WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: End-of-Life Care and How Communities Can Become "Conversation Ready"

​Date: January 15, 2015

Featuring:

• Jean Abbott, MD, MH, The Conversation Project, Boulder County; Faculty, Center for Bioethics and Humanity and Professor Emerita, Emergency Medicine, University of Colorado
• Diana Silvey, MA, Program Director, Winter Park Health Foundation
• Kimberlie Flowers, MSW, LICSW, Senior Outreach Social Worker, Elder Services of the Merrimack Valley (Northeastern Massachusetts)
• Kate DeBartolo, National Field Manager, The Conversation Project, Institute for Healthcare Improvement

It doesn't necessarily “take a village” to have a conversation with loved ones about wishes for end-of-life care. But it can help to have others in the community to turn to for ideas, resources, and support – especially if the “kitchen table” conversation with important people in one’s life isn’t happening so readily. Sometimes it’s easier to start this conversation with peers who get together once a week at the community center. Or with a rabbi or minister. Or, initially, with perfect strangers who’ve started to meet at the local library to talk about death and dying.

 

With an aging population, and too many people not dying as they’d choose, community groups all across the US are creating more ways and places for people of all ages, and states of health, to articulate their end-of-life care preferences, and to make sure their preferences are known and respected by loved ones and local health care alike. That's what we took a look at on this WIHI.

WIHI: 10 Things Every Hospital Needs to Know to Be Safe

Date: December 16, 2014

Featuring:

• Robert Wachter, MD, Professor and Associate Chair, Department of Medicine, University of California, San Francisco

WIHI is pleased to present a special edition podcast, featuring renowned hospitalist and health care safety expert, Dr. Robert Wachter. WIHI recorded Dr. Wachter’s remarks on December 10, 2014, in Orlando, Florida, at the Institute for Healthcare Improvement’s 26th Annual National Forum on Quality Improvement in Health Care.
 
Robert Wachter is Professor and Associate Chair of the Department of Medicine at the University of California at San Francisco, where he directs the 60-physician Division of Hospital Medicine. He’s the author of 250 articles and six books, coined the term “hospitalist” in 1996, and is generally considered the “father” of the hospitalist field, the fastest-growing specialty in the history of modern medicine. In 2004 Dr. Wachter received the John M. Eisenberg Award, the nation's top honor in patient safety. He is currently completing a book about how computers are changing the practice of medicine, which will be published in 2015.



Dr. Wachter (pictured above left) spoke for about fifty minutes and then took questions from the audience, moderated by IHI’s Director of Communications, and WIHI Host and Producer, Madge Kaplan (pictured above right with Dr. Watcher). The podcast begins with IHI Executive Director Frank Federico introducing Dr. Wachter.

WIHI: The Road to Team-Based Primary Care and Behavioral Health

Date: ​December 4, 2014

Featuring:

• Ed Wagner, MD, MPH, Director Emeritus, MacColl Center for Health Care Innovation; Senior Investigator, Group Health Research Institute
• Robin Henderson, PsyD, Chief Behavioral Health Officer and Vice President, Strategic Integration, St. Charles Health System (Bend, Oregon)
• Parinda Khatri, PhD, Chief Clinical Officer, Cherokee Health Systems (Knoxville, Tennessee)
• Mara Laderman, MSPH, Senior Research Associate, IHI

Primary care practices across the US are facing a number of important challenges right now; prominent among them is doing a much better job at recognizing and helping patients with behavioral health issues. The operative term for this is “integration” — a notion that ranges from, at minimum, co-locating behavioral health services and counselors in primary care settings; to, at best, everyone on staff having greater training and skills to detect and address the mental health and behavioral challenges that may be impacting a patient’s health. And, together as a clinical team, working with patients on "whole person" solutions.

Achieving this level of capacity doesn’t happen overnight, and we discussed why it’s an essential aim on this WIHI. This topic is also the focus of the IHI Collaborative, Optimize Primary Care Teams to Meet Patients' Medical AND Behavioral Needs.  

