WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: The Leaders Needed for the Changes Health Care Needs

Date: November 4, 2010

Featuring:

• Marshall Ganz, MPA, PhD, Lecturer in Public Policy, Harvard University
• Kate B. Hilton, MTS, JD, Principal in Practice, Leading Change; Leadership Coach, NHS England; Director, Organizing for Health

If you don’t work in the health care system, it’s sometimes hard to understand why, when so much is known about better ways to take care of patients and better ways to deliver quality at lower cost, people don’t just “do it!” What’s so complicated? If one hospital or hospital system has dramatically lowered infection rates, trained its practitioners to work as teams, AND coordinates with outpatient clinics to help people with serious, chronic conditions avoid the emergency department, then why can’t all hospitals do this? What’s the excuse?

Well, there is no “excuse” per se, but the reasons for the uneven and unreliable pace of change are many and complex. So much so that many health care improvement experts believe that the massive challenges facing health care systems in the US and in other countries, such as the UK, now require a new type of focus and mobilization. Where else in society have broad based, necessary changes come about before? How does this happen? Who makes it happen? Enter Marshall Ganz whose organizing in the civil rights movement and with everyone from farm workers to political candidates is legendary. This is the same Marshall Ganz, whose 2009 IHI National Forum keynote had several thousand attendees taking copious notes.

Marshall and Kate Hilton are in the midst of a timely initiative dubbed Organizing for Health. In a nutshell, the two are harnessing some of the best known and proven practices from community organizing and successful social and political movements, to help spawn a new type of health care leader—one who can then mobilize colleagues and staff to create fundamental, organizational change. And we’re not just talking about a better run chart. It’s about new goals, new skills, new ways of working across all health care settings, new partnerships with patients and families, and new teamwork; it’s about meeting new cost and payment expectations, and the needs of an expanding number of patients coming into the US health care system with insurance for the first time.

WIHI host Madge Kaplan welcomes Marshall Ganz and Kate Hilton to share a fresh vision for health care reform that could change business as usual in your organization.

WIHI: The Power to Detect and Reduce Harm: IHI’s Global Trigger Tool and Adverse Events in the US

Date: October 21, 2010

 

Featuring:

• Lee Adler, DO, Vice President for Quality, Safety, Innovation, and Research, Florida Hospital
• Ruth Ann Dorrill, MPA, Team Leader, Office of Inspector General, US Department of Health and Human Services
• Amy Ashcraft, Senior Analyst, Office of Inspector General, US Department of Health and Human Services
• Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement
• Fran Griffin, Senior Manager of Clinical Programs for BD Medical/Medical Surgical Systems; Faculty, Institute for Healthcare Improvement

 

How often are patients harmed in US hospitals, and what is the best way to determine this? Ever since the Institute of Medicine (IOM) estimated that up to 98,000 patients die in hospitals each year due to medical errors, and some subsequent studies that claim the number is much higher, getting a more precise “national” handle on where and when and how frequently harm occurs has bedeviled most researchers. Without a baseline, it’s been impossible to state with any certainty whether patients are any safer today in US hospitals than they were ten years ago, when the IOM issued its seminal report.

This is the backdrop for a groundbreaking series of studies that the Office of Inspector General (OIG) at the Department of Health and Human Services has been undertaking. In the past two years, the OIG has issued a series of reports focused on harm that reaches hospitalized Medicare recipients, including analysis of the sensitivity and accuracy of methods for detecting harm. Its most recent report, slated for publication in October, provides a first-of-its-kind national incidence rate for adverse events.

IHI’s Global Trigger Tool, designed to facilitate a retrospective review of medical records to identify adverse events, combined with a physician review, has been singled out by the OIG as a powerful means of determining when an adverse event has occurred.

This WIHI offers a window into all the research findings — straight from the experts — and their significance for patient safety, harm detection, improvement work, and policy reform going forward.

WIHI: Reducing Readmissions, Restoring Revenues: Making Good Care Count

Date: October 7, 2010

 

Featuring:

• Amy Boutwell, MD, MPP, Director of Health Policy Strategy, Institute for Healthcare Improvement
• Jeffrey Burke, Director, Financial Decision Support, Spectrum Health
• Rosemary Rotty, Director, Financial Planning, UMass Memorial Health Care

You’d be hard pressed to find anyone working in a hospital who’d say, “Yes, we really want Mrs. Jones to be back here a few days after she’s been discharged, running a fever, suffering complications from surgery, and now needing to be readmitted so we can run more tests.” And yet, scratch the surface of even the most dedicated hospital these days, working hard on sending people home with appropriate information, support, and planning… and you’ll find someone working late who’s been asked to come up with the business model that’s going to replace all the lost revenues when those “unwanted” readmissions are reduced!

