WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Family Caregiving, Caregivers, and Compassion

Date: October 5, 2011​

Featuring:

• Arthur Kleinman, MD, Esther and Sidney Rabb Professor of Anthropology, Professor of Medical Anthropology, Professor of Psychiatry, William Fung Director: Harvard University, Harvard Medical School, Harvard University Asia Center
• Jeremy Boal, MD, Chief Medical Officer, North Shore–LIJ Health System; Professor of Medicine, Hofstra North Shore–LIJ School of Medicine
• Dana R. Lustbader MD, FCCM, FCCP, FAAHPM, Section Head, Palliative Medicine, North Shore–Long Island Jewish Medical Center; Program Director, Palliative Medicine Fellowship, North Shore–LIJ; founding Director, Palliative Care Unit, North Shore University Hospital; Assistant Medical Director, New York Organ Donor Network  
• Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement

When we talk about caring for loved ones with serious illness, we usually focus on the problems and challenges most of all. And that makes sense. There is nothing easy or simple about family caregiving, and when it’s required of spouses and grown children the burdens can be especially high. Still, when you hear Arthur Kleinman describe what it was like to take care of his wife before she died, the words that jump out are honor, respect, and love ― even in the midst of grief, fatigue, and loneliness.

Kleinman, a psychiatrist and medical anthropologist, discovered that caregiving could be transformative, especially the further away he got from the fast-paced, high-tech world of cure and intervention that characterize so much of health care today. But there doesn’t have to be such a divide ― not if health care providers can become more comfortable talking with patients and families about serious illness, more familiar with the benefits of palliative and end-of-life care, and more capable of appreciating the power of compassion.

This WIHI discusses the very human “call to action” that family caregiving poses for all of health care today. WIHI host Madge Kaplan talks with Arthur Kleinman, two physicians from North Shore-Long Island Jewish (NSLIJ) Health System ― Chief Medical Officer Jeremy Boal and Intensivist and Palliative Care program director Dana Lustbader ― and IHI Vice President Andrea Kabcenell. In partnership with the Institute for Healthcare Improvement, NSLIJ is on the cusp of bringing a great deal more expertise and knowledge to bear on how their 15 hospitals, long-term care facilities, and home health agencies can better respond to and support patients and families facing serious illness. This is a perfect moment and opportunity to engage with this team in shared learning.

As Arthur Kleinman told The New York Times: “There is a moral task of caregiving, and that involves just being there, being with that person and being committed. When there is nothing that can be done, we have to be able to say, ‘Look, I’m with you in this experience. Right through to the end of it.’ ”

 

WIHI: Managing Medication Shortage: Best Practices for a Crisis

Date: September 22, 2011

Featuring:

• Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement​
• Michael R. Cohen, RPh, MS, ScD, FASHP, President, Institute for Safe Medication Practices
• Lynn Eschenbacher, PharmD, MBA, Assistant Director of Clinical Services and Director PGY-1 Pharmacy Residency Program, WakeMed Health and Hospitals

 

Medication safety has gotten a lot more challenging in the past year or so, due to circumstances health care providers can’t typically predict or control: a growing, critical shortage of prescription drugs, hundreds of them, including mainstay generics hospitals use to treat several forms of cancer.  News organizations have begun to pay attention to the trend because of the tough decisions providers and patients now face when preferred treatments for certain types of aggressive leukemia or testicular cancer aren’t available.

A recent story on The PBS NewsHour offers one of the more comprehensive looks at the underlying industry practices, product decisions, and manufacturing problems that have led to the crisis—a crisis that’s enabled a gray market to now traffic in scarce supplies of certain drugs in order to offer them for sale at astronomically higher prices. 

