WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Reports from the Frontlines of Effective Crisis Management

Date: April 7, 2011

Featuring:

• James Conway, MS, FACHE, Senior Fellow, Institute for Healthcare Improvement; Adjunct Faculty, Harvard School of Public Health
• Anthony A. Armada, FACHE, President, Advocate Lutheran General Hospital, Advocate Lutheran General Children’s Hospital
• Michael A. Fisher, President and CEO, Cincinnati Children’s Hospital Medical Center (CCHMC)
• Uma R. Kotagal, MD, MBBS, MSc, Senior Vice President, Quality, Safety and Transformation, CCHMC; Executive Director, James M. Anderson Center for Health Systems Excellence
• Michelle Hoppes, RN, MS, President, American Society for Healthcare Risk Management; Senior Vice President and National Director for Healthcare Risk Management and Patient Safety, Sedgwick Claims Management Services

When IHI published a white paper last year written by Jim Conway and three colleagues, there was little doubt that health care organizations were seeking guidance on the best and most transparent ways to prepare for and respond to serious medical crises. However, the September 2010 publication of Respectful Management of Serious Clinical Adverse Events, hit a nerve (in the best sense) that even the authors couldn’t have predicted: there have been thousands of downloads of the white paper from IHI.org, and dozens of organizations and health care providers have been eager to spread its guiding content far and wide.

Not only that, the compilation of tools and best practices — from having a plan ready to be implemented, to enacting the plan, to ensuring that everyone affected has what they need, when they need it — wound up serving as a resource for several hospitals facing unfortunate clinical occurrences. Leaders from two of the affected hospitals — Michael Fisher and Uma Kotagal from Cincinnati Children’s and Tony Armada from Advocate Lutheran — join Jim Conway to discuss what they learned, in real time, about the critical importance of making crisis management a part of every organization’s culture of quality and safety. Among other things, patient- and family-centeredness must anticipate those moments “when things go wrong.”

Michelle Hoppes also joins the program to offer her perspective and that of the changing world of hospital risk management to align with a respectful response to serious adverse events.

WIHI: Primary Care's (New) Pressures and Possibilities

Date: March 17, 2011

Featuring:

• Karen Boudreau, MD, FAAFP, Senior Vice President, Institute for Healthcare Improvement; Medical Director, IHI Continuum Portfolio
• Connie Davis, MN, RN, Geriatric Nurse Practitioner, IHI Faculty; ImpactBC Senior Faculty for Patients as Partners and Adjunct Faculty, University of British Columbia School of Nursing
• John H. Wasson, MD, Professor of Community and Family Medicine, Dartmouth Medical School
• Sheila Allison, Peer Coach, Patient Advisor, Patient Voices Network (BC, Canada); Volunteer Facilitator, University of Victoria Centre on Aging – Self-Management Program

Next to electronic health records (EHRs), there’s probably no other area of health care receiving as much attention these days as primary care. It’s easy to see why. Like EHRs, new and improved primary care models are considered ground zero for a system that’s better coordinated, integrated, and efficient. Hopes are high, especially in the US, that with a more robust and reliable infrastructure of primary care, there will be fewer dropped balls, fewer unnecessary referrals to expensive specialists, and less use of emergency departments for non-urgent care.

Sometimes it’s hard to assign one overarching phrase to all the activities now underway to help primary care practices make this strategic leap. That’s why WIHI host Madge Kaplan talks with four experts who have a good picture of what’s going on and, most importantly, can articulate today’s fundamental drivers for transforming primary care.

Sheila Allison’s work with Patient Voices Network in Canada represents the best of what patients and families can bring to the table to ensure that primary care redesign is truly patient-centered. Committed to improving chronic care, Connie Davis has been helping build bridges between clinicians, patients, and families for years. Drs. Karen Boudreau and John Wasson, who often work with Connie, round out the WIHI panel with their keen knowledge of how critical it is for clinical and quality leaders to “get primary care right” — especially as health care becomes less and less hospital-centric and more community oriented.

There are plenty of wrinkles, lots of noise, and head-spinning agendas surrounding primary care. This WIHI will help you get a handle on what you should be spending your time on and why.