WIHI: 100 Million Healthier Lives by 2020

Date: ​November 20, 2014

Featuring:

• Soma Stout, MD, MS, Executive External Lead for Health Improvement, Institute for Healthcare Improvement (IHI)
• Erin Healy, JD, Director, Knowledge Sharing, Community Solutions
• Kevin Barnett, DrPH, MCP, Senior Investigator, Public Health Institute
• Ninon Lewis, MS, Director, Triple Aim for Populations, IHI

When IHI first introduced the framework of the Triple Aim in 2008, we couldn’t have imagined how much it would resonate with health and health care improvers all over the world. Six years and much on the ground experience later, this pursuit of better experience of care, better health, and lower costs, is taking a new, exciting turn.

The Guiding Coalition was launched this October by IHI and some 30 founding partners with the goal of making a demonstrable improvement in the health of communities on a global scale…starting in the US. One of the driving principles behind the effort — which over 200 individuals and organizations from across public health, community health, health care, policy, and more have already signed on to — is to learn from and support community innovations and initiatives that are right now having an impact on people’s health. Millions stand to gain if what’s effective is better understood and spread.

But how does change of this sort happen in measurable ways…especially to achieve the goal of improving the health of 100 million people over the next five years? And, how can hospitals and health care organizations not just say they want to support and strengthen community efforts around health, but actually become part of the fabric and infrastructure and two-way learning that makes it possible? That's where we picked up on this WIHI.

WIHI: Optimizing Safety with the Electronic Health Record: The Latest on Glitches and Fixes from the Frontlines

Date: November 6, 2014

Featuring:

• David Classen, MD, CMIO, Pascal Metrics; Associate Professor of Medicine and Consultant in Infectious Diseases, University of Utah School of Medicine
• Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement
• Ann Bisantz, PhD, Professor and Chair, Industrial and Systems Engineering, University at Buffalo, The State University of New York

As the implementation of electronic health records (EHR) increases across healthcare, so has awareness of new patient safety risks that the technology has either introduced or exposed.  The very same EHR being counted on to improve communication, safety, and continuity of care across multiple settings and providers turns out to have features that can have the opposite effect. Getting a good handle on where the vulnerabilities lie is the first step toward coming up with solutions.

Some of the most prominent concerns include EHR systems that generate so many online warnings that clinicians and staff complain of “alert fatigue” and have come up with workarounds to avoid them. To save time, practitioners have also developed the habit of updating a patient’s EHR with a lot of copying and pasting, often forwarding medical information that no one has recently reviewed and that may contain inaccuracies. Computer programs that allow doctors to open up and work on multiple electronic patient records at the same time is another accident waiting to happen, according to some. When combined with being interrupted or distracted, it’s not hard to imagine all the mix-ups that can and do occur.

We’re in the middle of a learning curve to ensure the EHR doesn’t bring new harm to patients and facilitates, rather than disrupts, an organization’s reliable processes and patient safety culture.

WIHI: Better Care and Better Value for Hip and Knee Replacement

Date: October 23, 2014
 
Featuring:

• Robert S. Kaplan, MS, PhD, Senior Fellow and Marvin Bower Professor of Leadership Development, Emeritus, Harvard Business School
• Katharine Luther, RN, MPM, Vice President, Institute for Healthcare Improvement
• Catherine Abbott, MSN, RN, Administrator, Performance Improvement, Hackensack University Medical Center
• Jenny Rosengrant, RN, BSN, Orthopedic Nurse Navigator, Moses Taylor Hospital

Hips and knees are replaced in record numbers these days and these frequent procedures have comparatively low rates of harm and complications, bringing new scrutiny of performance and opportunities for improvement.