Against this backdrop, and while policy makers, members of Congress, and the US Food and Drug Administration seek both short-term and longer-term solutions, hospitals have no choice but to develop strategies and best practices that assume, for now, prescription drug shortages. WIHI host Madge Kaplan welcomes three people who have their fingers on the pulse of what’s going on and are actively working to help organizations effectively manage a complex situation. IHI’s Frank Federico, the ISMP’s Michael Cohen, and WakeMed’s Lynn Eschenbacher are three pharmacy-trained improvers who’ve tapped their expertise on medication safety to come up with new strategies that can enable hospital staff to stay on top of the fast-moving drug shortage problem on a daily basis. Learn how Lynn Eschenbacher’s hospital system in particular is effectively dealing with the crisis. 
 
Additional information:

• Read an article in Healthcare Executive about the drug shortages, written by Frank Federico, Bona Benjamin, and Michael Cohen.
• We’d also draw your attention to a Premier healthcare alliance analysis of the gray market, which provides critical facts and guidance for hospital pharmacists and staff who purchase prescriptions.

WIHI: Always Events: Raising Expectations for Patient Experience​

Date: September 8, 2011

Featuring:

• Lucile O. Hanscom, Executive Director, Picker Institute
• Dale Shaller, MPA, Principal, Shaller Consulting Group
• Martha Hayward, Lead for Public-Patient Engagement, Institute for Healthcare Improvement
• Gaye Smith, Chief Patient Experience and Service Officer, Vanderbilt University Medical Center
• Anthony M. DiGioia, MD, Founder, The Orthopaedic Program and Innovation Center, Magee-Womens Hospital of UPMC

Most of us are familiar with the National Quality Forum’s list of Serious Reportable Events in health care — often referred to as “Never Events.” There’s a wide consensus that everything from performing surgery on the wrong patient or wrong site, to a medication error-induced death, to a physical assault aren’t only tragic and harmful, they are not supposed to happen. Period. It’s a strong statement about patient safety and what the system as a whole should not be willing to tolerate. And, by extension, it’s a call to action to do better and to take care of patients differently so that terrible things do not occur.  

There are, of course, many ways to draw a line in the sand or to envision the health care system patients deserve and that providers want to work in. One of the most innovative in the last few years has been the Picker Institute’s development of a concept they’ve dubbed “Always Events^®.” First conceived in 2009, Always Events^®are activities and processes that should routinely be part of patient care and the patient and family experience, to ensure optimal communication, discharge, handoffs, transitions, health literacy, and more.

WIHI welcomes the Picker Institute’s Executive Director, Lucile Hanscom; consultant Dale Shaller, who has an extensive history developing benchmarks and measurement systems for patient-centered care; Martha Hayward, who has been working with IHI to help shape public and patient engagement, drawing on her own history as a patient and as a strong and effective leader in Massachusetts; and dynamic leaders from two organizations that have received Always Events Challenge Grants: Gaye Smith of Vanderbilt University Medical Center and Tony DiGioia of the University of Pittsburgh Medical Center (UPMC).

Dr. DiGioia’s groundbreaking improvements at UPMC are anchored in a first of its kind patient- and family-centered methodology. Picker’s support is helping to integrate these processes into the hospital’s transplant program. The grant-funded work at Vanderbilt, under Gaye Smith, is targeting better communication and collaboration between patients, family members, and providers to prevent patient falls during hospital stays.

WIHI: Payment Reform As We Speak

Date: July 21, 2011

Featuring:

• Stuart H. Altman, PhD, Sol C. Chaikin Professor of National Health Policy and former Dean of The Heller School for Social Policy and Management, Brandeis University
• Jeffrey Selberg, MHA, Executive Vice President and Chief Operating Office, Institute for Healthcare Improvement

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What's the value of value-based purchasing? This is the term used for a new initiative of the Centers for Medicare and Medicaid Services (CMS) that is perhaps the government’s boldest move yet to tie hospital reimbursement to quality, focused initially on 13 measures, including patient satisfaction. The intent is pretty clear, but how likely is it that the new “carrot,” in the form of bonus payments starting in October 2012, will accelerate better patient care and usher in a new day of financial expectations?