WIHI: Health Care’s Newest Improvers: Patient and Family Advisors

Date: March 10, 2011

Featuring:

• Kristine White, RN, BSN, MBA, Vice President, Innovation and Patient Affairs, Spectrum Health System
• Cindy Sayre, MN, ARNP, Director, Professional Practice and Patient- and Family-Centered Care, University of Washington Medical Center
• Dorothea Handron, EdD, APRN, Faculty Emeritus, College of Nursing, East Carolina University; Patient-Family Advisor, University Health Systems of Eastern North Carolina
• Brandelyn Bergstedt, Coordinator, Patient and Family Advisor Program, Evergreen Hospital Medical Center
• Martha Hayward, Executive Director, The Partnership for Healthcare Excellence; Founder, Women’s Health Exchange; Member, Dana Farber Cancer Institute Patient Advisory Council

Here’s the first thing one discovers when planning a program about Patient and Family Advisory Councils (PFACs): there are now hundreds and hundreds of them at hospitals all across the US, and they’re a growing phenomenon internationally. In fact, there are so many outstanding examples of patients and family members rolling up their sleeves to improve the health care system, alongside quality leaders and clinicians, that it’s not easy to choose just a handful of examples to highlight.

WIHI host Madge Kaplan has assembled a terrific panel that is sure to leave you inspired and with a much clearer sense of what PFACs do and how they’re contributing to the redesign of health care today. Learn from Kristine White, Cindy Sayre, Dorothea Handron, Brandelyn Bergstedt, and Martha Hayward — each of whom represents, first, a new attitude among health care executives to fully embrace the insights and experience of patients and families; and, second, a growing sophistication among people once thought of as “outsiders” as they tackle some of health care’s most intractable problems.

Whether it’s how patients and family members feel welcomed (or not) when they walk through the door of a hospital, access to loved ones in the ICU, reliable communication with providers, or prevention of infections and medication errors, there is hardly an issue that PFACs are not involved in helping to solve or improve.

Learn how to develop and support PFACs at your organization, what makes for an effective council, and how to create clear guidelines and expectations.

 

WIHI: The Newest Innovator on the Block: Center for Medicare and Medicaid Innovation

Date: February 24, 2011

Featuring:

• Rick Gilfillan, MD, Acting Director, Center for Medicare and Medicaid Innovation

Most of us are familiar with the various demonstration projects the Centers for Medicare & Medicaid Services (CMS) has sponsored over the years. This year CMS is taking the notion of figuring out “what works” when it comes to better patient care to an entirely new level, with the launch of the Innovation Center at CMS.

Rick Gilfillan, fresh from helping to redesign payment methods at the Geisinger Health System to align with quality outcomes — and gaining national recognition as a result — is now applying his passion for improvement to the country as a whole. As the Innovation Center ramps up, Dr. Gilfillan is eager to keep everyone up to date with what’s on the broader agenda and what’s most immediately in store.

WIHI host Madge Kaplan talks with Dr. Gilfillan, who explains the strategy behind the Innovation Center and the prospects for seeding much more robust work with both new payment and service delivery models. Dr. Gilfillan is not alone in believing that a lot of great models exist already. The challenge comes in first harnessing these best practices and then spreading them. It’s this last issue that he has been hearing about in spades; the need to diffuse new models quickly and effectively has never been greater and requires a national learning network and infrastructure that currently doesn’t exist, but can be created.

WIHI: A Legible Prescription for Health Care

Date: February 10, 2011

Featuring:

• Pauline Chen, MD, Columnist, The New York Times;  Author, Final Exam: A Surgeon’s Reflections on Mortality

Every now and again, a physician begins writing a regular column for a publication and you find yourself hooked before you know it. Part of it has to do with our being offered a way to better understand “how doctors think” and what they think about.

In the case of Pauline Chen, what stands out is her frank honesty about what works and what isn’t working in medicine, not only affecting patients, but the ways physicians interact with one another, and with other practitioners. Many of Dr. Chen’s columns spring from her day-to-day experiences — from confronting assumptions about patients that physicians hold onto to confronting one’s own loss of confidence after making a mistake.

Here’s an excerpt from her May 2010 New York Times column, "When Patients Share Their Stories, Health May Improve":
"Devastated, I withdrew my needle and quickly took steps to confirm, then care for, his punctured lung. But a few days later in the ICU when one of the heart surgeons asked me to place a central line in another patient, I couldn’t help but hesitate. He repeated himself and then I confessed. I had lost my nerve with this once seemingly straightforward procedure."

WIHI host Madge Kaplan and Pauline Chen discuss a whole host of topics, starting with language and the ways in which certain words and formal ways of describing a patient’s condition create distance rather than any sort of  bond. Dr. Chen also wonders about the human barriers inadvertently created between doctor and patient when the best infection prevention precautions are in place. And is there a danger of giving too much weight to what patients score or say in satisfaction surveys?

