emergency Medicine, Seattle Children’s Hospital
• Angela Statile, MD, MEd, Attending Physician, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center

Thirty-two abstracts and 56 posterboards were shared at IHI’s 20th Annual Scientific Symposium this past December. At the end of the day, the audience voted three of these as the best for clarity of presentation and strength of research. We gathered the leaders of the teams behind the winning presentations to talk about their work on this WIHI.

IHI’s Senior Scientist Gareth Parry, who runs the Scientific Symposium, kicked off our discussion with some framing about the state of health and health care improvement science in the US and globally. He also set the stage for us to hear about the three winning presentations of exemplar initiatives: a multi-year effort at Seattle Children’s Hospital to improve the care pathways for children suffering from chronic asthma; the successful implementation of new processes at Cincinnati Children’s Hospital Medical Center to reduce discharge-related waits and delays for children with complex medical problems and illnesses; and the creation of a medical resident-led consultation team at a Veterans Administration Medical Center to increase the number of error reports submitted by residents and to ensure that safety concerns are addressed.

WIHI: The Ups and Downs of Health Care Costs and Reform

Date: February 12, 2015

Featuring:

• Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement
• David Cutler, PhD, Otto Eckstein Professor of Applied Economics, Harvard University, Harvard Kennedy School of Government, Harvard School of Public Health

There are lots of health care issues to speculate about in the coming year. Here in the US, the ongoing expansion of health insurance coverage is an ambitious work in progress that continues to face plenty of political and legal headwinds. And then there’s the still glaring and still growing $3 trillion national price tag of US health care. Some are encouraged that health spending is slowing, but do we have any strong evidence that improvements in the quality of care, safety, and IT, coupled with payment reforms that increasingly tie reimbursements to quality and value, are key factors?

Fortunately, our guests on this WIHI, Don Berwick and David Cutler, bring important improvement, policy, and economic perspectives to the table to help make sense of the current environment and what’s ahead.

Against the backdrop of the Affordable Care Act and other significant initiatives, our guests offered their assessments of recent progress with better care and lower costs, and where efforts need to continue to yield even bigger benefits. We also touched upon the following: global payments and the various payer-led financial carrots and sticks in play right now designed to improve health care delivery; the state of statewide reforms, Medicaid expansion, and community-led, population health-driven experiments; and the bright spots and storm clouds on the horizon with respect to policy makers, politicians, and the public where there are still major divides.

WIHI: When Everyone Knows Your Name: Identifying Patients with Complex Needs

Date: January 29, 2015

Featuring:

• Catherine Craig, MPA, MSW, Independent Consultant; Faculty, Better Health and Lower Costs for Patients with Complex Needs, IHI
• Matt Stiefel, MPA, MS, Senior Director, Center for Population Health Care Management Institute, Kaiser Permanente
• Eleni Carr, MBA, MSW, Senior Director of Care Integration, Cambridge Health Alliance
• Kathy Weiner, MHSA, Regional Executive Director, Medicare, Kaiser Permanente

 A relatively small percentage of the US population accounts for the largest share of health care costs. Everyone knows who we're talking about, right? Well, not exactly. Broad assumptions (e.g., high utilizers of the emergency department) and sweeping generalizations often substitute for more robust inquiries and analysis designed to better pinpoint a hospital or clinic's patients with unmanaged, complex health problems. And, without this specificity, it's hard to know who will benefit most from additional supports and interventions.

This is among the reasons why an IHI Collaborative involving some 45 health care organizations has been focusing like a laser this past year on developing reliable ways to identify patients with complex needs. It's hard but necessary work, and we explored just what that hard work entails on this WIHI.