IHI’s Jeff Selberg says the answer isn’t clear BUT, as a former hospital executive, he can’t imagine sitting on his hands waiting to see how things will play out. In other words, to Jeff, the handwriting is on the wall, and depending on how hospital leaders react, the money is either on the table or eventually being taken off the table and…most importantly, it’s not going to be put back. There is just no viable future, he says, for a health care system that’s hospital-centric, episode-centric, and procedure-centric. And it’s not just CMS that’s throwing down the gauntlet. So are employers and private insurers. The good news is that some health care providers are getting the message; Selberg hopes we can all learn from their example.

Stuart Altman doesn’t disagree. But the seasoned health care economist has been around too long, and in and out of government often enough, to know how hard it is to forge policy and payment reforms of the CMS value-based sort. Decades of doing things differently is a hard habit to break. On the other hand, like Jeff, Stuart wouldn’t advise hospitals to sit this one out, and he worries about serious unintended consequences for patients if the hospital system doesn’t develop new business models built upon delivering high quality most of all.

WIHI host Madge Kaplan welcomes Stuart Altman and Jeff Selberg for an interesting discussion.

WIHI: Improving Health Care: The Global View

Date: July 7, 2011

Featuring:

• Lord Nigel Crisp, Strategic Advisor on Global Health and Senior Fellow, Institute for Healthcare Improvement; Author, Turning the World Upside Down: The Search for Global Health in the 21st Century
• Pierre Barker, MD, Senior Vice President for IHI improvement initiatives in South Africa, Ghana, Malawi, and India
• Pedro Delgado, MSc, Executive Director for IHI large-scale health system improvement efforts in Europe and Latin America

Health care improvers in the US have so much on their plates these days, it can seem like a luxury to focus on what’s happening in other countries. That’s unfortunate because health care improvement has become a global endeavor, and nations of all sizes and stages of development are confronting strikingly similar issues.

These include how to care for aging populations, how to give individuals the tools to be shared decision makers and managers of their chronic conditions, and how to design systems that optimize communication and coordination across the continuum of care. Also, how to take advantage of the resourcefulness patients and communities themselves bring to the table.

On any given day, improvers on several continents are taking part in collaboratives and applying improvement methods to increase cancer screenings, improve maternal and child health, track the days a hospital’s ICU is infection-free, and more. The riches of new ideas and innovations now come as equally from South Africa as South Carolina… as generously from Jonkoping, Sweden, as Green Bay, Wisconsin.

Lord Nigel Crisp, Dr. Pierre Barker, and Pedro Delgado join WIHI host Madge Kaplan to discuss the maturing work in Ghana and South Africa, new improvement initiatives in Latin America, and what Nigel Crisp meant when he titled his recent book, Turning the World Upside Down.

There isn’t a country, anywhere, that can afford to stand still when it comes to rising health care costs, and this creates a tremendous opening for the international improvement community to demonstrate what’s possible when the focus shifts to quality, safety, and overall population health.

WIHI: New Models for Patients with Multiple Health and Social Needs

Date: June 23, 2011

Featuring:

• Catherine Craig, LMSW, MPA, Director of Health Integration – National Programs, Common Ground
• Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine, New York University School of Medicine
• Geraint Lewis, MA, MSc, FRCP, FFPH, Public Health Physician and Senior Fellow, The Nuffield Trust, UK

There isn’t a health care provider anywhere in the US who hasn’t witnessed the disconnect between a patient with multiple health and social needs and the systems available to help that individual. The gap between what’s needed and what’s available (and what’s paid for) is often staggering. Stories abound of doctors and nurses and social workers painstakingly trying to patch together services that might function as an alternative to the hospital’s emergency department, get a prescription filled, get someone a hot meal… and on it goes. There are communities in the US and other countries that have worked for years to do things better but, wherever you go, patients with multiple illnesses combined with a lot of instability in their lives present challenges far beyond the capability and current design of most health care systems.