Even as payers, including Medicare, are poised to make hospitals that don’t reduce their readmissions feel added financial pain, the fiscal impact on hospitals doing the right thing, right now, is already real. At times, it feels like it comes down to “choose your poison.” That’s why, experts say, hospitals have often made the unbelievable decision of throwing successful readmission reduction programs overboard, quite simply because they can’t afford the negative effect on the bottom line.

IHI’s STAAR (STate Action on Avoidable Rehospitalizations) initiative is taking a hard look at finances, working with a courageous group of hospitals that are learning how to open their books and analyze their admissions (and readmissions) patterns with some new eyes and new thinking. As with any serious commitment to improvement, knowing the facts is the essential first step. It turns out that asking one set of hard, financial questions, leads to others about utilization patterns and overall hospital operations… helping hospitals get ever closer to truly understanding how to care for patients in the right place, at the right time.

WIHI host Madge Kaplan talks with Amy Boutwell from the STAAR initiative and two hospital leaders who crunch numbers, Jeffrey Burke and Rosemary Rotty, share why it’s critically important to make the financial impact of reducing readmissions a living, breathing, part of your quality agenda.

WIHI: The Buzz about Medical Training: It’s (Slowly) Changing

Date: September 23, 2010

Featuring:

• Lawrence Smith, MD, Dean, Hofstra/North Shore-Long Island Jewish School of Medicine; Chief Medical Officer, North Shore-LIJ Health System
• John Rock, MD, Founding Dean, Herbert Wertheim College of Medicine at Florida International University
• M. Brownell Anderson, Senior Director, Educational Affairs, Association of American Medical Colleges (AAMC)

It’s not easy to turn medical training upside down to better fit the needs of today’s patients and health care system. Consider that the last major reform occurred some 100 years ago and many, many institutions and individuals would say they’ve done just fine with the basics and, besides, some of the new content areas like “humanism” would be nice to know, but they’re hardly essential. I’m going to be a surgeon, after all!

Well, don’t try that out on the Deans of some 20 new medical schools. The attitude also might not wash with a new breed of curriculum architects who pair students with patients in low-income neighborhoods from day one, who insist on the mastery of good communication skills, and who have begun to weave the science and the tools of quality improvement and patient safety in and out of all science and clinical coursework. This is the new reality for future doctors and a lot of the changes are occurring at the grassroots, school by school, with educational leaders and governing bodies just now harnessing the best that’s out there to create a new blueprint for medical training, overall.

Dr. Lawrence Smith is serious about change. At his brand new medical school, Hofstra/North Shore–LIJ, first-year students will, among other things, get certified as EMTs and learn firsthand about teamwork and what patients and families need in crisis situations. At the Wertheim College of Medicine–Florida International University, Dean John Rock is sending medical students into diverse and complex communities so they’ll immediately appreciate medical realities within the context of social and economic realities. The AAMC’s Brownie Anderson, who’s in regular contact with all the new Dean innovators, joins WIHI fresh off a conference highlighting a vast amount of change occurring at all the nation’s medical schools. Whether it’s the IHI Open School or the virtual MyCaseSpace pioneered by the University of Central Florida, change is in the air and on the ground.

WIHI: Leaders Never Stop Learning

Date: September 9, 2010

Featuring:

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

Here's the thing about IHI's new President and CEO, Maureen Bisognano: she has unshakable optimism. And it's not because she wears rose-colored glasses or is looking at a different health care world than the rest of us. No, Maureen’s optimism is fed by her regular contact with some of health care's most reliable sources: patients and families, front-line providers, leaders — all of whom know firsthand where the problems lie and where the opportunities reside. They also share Maureen’s belief, honed by over 25 years’ worth of experience working to improve patient care, that the next barrier is only as formidable as you make it. The questions always need to be, “What new processes can you test?”  “What new skills are needed?” “Who haven’t you included in the discussion?”

Talk to anyone who has met Maureen, and they’ll tell you she is a leader for our times; she’s keenly aware of every vexing and hard-nosed cost and policy issue the US health care system especially is facing, and clearer than ever how IHI and the quality improvement movement can and must provide a path forward.

Opportunity has knocked for health care reform in tandem with quality and patient safety like never before. WIHI host Madge Kaplan has a candid discussion with Maureen about these issues and more.