WIHI: Alert to Change: New Models for Residency Work Hours

Date: January 27, 2011
 
Featuring:

• Christopher P. Landrigan, MD, MPH, Director, Sleep and Patient Safety Program, Brigham and Women’s Hospital
• David B. Sweet, MD, FACP, Program Director, Internal Medicine Residency, Summa Health System
• James F. Whiting, MD, Surgical Director, Maine Transplant Program and Surgical Residency Program Director, Maine Medical Center
• Don Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement  

 

Rules are rules, but efforts to limit the number of hours medical residents can work before getting rest and sleep have not gone down easily in the US. The latest set of regulations from the Accreditation Council for Graduate Medical Education (ACGME), focused especially on first-year residents, is scheduled to go into effect in July 2011.

 

Amid ongoing debate about research tying long hours spent taking care of hospital patients to impaired judgment and an increased likelihood of making errors (or harming oneself), and what are fair and appropriate remedies, a growing number of residency programs are forging ahead. They’re redesigning schedules and handoff processes not only to comply with ACGME rules, but to adopt systems that are more team-based and that promise to better protect the health and safety of patients and providers alike.
 
There’s no magic, one-size-fits-all solution, but WIHI host Madge Kaplan welcomes a group of experts to shed light on trailblazing ideas and system redesigns that everyone engaged in training health professionals can learn from. At Summa Health System, for example, where Dr. David Sweet heads up the residency program, 16-hour limits are the organizing principle for all trainees. And that’s led to innovations that are gradually achieving greater buy-in and improved care. Dr. James Whiting is working hard to get ahead of the curve in Maine, and other residency programs that are actively linking training to patient safety are also highlighted.
 
Dr. Chris Landrigan has made a major contribution to the research concerning sleep and safety, and both he and Dr. Don Goldmann are keenly aware of the ways in which educational programs for residents, including access to faculty, have historically evolved around open-ended work schedules. There are big challenges ahead. But now, there are also models that can be studied and innovations that can be introduced.

WIHI: The Power of Specialty Care – and the Necessity to Use It Wisely

Date: January 13, 2011
 
Featuring:

• Neil Baker, MD, IHI Faculty and Improvement Advisor; Improvement Consultant, Neil Baker Consulting
• Lawrence Shapiro, MD, Managed Care Medical Director, Palo Alto Medical Foundation

Here’s something most clinical and quality leaders agree with: a lot of specialty care isn’t always necessary or beneficial. What’s more, there’s tremendous variation across the US in the use of specialist services — variation that tends to be driven by the volume of what’s available, not the health needs of a community’s residents.

Meanwhile, in the trenches of decision making and with state-of-the-art interventions available to diagnose and treat diseases of all sorts, doctors and patients want what’s best, and potentially lifesaving. We applaud the oncologist who’s carefully helping a patient with cancer weigh treatment options; we respect the cardiologist who’s prescribing someone who’s had a heart attack the best medications to prevent a recurrence; we want the C-section for the pregnant woman who might lose her baby otherwise. 

It’s in this context that Doctors Neil Baker and Lawrence Shapiro and others are hard at work creating a framework to help providers get closer to an appropriate use of specialty services — to reduce unnecessary health care costs and to deliver better care to patients. Neil Baker is the co-author of a 2010 IHI white paper, Reducing Costs Through the Appropriate Use of Specialty Services, that lays out a six-step process for generating good data about current practice patterns, analyzing the information, and making agreed-upon changes.

In this model, physicians (including those making referrals to specialists) are partners and problem solvers in their areas of expertise, not passive recipients of external rules. Just ask Lawrence Shapiro. The work that’s been underway at the Palo Alto Medical Foundation in California is case in point of what’s possible.

Improving when, why, and how specialty care is tapped also intersects with robust work going on across the country, and globally, with shared decision making — where patients, too, better understand their options and the benefits, or not, of obtaining specialty care. WIHI host Madge Kaplan delves into a topic that is not rocket science in terms of solutions, but deserves plenty of attention and requires the best minds, and experiences on the ground, in order to make the right kinds of changes.

