WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Working Toward Health Equity

Date: February 13, 2014

Featuring:

• Tessa Kerby, MPH, Manager, Measurement and Organizational Improvement, HealthPartners
• Yvonne Coghill, OBE, Senior Program Lead – Inclusion and Coaching, NHS Leadership Academy
• Dave Johnson, MBA, Regional Clinic Director in Primary Care, HealthPartners Medical Group
• Donald A. Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement
• Andrew Loehrer, MD, General Surgery Resident, Massachusetts General Hospital

In theory, quality improvement has the built-in capacity to reduce health care disparities and bridge gaps in outcomes and in the experience of care across race and ethnicity. After all, if you’re reliably implementing proven and effective care processes for patients suffering a heart attack, or having a stroke, or dealing with depression, or struggling with obesity, shouldn’t these interventions lift all boats? Would that it were that simple. Decades of research on health care disparities continue to point out how entrenched the problems are and how often even the most well-intentioned efforts miss the mark. However, we’re also now learning that where health care equity across race and ethnicity has improved, strategies have been truly pressure-tested and are multi-faceted.
 
What are some of these strategies, and what kinds of fresh thinking underpin them? Please listen to this WIHI on Working Toward Health Equity, to hear about progress that’s being made to reduce health disparities in ways that everyone can learn from. At HealthPartners, innovative and deliberate processes are dramatically closing gaps between white patients and patients of color undergoing breast and colorectal cancer screenings. Dr. Andrew Loehrer and colleagues are documenting powerful connections between insurance coverage and more equal access to certain surgeries. Yvonne Coghill and others at the NHS are demonstrating the critical need for a diverse workforce and, as important, making sure that diverse workforce is treated equitably and fairly. This, by any measure, helps ensure that all patients are treated fairly, too.  

 

IHI’s Dr. Don Goldmann joined our conversation to talk about how we move from an era of mountains of crucial and valuable research documenting lack of equity and health care disparities, to one that is solutions-focused and anchored by cultural competency in word and deed.

WIHI: SBAR: Structured Communication and Psychological Safety in Health Care

Date: January 30, 2014

Featuring:

• Michael Leonard, MD, Safe & Reliable Healthcare LLC; Adjunct Professor of Medicine, Duke University School of Medicine
• Audrey Lyndon, PhD, RNC, CNS-BC, FAAN, Associate Professor, UCSF School of Nursing
• Jill Morgan, BSN, MBA, NE-BC,Nurse Manager, ICU, UnityPoint Health – St. Luke’s Hospital
• Ansley Stone, OB Quality Coordinator, Carolinas HealthCare System

A few key concepts are ubiquitous in the world of health care improvement, and one of them is most definitely SBAR, an acronym for Situation-Background-Assessment-Recommendation. We have the Navy to thank and Kaiser Permanente’s Doug Bonacum and Suzanne Graham, along with Dr. Michael Leonard, for migrating this structured communication framework into the world of health care more than a decade ago. At its core, SBAR is a way for health professionals to effectively and succinctly convey critical information to one another to protect patient safety. Over time, SBAR has proven useful in a myriad of other ways as well. Still, how might we evaluate the utility of SBAR to advance today’s quality improvement and patient safety challenges? Has its singular power to “cut to the chase”  eroded over time? These questions and more are discussed on this WIHI.

The good news about SBAR is that it’s become part of broader ambitions around safety and reliability in many organizations. But, as we’ll learn from Michael Leonard and Audrey Lyndon, folding SBAR into a larger agenda can mask weaknesses that have crept in with the tool itself. For instance, nurses may have an easier time speaking “up the medical chain of command” using SBAR, but Lyndon says many still struggle with making clear recommendations… the R part. And it’s not always clear if those on the receiving end of structured communication listen effectively. Lyndon suggests there may be a need for a corollary tool to confirm “message received.”