Nothing like a challenge! WIHI has been tracking some timely work and research that goes by such exotic names as “predictive modeling” and “virtual wards” — or is as basic as care coordination and supportive housing. WIHI host Madge Kaplan talks with key experts leading the way in these areas to discuss new ways to work with patients to address underlying needs and manage chronic health problems that lessen dependence on expensive health care services. The good news is that wherever new models are being tried, they’re making a real, tangible difference.

Related information to this WIHI program includes a new IHI white paper on innovations in care coordination, co-authored by Catherine Craig, and Atul Gawande’s article, “The Hot Spotters," from the January 2011 New Yorker.

WIHI: Integrity On and Off the Page: A Discussion with JAMA’s (Departing) Editor-in-Chief

Date: June 9, 2011

Featuring:

• Catherine D. DeAngelis, MD, MPH, Editor-in-Chief, Journal of the American Medical Association

 

It's hard to imagine the Journal of the American Medical Association (JAMA) without its editor-in-chief, Cathy DeAngelis, who will be stepping down this July. Since 2000 Dr. DeAngelis, JAMA’s first woman editor, has steered the peer-reviewed publication in important new directions and successfully brought about greater scientific integrity across the medical research and publishing industry. Because of her efforts, as a condition of publication virtually all clinical trials in the US are now listed in a public registry. JAMA won’t consider industry-funded research unless it’s been independently vetted.

 

Dr. DeAngelis’ principled stands, along with her interest in the narrative side of practicing medicine, as well as health policy and reforming the status quo, have all made JAMA more accessible and “required reading” for a broader audience. And her own story — which began in a coal-mining town in northeastern Pennsylvania, and has included nursing, pediatrics, and teaching — is far from over! She is now preparing to return to the Johns Hopkins School of Medicine — this time around to start a Center for Professionalism in Medicine and the Related Professions. 

 

WIHI host Madge Kaplan talks with Dr. DeAngelis, who shares her thoughts about the challenges facing all research scientists today, including those engaged with improvement science, and her passion for maintaining the integrity of taking care of patients.

WIHI: Leading Across the Continuum

Date: May 5, 2011

Featuring:

• Maureen Bisognano, President and CEO, Institute for Healthcare Improvement

The last time WIHI sat down with Maureen Bisognano (September 9, 2010: "Leaders Never Stop Learning") she was newly ensconced as the head of IHI and everyone was getting a big dose of her undying optimism and passion for new designs to improve care that include input from patients and families every step of the way. Seven months later, Maureen is as committed to these principles as ever, in part because everywhere she travels she witnesses the benefits that true patient-centered care and true collaboration have on people’s lives — including the clinicians on the front lines.

And yet, it’s easy to understand why leaders of health care organizations today aren’t always so sure how to connect their own home-grown innovations to the high-stakes challenges cropping up on the larger stage. Will cultivating a robust system of patient advisors lead to better HCAHPS (satisfaction) scores? Greater fiscal stability? Will a unique partnership with a home care agency and the local senior center reduce unnecessary hospital readmissions enough to avoid losing out on reimbursements? If infection rates drop, along with endless backups in the emergency department, does this make the hospital a good candidate to form or be part of an accountable care organization (ACO)? If a clinical practice gets a “meaningful” electronic health record system up and running, and patients have new ways to see (and know) what doctors and nurses see (and know), will it make it easier to get certified as a medical home?

Leaders can’t just ask these questions today; they need to have some answers. They also need new ways to explain multiple priorities and simultaneous goals to their hard-working staff, as well as how all the efforts link to the larger aims of health care reform. Are there overarching frames that can help? Maureen Bisognano believes so. WIHI host Madge Kaplan talks with Maureen about her most recent travels, her learning, and her guidance for “leading across the continuum” of care.