WIHI: Against All Odds: Maternal Survival in Ghana and the US

Date: July 15, 2010

Featuring:

• Nana Twum-Danso, MD, MPH, FACPM, Director, Project Fives Alive!
• Jo Ivey Boufford, MD, President, New York Academy of Medicine
• Sue Gullo, RN, MS, Managing Director, Institute for Healthcare Improvement

 

It’s difficult to assess just how much progress is being made in the decades-long battle to prevent women from dying during pregnancy and childbirth. In April, The Lancet reported that worldwide maternal death rates dropped significantly from 1980 to 2008. The good news wasn’t uniformly shared across the 181 countries studied, but some global health experts felt there was reason for optimism. In May, the Kaiser Family Foundation presented a more sobering picture, suggesting that efforts to fulfill the United Nations Millennium Development Goal (MDG) of reducing maternal mortality by 75 percent by 2015 were not on track.

 

At the same time, new initiatives in some of the poorest parts of the globe are successfully targeting maternal health and delivering healthy prognoses for women and newborns alike. The work draws upon existing resources, takes into account geography and available transportation, respects local traditions, and utilizes the tools of quality improvement. In mostly rural northern Ghana, for instance, greater numbers of pregnant women are for the first time gaining access to skilled deliveries in clinics and hospitals – especially crucial when mother and baby may be in distress and most at risk.

 

WIHI host Madge Kaplan welcomes Dr. Nana Twum-Danso (Director of Project Fives Alive! in Ghana), Dr. Jo Ivey Boufford, and Sue Gullo to the program to share their frontline experiences on behalf of improved maternal health in Africa, New York City, and across the US. The trio will help connect the global dots about best practices in challenging settings. They’ll also discuss striking similarities between efforts to reduce maternal mortality in Africa and new approaches springing up in underserved and poor communities in the US.

 

And what of the differences? How can a country such as the US, with skyrocketing numbers of C-sections, frequent use of powerful medications to induce labor, and technology to address just about every imaginable situation work its way back to something closer to community and support, helping more women feel empowered before, during, and after childbirth? How can we prevent highly medicalized, high-tech births from becoming the “gold standard” for countries that have suffered from resource disadvantages for so long? One key is understanding the alternative approaches and making sure these become more widely known.

WIHI: Unprofessional Behavior Not Permitted Here

Date: July 1, 2010

Featuring:

• Barry Silbaugh, MD, MS, FACPE, CEO, American College of Physician Executives
• Kevin Stewart, FRCP, Medical Director Winchester and Eastleigh NHS Trust; Health Foundation Fellow, IHI
• Charlotte Guglielmi, RN, CNOR, Perioperative Nurse Specialist, BIDMC; President, Association of periOperative Registered Nurses
• Gerald B. Healy, MD, Emeritus Healy Chair in Otolaryngology, Children’s Hospital (Boston); Senior Fellow, IHI
• Ron Wyatt, MD, MHA, General Internist, Huntsville Hospital (Alabama); Merck Fellow, IHI

 

Over the years, the positions held by doctors in health care organizations have unfortunately empowered some to behave unprofessionally towards other staff and practitioners, especially nurses. Giving a pass to belligerent or temperamental clinicians, even while many of those affected quietly seethe, has been tolerated in part because of the pecking order in medicine, and in part as a nod to the organization’s sources of revenue.

 

Well, the times are a changing…and not just because hospitals are worried about their reputation or retaining staff. Those in a position to confront a culture that’s permitted outbursts and intimidation now consider such behavior a contributor to medical errors, and a major disruption to the teamwork and robust communication that’s so critical to patient safety and quality improvement today. It’s a start. And nurses with a penchant for coming down hard on other, less senior RNs, or giving new interns and residents a hard time, are also being called out.

 

WIHI host Madge Kaplan gathers an expert panel to parse out these complicated and controversial issues, get a handle on what regulators have to say about unprofessional conduct, and learn about a new determination among professional societies and hospitals to face up to behavior that truly has no place in a safe, high performing organization. The guests have stories to share and, most importantly, are tracking the solutions and policies that show the most promise. There’s word that that newer generations of health professionals are more willing to stand up to inappropriate behavior of colleagues and superiors alike. That’s the right spirit… now we need the systems to back this up.