Jill Morgan and Ansley Stone are nursing and quality leaders who can’t imagine health care today without SBAR. They point to the critical role that SBAR plays in ensuring safe care for pregnant women undergoing labor and delivery, and in drawing attention to any patient or staff situation that requires immediate attention and decision making. What’s your experience with SBAR? How might it be strengthened for safety work over the next ten years? How can SBAR become a solid communication tool for improved handoffs or enhance newer processes, such as daily safety huddles, to achieve what Michael Leonard calls “psychological safety” among all staff? Listen to the rich discussion with WIHI Host Madge Kaplan and guests.

WIHI: Violence Prevention and Community Health

Date: January 16, 2014

Featuring:

• Gilbert Salinas, MPA, Director of Patient and Community Relations, Rancho los Amigos National Rehabilitation Center, Kaiser Safety Net Fellow, Institute for Healthcare Improvement
• Thea James, MD, Emergency Medicine, Boston Medical Center; Director, Violence Intervention Advocacy Program
• Rachel A. Davis, Managing Director, Prevention Institute
• Kaile Shilling, Coalition Director, Violence Prevention Coalition (Los Angeles)

We’ve just come through a holiday season that’s bitter sweet for some — including families that have lost a loved one because of gun violence. Some incidents garner headlines more than others, due to the sheer magnitude of what’s transpired, the ages of the victims, the incredible shock to an otherwise quiet day in a quiet neighborhood, and the tragic consequences. For those in the trenches of working to reduce gun violence day to day — more often in communities and in health care systems all too familiar with gun-related deaths and injuries — every event stands out and has a story behind it.

How can health care organizations, the very ones that often receive the victims through the doors of their EDs, be more effective partners and leaders further upstream? How can gun violence prevention become part of emerging strategies to encompass and focus on better population health? The January 16, 2014, WIHI: Violence Prevention and Community Health is going to highlight some exemplar thinking and initiatives now gaining traction, that everyone can learn from.

Rachel Davis and Kaile Shilling each have their finger on the pulse of multiple efforts and coalitions that are right now taking a comprehensive preventive, public, and population health approach to reducing violence of all sorts. Dr. Thea James is responsible for close to a decade’s worth of pioneering work at Boston Medical Center that’s spread nationally, to help youth adopt better responses to high-risk situations, and to help medical staff deliver “trauma-informed care.” Gilbert Salinas, currently a Kaiser Permanente Safety Net Fellow at IHI, has garnered national attention for his work in Los Angeles, and with former Surgeon General David Satcher on a seminal 2001 “Report on Youth Violence.” Gilbert will also discuss a hospital-based intervention program he’s helped nurture, known as “Caught in the Crossfire.”

WIHI host Madge Kaplan talks with panelists, who offer a lot of great, actionable ideas for preventing and reducing gun violence.

WIHI: Patients as Partners in QI Research

Improvement Research Meets Patient Experience: Can Applying the Science of Improvement Accelerate Patient-Centered Outcomes?

Recorded live at the 19th Annual Scientific Symposium on Improving the Quality and Value of Health Care in Orlando, Florida

Date: December 9, 2013

Moderator: Madge Kaplan, Director of Communications, Institute for Healthcare Improvement

Panelists:

• Christian Farman, RN, Ryhov County Hospital, Sweden
• Peter Margolis, MD, PhD, Professor of Pediatrics, Director of Research, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, OH
• Libby Hoy, Founder, Patient and Family Centered Care Partners, CA

A key development in person- and family-centered care is the growing opportunity for patients to collaborate with improvement scientists on research designed to impact patient experience. No longer just an idea, the ways in which this partnership is currently being explored — and what can make it more possible — was the focus of a panel at the 19th Annual Scientific Symposium on Improving the Quality and Value of Health Care. The Symposium was held on December 9, alongside the 25th Annual IHI National Forum on Quality Improvement in Health Care.

Peter Margolis, Christian Farman, and Libby Hoy bring unique and complementary perspectives to the roles that patients and families might play, including being part of research funding proposals right from the start. The US government’s Agency for Healthcare Research & Quality (AHRQ) and Patient-Centered Outcomes Research Institute (PCORI) have begun to institute this level of inclusion as a requirement for some of their grants. The good news is that skilled and active patient and family advisors, now working with researchers, are able to share what a true collaboration looks like.