Public and private payers have begun targeting joint replacement for bundled payments and reimbursement tied to the quality of care, looking to include patient-reported outcomes. Health care providers who perform a lot of joint replacements have already been preparing to meet these new challenges. They’ve realized that there are multiple ways to improve the care experience for patients and save everyone money. For instance, reducing the amount of time patients spend in the hospital and setting up good supports for rehab at home can have a big impact on costs and how quickly people recover.

We covered some terrific innovations and “aha” discoveries on this WIHI. Robert Kaplan from the Harvard Business School explains the Time-Driven Activity-Based Costing (TDABC), a powerful way to capture and analyze every step and cost of the joint replacement process. IHI has been working with some 32 hip and knee replacement providers over the past year on TDABC and subsequent improvements as part of the IHI Joint Replacement Learning Community. We learn about them and their exciting work on this episode of WIHI.

WIHI: Mental Health Care in the Hospital: Preventing Harm, Promoting Safety

Date: ​October 9, 2014

Featuring:

• Kelly McCutcheon Adams, LICSW, Director, Institute for Healthcare Improvement
• Anna Roth, RN, MS, MPH, CEO, Contra Costa Regional Medical Center & Health Centers
• Teresa Pasquini, Mom/Advocate, Chair, Behavioral Healthcare Partnership, Contra Costa Regional Medical Center and Health Centers
• James F. O’Dea, PhD, MBA, Regional Director, Hartford Healthcare Behavioral Health Network
• Richard Wohl, MSW, MBA, President, Princeton House Behavioral Health; Senior Vice President, Princeton Healthcare System

With all the discussion going on about the integration of behavioral health with primary care in the outpatient setting, we don’t want to ignore what’s happening in the hospital for patients with psychiatric conditions and needs. Safety has been one of the major issues identified in recent years… safety for individuals in crisis, for the staff caring for them, and for family members. Those who’ve identified effective improvements are often the patients themselves.

We ventured into the acute care setting for this WIHI. IHI’s Kelly McCutcheon Adams set the scene for a terrific panel of guests who are working hard on partnering with patients and families to improve their overall experience in the hospital; the prevention of patient harm and staff injuries; the redesign of physical environments; better management of medications; and heading off crises in the making. 

 

Contra Costa’s Anna Roth and parent Teresa Pasquini shared a powerful story about collaboration, starting with transforming the experience of the psychiatric emergency. Richard Wohl from Princeton House Behavioral Health shared what goes into creating a state of the art, safe, inpatient facility and environment for patients in need of psychiatric hospitalization. The features and attributes will resonate with many. James O’Dea from Hartford Healthcare Behavioral Health Network described the “the three-legged stool” that frames his team’s improvement work, and new efforts to get further upstream with patients to help avoid the need for sudden trips to the ED and the hospital.

WIHI: From Here to CLER: Graduate Medical Education and the Clinical Learning Environment Review (CLER)

Date: September 24, 2014

Featuring:

• Kevin B. Weiss, MD, MPH, Senior Vice President, Institutional Accreditation, Accreditation Council for Graduate Medical Education (ACGME)
• Robin Wagner, RN, MHSA, Vice President, Clinical Learning Environment Review, ACGME
• Maren Batalden, MD, Medical Director of Hospital Quality, Associate Director of Graduate Medical Education for Quality and Safety, Cambridge Health Alliance (CHA)
• James Moses, MD, MPH, Medical Director of Quality Improvement, Boston Medical Center; Academic Advisor, IHI Open School for Health Professions

Whether or not you are directly involved in graduate medical education (GME), its priorities have implications for all of health care.

A new Institute of Medicine (IOM) report released over the summer has reignited debate and discussion about the financing and goals of GME in the US. Given that Medicare is the primary funder, to the tune of $15 billion per year, the report’s authors call for greater accountability for all the government support, along with a change in priorities. For example, the IOM committee points to a disconnect between what the health care system desperately needs right now — more cost-conscious doctors capable of improving patient care, managing population health, and committed to primary care — and residency programs that remain overwhelmingly hospital-based and focused on medical specialties.