WIHI: The Image of Better (Radiation) Imaging Practices

Date: June 17, 2010

Featuring:

• James R. Duncan, MD, PhD, Associate Professor of Radiology and Surgery, Washington University School of Medicine
• Richard T. Griffey, MD, MPH, Associate Chief for Quality and Safety, Emergency Medicine, Washington University School of Medicine

 

Have you had a CT scan lately? Chances are good that you have. In fact, you may have even had some repeat CT scans for the same problem — often because the original scans couldn’t be found. Until recently, we’ve been so enamored of this powerful diagnostic technology that most of us haven’t thought twice about repeating a scan, or considered the benefits versus the risks. Not to mention the costs. But we’re learning that a lifetime of exposure likely contributes to a greater risk of cancer. And many CT scans just aren’t needed, contributing to vast overutilization and significant health care spending. One person’s expense is of course another’s revenue, patients demand the best imaging, and physicians have a hard time saying no. What if they’ve missed something? How can we safely and wisely slow down this medical breakthrough?

 

WIHI host Madge Kaplan welcomes Drs. James Duncan and Richard Griffey. As the amount of radiation Americans are exposed to from medical imaging skyrockets, notably among children, various federal agencies, radiologists, and improvement experts are taking notice and suggesting changes.

 

Duncan and Griffey discuss the latest research on radiation imaging risks; new thinking about appropriate doses and the technology that can support greater accuracy; options for alternative imaging (e.g., ultrasound or MRI); decision supports for patients and clinicians; and more. Did you know that the International Atomic Energy Agency is spearheading the introduction of a “smart card” that could keep track of how much medical radiation an individual has been exposed to?

WIHI: Learning by Data and by Doing: Low-Cost, High-Quality Health Care in America

Date: June 3, 2010

Featuring:

• Carol Beasley, Director, Institute for Healthcare Improvement
• Tom Nolan, PhD, Statistician and Co-Founder, Associates in Process Improvement; Senior Fellow, IHI
• Laura K. Landy, President and CEO, Fannie E. Rippel Foundation

 

What happens when health care leaders from different regions in the country get in the same room and talk about their efforts to redesign patient care? Among other things, there’s often a sense of relief that, across state lines and political affiliations, there’s a shared concern for improving people’s health, improving their health care experiences, and lowering the costs of care. Washington may be able to bring about broad reforms for health care, but communities of all shapes and sizes are increasingly being looked to for the day-to-day solutions and innovations that will “bend the cost curve” and offer new, humane models for the future.

 

Fresh off a meeting in the Washington, DC, focused on building low-cost, high-quality health care regions in America, WIHI hosts a timely discussion about what 14 “Hospital Referral Regions” are starting to figure out about their quality data, their cost data, and the way forward. John Hogan is at the nexus of important changes taking place in Tallahassee, Florida; Tom Nolan, Carol Beasley, and Laura Landy are part of a group of national leaders (others include Don Berwick, Elliott Fisher, Atul Gawande, and Mark McClellan) who’ve been digging for the data and the ingenuity across the country that can be harnessed, shared, and turned into blueprints for change the nation so badly needs.

 

Grab your competitor from across town, or find a collaborator, or notify anyone you think is a stakeholder in your community looking for fresh thinking about costs, quality, and the health of the population. You’re sure to walk away with some new ideas from this WIHI.

WIHI: Coaching’s the Thing for Primary Care Practice

​Date: May 20, 2010

Featuring:

• Ann Lefebvre, MSW, CPHQ, Associate Director, North Carolina Area Health Education Centers Program
• Neil Baker, MD, IHI Faculty and Improvement Advisor, and Improvement Consultant
• Cory B. Sevin, RN, MSN, NP, Director, Institute for Healthcare Improvement
• Roger Chaufournier, CEO, CSI Solutions

 

Primary care practice in the US is undergoing a transformation. In many instances the offices still look cramped and, unlike hospitals, the changes don’t take the form of major new construction. But look closely: those sagging shelves of patient files are giving way to electronic health records; practitioners are tapping into online expertise to help with diagnoses and apply evidence-based medicine; patients have their own web portals; and people with similar chronic conditions sometimes meet as a group with a single provider for shared learning and greater efficiency. And, in case you haven’t heard, health care reformers are looking to primary care like never before to pave a better path to prevention, continuity of care, and cost containment for the country as a whole. Could the expectations be any higher?

 

Maybe so — don’t forget the medical home, which is why the newest kid on the block is something called the Primary Care Coach: someone specially trained to help office practices make sense of all these ambitions AND the successful and meaningful use of health information technology.

 

WIHI host Madge Kaplan welcomes a panel of experts, each of whom is now engaged in one way or another with leading the redesign of primary care. In addition to learning more about coaches for primary care, hear about the innovative Health Information Technology Regional Extension Centers (RECs) now popping up across the US to help office practices adopt electronic health records. One key goal of all the current efforts is to make sure technology is used in service of healthy outcomes and quality improvement, and not the other way around.