We hope you find this Special Edition WIHI Podcast interesting and helpful as you move forward with your work. Tell a colleague about this podcast, too!

WIHI: New Leadership Skills for Better Health and Health Care

Date: November 21, 2013

Featuring:  

• Gary R. Yates, MD, President, Sentara Quality Care Network; former Senior Vice President and Chief Medical Officer, Sentara Healthcare
• Lee Sacks, MD, Executive Vice President & Chief Medical Officer, Advocate Health Care; Chief Executive Officer, Advocate Physician Partners
• Derek Feeley, Executive Vice President, Institute for Healthcare Improvement
• Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement

IHI has been doing a lot of thinking of late about leaders and leadership… in particular the skills, behaviors, and outlook necessary to steer today's health care organizations toward a very different future. A new IHI white paper (working title: High-Impact Leadership) will be out before the end of the year that captures this complex transition. Among other things, it offers a new framework for leaders who are not just responsible for making change manageable, but enthusiastically supported by all staff. You can get an early look at the new leadership framework on the Nov. 21 WIHI: New Leadership Skills for Better Health and Health Care. One of the goals of this WIHI is to clarify the relationship between the growing focus on population health and the shift from volume to value, and the corresponding leadership skills required to address these challenges.

At Advocate Health Care, Dr. Lee Sacks has been hard at work learning by doing, with the help of other physician leaders. He explains in concrete terms what his team’s leadership practices look like day to day, including those needed to lead an Accountable Care Organization (ACO). Sentara’s Dr. Gary Yates spent his time on WIHI outlining key leadership behaviors that signal to staff how change is going to come about and what’s expected of everyone. If leaders want to alter the perception that they alone have all the answers, hashed out in some corner office, they must become a regular, approachable, and authentic presence throughout the organization. Discussions in the hallways talking with staff, and learning from patients and patient stories, need to become the norm.
 
Fresh from his NHS Scotland leadership perch, IHI’s Derek Feeley has been thinking hard about what’s applicable and relevant to the US context and in many other countries seeking better health for their citizens. He, along with Andrea Kabcenell, discuss how leaders can better manage and prioritize all the tasks necessary to succeed.

WIHI: Improving Safety and Satisfaction in Ambulatory Care

Date: ​​November 7, 2013

Featuring:

• Gordon Schiff, MD, Associate Director, Brigham Center for Patient Safety Research and Practice, Brigham and Women's Hospital
• Nicholas Leydon, MPH, Director, PROMISES Project, Massachusetts Department of Public Health
• Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement (IHI)
• Damian Folch, MD, Family Practice and Lifestyle Medicine (Chelmsford, MA)

We don’t typically associate the ambulatory care setting with serious lapses in quality that threaten patient safety. Much of the improvement in recent years targeting outpatient care has focused on access, waiting times, communication, and coordination of care. But these areas ripe for change have often obscured others that, if not handled well, can have even more dire consequences: the ordering of tests, the timely handling and communication of results, and the overall process of making a diagnosis in response to a patient’s symptoms or complaints, including making referrals to specialists.

This WIHI explores what’s been learned from a three-year initiative known as PROMISES, charged with reducing malpractice risk in the ambulatory setting by making care safer, more efficient, and more reliable.

The WIHI panel will be headed up by the lead researcher for PROMISES, Dr. Gordon Schiff, who’s also the lead author of a recently published article in JAMA Internal Medicine ("Primary Care Closed Claims Experience of Massachusetts Malpractice Insurers") that found that the lion’s share of malpractice claims in Massachusetts primary care practices relate to allegations of misdiagnosis stemming, in part, from dropped balls with test results. This finding matches national trends, which is why the work of PROMISES, centered on making improvements at 16 sites, should resonate with many.

Dr. Damian Folch worked on improvements at his practice in Chelmsford, MA, and he and other sites were coached by Improvement Advisors, including Nicholas Leydon. Because it’s rarely a matter of one thing that’s been missed or that can go wrong, IHI’s Frank Federico will help us understand why a systems approach is critical to managing the many things that transpire in the ambulatory setting, including careful tracking of prescribed medications.