WIHI: Palliative Care = Quality Care

Date: April 21, 2011

Featuring:

• Jennifer Temel, MD, Director, Fellowship Program at Massachusetts General Hospital (MGH); Clinical Director, Thoracic Oncology, MGH; Assistant Professor in Medicine, Harvard Medical School
• Daniel Ray, MD, Medical Director, Medical Critical Care Program and Fellowship Director, Hospice and Palliative Medicine, Lehigh Valley Health Network
• Allan Ramsay, MD, Medical Director, Palliative Care Service, Fletcher Allen Health Care; Professor and Associate Chair, Department of Family Medicine, University of Vermont College of Medicine

 
Sometimes when a researcher’s work gets published in an academic journal, intense media attention isn’t the full story. Since August 2010, when Dr. Jennifer Temel’s New England Journal of Medicine article was published, the findings have had a major impact on clinical leaders on the frontlines of palliative care. Just ask Dr. Allan Ramsay from Fletcher Allen in Vermont. He and his colleagues couldn’t pass around the NEJM article fast enough! For the first time, a prominent study showed that patients newly diagnosed with terminal lung cancer who received palliative care not only experienced less pain and better quality of life, they also lived longer.

The benefits of palliative care, and indeed the entire concept, have often been obscured by more intense debates and focus on hospice and what patients need at the very end of life. And, for understandable reasons. But palliative care, as a viable approach and a set of practices that can relieve suffering and improve daily life for patients facing life-threatening illnesses is gaining ground in outpatient and inpatient settings alike. As we witness this evolution in real time, this WIHI gets closer to researchers and clinicians shaping the programs and services. Some, like Dr. Daniel Ray at Lehigh Valley, have been working on building the professional skill sets and patient-centered processes for the past decade.

WIHI host Madge Kaplan talks with Drs. Temel, Ramsay, and Ray to learn from their expertise and get a better sense of palliative care as an integrated and integral part of the quality agenda. The trio is eager to help others in health care find ways to overcome real and perceived barriers, using evidence, education, and small tests of change.

WIHI: The Power to Detect and Improve: Revisiting the IHI Global Trigger Tool and Adverse Events

Date: April 14, 2011

Featuring:

• David C. Classen, MD, MS, Associate Professor of Medicine, University of Utah; Active Consultant in Infectious Diseases, University of Utah School of Medicine; Senior Partner, CSC
• Roger K. Resar, MD, Senior Fellow, Institute for Healthcare Improvement
• Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement
• Kathleen M. Haig, RN, Corporate Patient Safety Officer, OSF Health Care System

It’s safe to say that reducing harm is a priority at virtually every health care delivery organization today in the US. Few health care leaders waste time anymore defending high rates of hospital-acquired infections or medication errors. Progress is also notable in this country and other nations similarly focused on improvement, when it comes to significant reductions in infections associated with use of central lines, ventilators, resistant bacteria, or with events such as preventable patient falls.

That’s the good news. The mixed news is that when independent researchers dig deep into patient charts and look for signs (or triggers) of adverse events using the IHI Global Trigger Tool (GTT) or something approximate — conducting reviews over a month, several months, even several years — they’re finding higher rates of harm than even the most committed improvers realize exist, especially if they’ve been relying on other, common detection methodologies. The latest findings to reinforce this gap in perception and facts on the ground have just been published in the journal, Health Affairs.

The article’s two leading authors, David Classen and Roger Resar, would like to help everyone make better sense of the mounting evidence that points to the power of the IHI GTT as a measurement and detection tool. WIHI host Madge Kaplan welcomes the two to the program, along with IHI Vice President Andrea Kabcenell and Kathleen Haig of OSF St. Francis Medical Center.

Drawing on our guests’ expertise, the goal of this timely WIHI is to explain why overall rates of adverse events haven’t been as affected by improvement strategies as many would have expected; how use of the IHI GTT can deepen understanding of where problems persist; what improvement strategies may best address areas in need of attention; and how it’s possible to work successfully with the GTT as part of an overall patient safety and harm reduction strategy — just ask OSF, which has seen marked improvement across their system and raised awareness with help from the regular, routine use of the GTT at seven hospitals.

We know everyone is working hard on multiple fronts to improve quality and safety. If efforts can become more targeted and effective, based on more robust detection methodologies, that’s a good thing.

 

 

Read the Health Affairs article.