 

This is not the first time we’ve heard calls to reform GME, or the first time we’ve seen efforts to respond by the accrediting body itself, the Accreditation Council for Graduate Medical Education (ACGME). They’re in the midst of rolling out a new set of residency training expectations that are more aligned with delivering value and helping patients achieve optimal health. The program is called the Clinical Learning Environment Review.

 

Learn from our panel of experts as we explored the goals of CLER and the specific ways residents are being asked to contribute to patient safety, quality improvement, care transitions, supervision, duty management, and professionalism.

WIHI: Tread Water No More! Making Sense of Patient Experience Data

Date: September 11, 2014

Featuring:

• Kevin Little, PhD, Improvement Advisor, Institute for Healthcare Improvement (IHI); Principal, Informing Ecological Design, LLC
• Kristine KS White, RN, BSN, MBA, Faculty, IHI; Principal, Aerate Consulting; Co-founder, Aefina Partners, LLC
• Kathy Klock, Senior Vice President, Human Resources & Clinical Support Services, Gundersen Health System
• James Bonner, LMSW, Director of Patient Experience, Spectrum Health

Have you been poring over some patient survey or patient experience data lately? Chances are good you have. How did you make sense of what you saw? What actions are you taking as a result of what you learned? Not sure? Unclear what to make of the information or what to do with it? You are not alone! In fact, as the ways to learn about how patients experience their care and their caregivers have grown, so has the confusion about how to interpret the data and how to make the best use of it.

We invited Kris White and Kevin Little to lead the discussion, both of whom are determined to pull listeners out of whatever morass of patient-generated information they might be drowning in. Kathy Klock from Gundersen Health System and James Bonner from Spectrum Health joined to discuss how their organizations are successfully navigating the patient experience data waters.

 

Learn about a terrific set of guiding principles for appreciating and distinguishing among the wide range of methods health care organizations are using to decipher patient experience data and the comprehensive picture that emerges from patient surveys, focus groups, patient and family advisory councils, and much more. 

WIHI: Preventing Financial Harm to Patients: The Costs of Care Initiative

Date: August 21, 2014

Featuring:

• Neel Shah, MD, MPP, Founder and Executive Director, Costs of Care
• September Wallingford, RN, MSN, Brigham and Women’s Hospital; Director for Nursing Advocacy, Costs of Care
• Christopher Moriates, MD, Assistant Clinical Professor, UCSF; Director, Center for Healthcare Value’s “Caring Wisely"; Director of Implementation Initiatives, Costs of Care​
• Michele Rhee, Director of Program Initiatives, National Brain Tumor Society; Director of Strategic Initiatives, Costs of Care

It's an all-too-familiar scenario: a doctor mapping out next steps at a medical appointment — perhaps prescribing new medications or ordering some tests —oblivious to the costs, including whether the patient might bear the brunt of them.  Some now consider this a form of harm that physicians, nurses, and others need to become more conscious of and do everything possible to prevent. That’s why we hope you’ll listen to this WIHI, where our guests discuss an innovative effort in the US to help caregivers make more high-value decisions that can protect patients from unnecessary care and expenses.

Fortunately, more providers today appreciate that they have a role to play in reducing overall health care costs in the US — especially when entrenched habits and “business as usual” lead to ordering a lot of procedures of questionable value. But it’s newer to translate this awareness into honest discussions with patients about treatment options in the context of their specific medical benefits and any financial concerns. Doing this in a way that does not compromise care, proponents argue, is both essential and possible.
 
Asking doctors and nurses to become more accountable for the financial burdens they may be unwittingly imposing on their patients has been the work of Dr. Neel Shah, the founder of Costs of Care. Dr. Shah and the assembled panel for the August 21 WIHI walked us through the many ways patients and their caregivers can both become more cost-conscious and, together, make better decisions. It’s a different kind of partnership that, on the one hand, can ensure that recommended care is followed and feasible; and on the other hand, could prevent someone from medical bankruptcy.