This WIHI promises to be rich with results and real-world experience, and it will offer you ways to get involved to help shape and spread further change. Could your team use a PROMISES Patient Safety Curriculum? Would you like to explore becoming a Primary Care Patient Safety Innovator? Listen to the discussion on this WIHI.

WIHI: Who’s Conversation Ready? How Health Care Can Respect End-of-Life Wishes

Date: October 24, 2013

Featuring:

• Kelly McCutcheon Adams, LICSW, Director, Institute for Healthcare Improvement
• Lauge Sokol-Hessner, MD, Attending Physician, Beth Israel Deaconess Medical Center (BIDMC)
• Kate Lally, MD, Medical Director of Palliative Care, Kent Hospital and Medical Director, VNA of Care New England
• Donna L. Smith, MD, MBA, Medical Director of Virginia Mason Clinics at Virginia Mason Medical Center

 
For over a year, building on others’ great work, IHI has been engaged in two groundbreaking initiatives to reduce the confusion and improve the circumstances that surround end-of-life care for most Americans in the US. The Conversation Project, founded in collaboration with IHI, is a grassroots effort to encourage and enable every one of us to discuss our wishes regarding end-of-life care with our friends and loved ones, long before there’s a medical crisis. The second initiative, Conversation Ready, is designed to capture the ways in which health care organizations can effectively respect and respond to these wishes. Ten organizations have been working with IHI to share and refine their best practices, and this WIHI checks in on what they’ve learned so far. 

Three clinical leaders from notable health care systems were on hand for this WIHI, along with IHI’s Kelly McCutcheon Adams. You’ll hear about an effort underway at BIDMC to embed a system of “4 Rs” into all patient engagements: Reaching out to learn a patient’s end-of-life preferences and values, followed by processes to Record and reliably Retrieve and Respect the information. Care New England has a number of innovations underway, including the designation of a “conversation nurse” who ensures that the goals of patients and families stay at the forefront of all end-life decision making. At Virginia Mason Medical Center in Seattle, the electronic medical record is becoming an effective home base for important and visible information about preferences regarding end-of-life care.

WIHI: New Staffing Models for Primary Care

Date: October 10, 2013

Featuring:​

• Ed Wagner, MD, MPH, MACP, Director Emeritus, MacColl Center for Health Care Innovation, Group Health Research Institute
• Trissa Torres, MD, MSPH, FACPM, Senior Vice President, Institute for Healthcare Improvement
• Kirsten Meisinger, MD, Medical Director, Union Square Family Health Center, Cambridge Health Alliance
• Thad Schilling, MD, Medical Director, Patient-Centered Medical Home, Harvard Vanguard Medical Associates-Medford (MA)
   

What does it take to be a high-functioning primary care practice today in the US? Some 30 sites of all shapes and sizes are in the midst of being studied in hopes of answering this very question. The Robert Wood Johnson Foundation and the MacColl Center for Health Care Innovation selected these practices because of their exemplary and innovative staffing models. Figuring out the best ways to delegate  responsibilities and work as a team is one of the central needs for all primary care providers today, and midway through the project  known as LEAP (Learning from Effective Ambulatory Practices) WIHI will get a look at the success factors that LEAP has identified thus far. 

Dr. Ed Wagner of the MacColl Center is LEAP’s Project Director (along with Margaret Flinter, APRN, Phd) and he’ll be heading up the discussion on the October 10 WIHI: New Staffing Models for Primary Care. Dr. Wagner developed the Chronic Care Model, which was groundbreaking for office practices in the late 1990s and remains foundational to the creation of patient-centered medical homes today. Changing how providers and staff both divide up the work and share responsibility for every patient is a critical part of this transformation, and Drs. Kirsten Meisinger and Thad Schilling will use their time on this WIHI to share what they’ve been doing that’s earning their sites accolades and, most importantly, achieving better results.

IHI’s Trissa Torres is no stranger to primary care transformation. Prior to joining IHI, Dr. Torres helped pioneer new care models for the Genesys Health System in Michigan and developed the concept and role of “Health Navigators” to help patients build upon an office visit and identify further support in the community. We hope you will listen!