WIHI: The Patient Activist

Date: December 16, 2010
 
Featuring:

• Bill Thatcher, Executive Director, Cautious Patient Foundation
• Barbara Balik, RN, EdD, Senior Faculty, Institute for Healthcare Improvement
• Tricia Pil, MD, Pediatrician, Medical Writer, University Health Sciences Project Coordinator, Patient Activist
• Charles Maclean, PhD, Founder, PhilanthropyNow

 
The activated patient and family member – often seeking to ensure that whatever “bad” thing happened to them doesn’t happen to anyone else – is, thankfully, no longer a new phenomenon. Today in the US, hundreds of organizations of all sizes and reach are gaining a voice and the expertise to help solve some of health care’s most intractable quality and safety problems. The rapid growth of patient advisory councils is just the latest example of patients becoming an integral and integrated force in the redesign of care.
 
On December 5, 2010, thanks to the generosity of the Cautious Patient Foundation and others, some 50 patient leaders gathered at IHI’s Annual National Forum to consider their work to date and how, by combining forces, they can be an even more effective force for change. This WIHI shares the energy and discussion from the Leadership Summit for Patient Activists and Partners in Quality and Safety, featuring four people whose work has been crucial to laying the foundation for a new era of patient activism.
 
We’re all patients at some point, and that common experience – and sometimes unfortunate experience – is what’s bringing physicians, researchers, lawyers, parents, and every combination you can think of together to compare notes and plan for the hard work ahead.

WIHI: Finding the Will to Bend the Cost Curve

Date: December 2, 2010

Featuring:

• Jeffrey Selberg, MHA, Executive Vice President and COO, Institute for Healthcare Improvement
• Robert Murray, Executive Director, Maryland Health Services Cost Review Commission

 

The phrase, “bending the cost curve,” has an elegance to it that almost belies the complexity of what it’s going to take to achieve this aim. Medical home, accountable care organizations, bundled payments, global payments, value-based purchasing…they’re all in the mix. But how does it all add up, and is there a more effective overarching strategy still to come? 
 
IHI’s Executive Vice President and COO, Jeff Selberg, has been digging into where things stand with “bending the cost curve” efforts, especially in the US, and he has some important ideas and framing that he’d like to offer to WIHI participants to move efforts forward. Robert Murray has been overseeing, at one level, one of the longest-running payment and cost control initiatives in the country – in the state of Maryland, where an all-payer hospital rate-setting system has pushed hospital costs steadily downward, below the national average. The Maryland Health Services Cost Review Commission is deeply engaged in other initiatives, too, including the country’s first bundled payment system for outpatient hospital services.
 
There are no easy fixes, but there’s no turning away from the cost issues either. Especially if we’re also talking about quality care, improved health, and greater access to insurance coverage and primary care for everyone. What is happening in your state and your community that helps solve this cost/quality puzzle?

WIHI: Nursing’s New Roadmap: Education, the Workforce, and Health Care Quality

Date: November 18, 2010

 

Featuring:

• Donna Shalala, PhD, former US Secretary of Health and Human Services; President, University of Miami; Chair, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, Institute of Medicine
• Linda Burnes Bolton, DrPH, RN, FAAN, Vice President for Nursing and Chief Nursing Officer, Cedars-Sinai Medical Center; Vice Chair, IOM Committee on the Future of Nursing
• Patricia Benner, RN, PhD, FAAN, Senior Scholar, Carnegie Foundation for the Advancement of Teaching; Author, Educating Nurses: A Call for Radical Transformation and From Novice to Expert: Excellence and Power in Nursing

 

What’s it going to take for the health care system to take full advantage of the potential of nurses – and for nurses to realize their full potential? These twin questions are not new to the nursing profession, or to policy makers. Both groups have been wrestling for years to find the right levers to increase not just the ranks of RNs, but their skills and recognition as key members of health care teams. Although this has led to some successes and improvements, the solutions haven’t kept up with demands. Health care reform has only intensified the need to sharpen strategies, especially as nurses have the potential to play a critical role in creating a more patient-centered, integrated delivery system.

 

In October, the Institute of Medicine released a report called The Future of Nursing: Leading Change, Advancing Health. The study committee’s Chair and Vice Chair, Donna Shalala and Linda Burnes Bolton, join WIHI to review the recommendations and to talk about how to turn the substantial report into action. Everyone in health care, not just nurses, has a role to play in driving many of the ideas forward. One of health care’s and nursing’s most respected educators, Patricia Benner, will round out the panel with some special focus on the changes needed in nursing education to ensure that RNs have the necessary skills and preparation to assume greater leadership and patient care roles.

 

Any discussion about the goals and ambitions for any health profession must take into consideration how these align with the needs of health care reform – including better quality, better health, at reduced costs.