WIHI: Recognizing Person- and Family-Centered Care: Always Events at IHI

Date: September 26, 2013

Featuring:

• Pat Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement (IHI)
• Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement (IHI)
• Kristina Andersen, BSN, RN, SMART Discharge Project Coordinator, Anne Arundel Medical Center
• Cherry R. Shogren, MSN, RN, Director of Clinical Professional Development, UnityPoint Health (Des Moines, Iowa)

We have the Picker Institute to thank for some of our earliest understandings of patient-centered care. Besides coining the phrase itself, Picker was among the first to hold health care accountable for its actions according to principles such as listening to patients, respecting their knowledge and emotional needs, welcoming family and friends into the decision process, and more. To better learn what’s possible and measurable, in 2010 Picker developed Always Events — a set of reliable practices that should happen for all patients, all the time — and a recognition program to spotlight organizations committed to this level of transformation.

Picker handed over the reins of Always Events to IHI in January 2013, and now IHI is set to re-launch the program. You can get a first look at what’s in store on this WIHI. Martha Hayward and Barbara Balik have been hard at work developing guidelines that pick up where Picker’s efforts left off, in hopes of jumpstarting many more innovative approaches to patient engagement worthy of recognition. The SMART Discharge Protocol at Anne Arundel Medical Center in Annapolis, Maryland, is a strong example of the type of stand-out work IHI will be looking for. Kristina Andersen, the project’s lead, will be on hand to explain its components and the impact a better discharge process is having on emergency department use and readmissions.

What’s now thought of as patient- and family-centered care, or person- and family-centered care, continues to be a work in progress, as does better understanding of the impact patient engagement has on outcomes, safety, reducing waste, and overall quality across the continuum of care. The only way to pinpoint what’s most effective is to get involved in the work itself. That’s the spirit behind the re-launch of Always Events at IHI, and we hope you’ll listen to this WIHI and take part in the initiative.

 

WIHI: On the (Virtual) Road with Mobile Clinics and Population Health

Date: September 12, 2013

Featuring:

• Nancy Oriol, MD, Dean of Students, Harvard Medical School; Co-Principal Investigator, Mobile Health Map; Co-Founder, Family Van, Boston, MA
• Leonel Lacayo, MD, Gastroenterologist, Glenwood Hospital; Co-Founder, Health Hut, Ruston, LA
• Anthony Vavasis, MD, Director of Medicine, Callen-Lorde Community Health Center, New York City, NY; Co-Principal Investigator, Mobile Health Map; Board Chair, Mobile Health Clinics Association
• Jennifer Bennet, BA, Executive Director, Family Van and Mobile Health Map
• Niñon Lewis, MS, Director, Triple Aim Initiatives, Institute for Healthcare Improvement, Cambridge, MA

 
What’s the first thing that comes to mind when you spot a mobile health clinic? Good
people, probably volunteering their time, traveling to underserved neighborhoods to offer screenings, health education, and some helpful, friendly guidance on where to go for anything more serious or chronic that should be checked out? If this is your impression, it’s fairly accurate. Except for one thing. Nowadays, more and more mobile health vans are an integral part of the health care system… especially in cities and communities where traditional bricks-and-mortar health care services are linking up with innovative community outreach programs that, together, can better manage population health.

With that as a backdrop, we hit the (virtual) road with some of the leading innovators and researchers who are injecting new fuel and purpose into more than 2,000 mobile health clinics across the US. They’re doing this by mapping what’s taking place at a range of health clinics mounted on wheels, and also by carefully investigating health issues that can be impacted and maybe even better addressed by a mobile health van. 

If we’re serious about improving population health, it’s critical to look hard at what’s
already “out there” that’s working or helping, and then determine how to strengthen its role. Mobile health clinics are increasingly one such trusted and effective resource in many communities. WIHI host Madge Kaplan and IHI’s Ninon Lewis invite you to find out the latest on mobile clinics from an expert panel of clinicians and researchers on the forefront of the issue.