WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Success at the Right Speed: Learning from Toyota

Date: May 6, 2010

Featuring: 

• Steven J. Spear, Senior Lecturer, Massachusetts Institute of Technology; Senior Fellow, IHI
• John Toussaint, Founder and President, ThedaCare Center for Healthcare Value; Author, On the Mend
• Gary Kaplan, MD, Chairman and CEO, Virginia Mason Health System

 

When Toyota began to stumble in the late summer and fall of 2009 because of serious safety problems, the world gasped. And understandably so. Faulty gas pedals and brake systems were the last things anyone expected from the world’s number one car maker. Indeed, the high standards for quality and safety that revolutionized auto manufacturing and that inspired many other industries, health care included, to learn from Toyota, were viewed as indelible. Not any more. That’s probably a good thing in the long run, say those who’ve followed the company over the years; it’s an unfortunate turn of events, but an important wake-up call that anyone committed to sustaining gains over the long run can and must learn from. 

John Toussaint, Gary Kaplan, and Steven Spear are some of this country’s top students, teachers, and implementers of Toyota methods as they apply to health care. They join WIHI host Madge Kaplan to share their analysis and wisdom about why it’s critical to “keep your eyes on the road” of improvement and not succumb to a lot of distractions and the latest shiny idea or ambition. The trio is confident that Toyota will work its way out of the current situation and restore its trust with consumers. But where in your own health care organization are there early warning signs of arrogance and loss of respect and humility towards patients and staff in hopes of workarounds and easy gains?

WIHI: The Meaningful Methodology of Patient- and Family-Centered Care

Date: April 22, 2010

Featuring: 

• Anthony M. DiGioia, MD, Founder, The Orthopaedic Program and Innovation Center, Magee-Womens Hospital of UPMC
• Dale Shaller, Principal, Shaller Consulting Group

 

There’s no particular reason why a patient- and family-centered care program would start off in a hospital’s orthopaedic surgery department, but if you’ve had the pleasure of speaking with Dr. Tony DiGioia you’d know immediately why that’s the way things went. Passionate about improving care for patients, Dr. DiGioia first saw all sorts of opportunities right in front of his nose at Magee-Womens Hospital, part of the University of Pittsburgh Medical Center (UPMC). The rest, as they say, is history.

There are now some 16 working groups in the UPMC system innovating and implementing communication and navigation processes that smooth the way for patients having elective surgery, dealing with urgent care, or facing a transition home. There’s an online Innovation Center to capture learning AND to share tools and resources and strategies with anyone interested. And, perhaps most importantly, Dr. DiGioia and his colleagues have developed a methodology for implementing patient- and family-centered care programs, taking a lot of the guess work and starting from scratch out of the picture.

WIHI host Madge Kaplan welcomes Dr. Tony DiGioia and Dale Shaller, one of the country’s foremost experts on improving quality and safety in health care and increasing patient satisfaction. If your head is spinning with so many definitions of patient- and family-centered care that you’re not sure whose interpretation to believe, OR you fear the concept is in danger of becoming more a matter of good intentions than actual results, this is a WIHI discussion you don’t want to miss.

WIHI: Momentum for Maternity of the Safest Kind

Date: April 8, 2010

Featuring:

• Sue Gullo, RN, MS, Managing Director, Institute for Healthcare Improvement
• Maureen P. Corry, MPH, Executive Director, Childbirth Connection
• Rima Jolivet, CNM, MSN, MPH, Associate Director of Programs, Childbirth Connection
• Peter H. Cherouny, MD, The University of Vermont College of Medicine

 

Here’s how most of us are exposed to the state of health care for pregnant women, new mothers, and newborns: we hear about it in the news. And the issues are usually presented in an alarming and fragmented fashion: high rates of infant mortality and disparities across race and ethnicity; high-tech interventions for premature infants; a dramatic rise in caesarean or c-sections; induced delivery prior to 39 weeks. At the same time, Ob/Gyn complications remain unacceptably high, as do maternal deaths.

Here’s another picture to consider: an emerging coalition of maternity care leaders in the US armed with a Blueprint for Action and a “2020 Vision” that aims to transform maternal and newborn experience from one fraught with danger and risks to what it should be: a safe, healthy, celebratory start to childhood and parenting.

WIHI host Madge Kaplan welcomes Maureen Corry and Rima Jolivet from Childbirth Connection to explain the new energy they’ve ignited to ensure that good quality maternal health is reliably understood and practiced on a wide scale.

High-quality, safe, cost-effective maternity care is a growing part of IHI’s work globally – in Malawi and Ghana – and central to IHI’s work in the US. Sue Gullo and Peter Cherouny work with some 50 hospital teams in IHI’s Improving Perinatal Care Community to reduce harm and variation, and to improve patient-centered care and teamwork among all concerned. Sue Gullo talks about a new way of thinking, a “mind shift” that brings the needs of pregnant women, new moms, and infants into the foreground like never before.

Learn more about accelerating change and implementing processes to reduce misuse, overuse, and underuse of maternity care. Good things happen when experts unite around good care and good policies.

WIHI: The Next Wave of Reform for Medical Education

Date: March 31, 2010

Featuring: 

• Donald M. Berwick, MD, Former President and CEO, Institute for Healthcare Improvement
• Lucian L. Leape, MD, Chair, Lucian Leape Institute at NPSF, and Adjunct Professor of Health Policy, Harvard School of Public Health
• Dennis S. O’Leary, MD, President Emeritus, The Joint Commission
• Diane C. Pinakiewicz, President, Lucian Leape Institute at NPSF

What do today’s medical students need to know to safely and effectively take care of patients? This question isn’t really a new one. But in recent years, the focus on making sure students are prepared to practice in an environment dominated by advancements in medical treatment has been coupled with something equally urgent: the need for newly minted MDs to listen effectively, to engage in difficult conversations, to work as members of teams, and to practice with sharpened awareness and skills drawn from the very latest in improvement science and patient safety.​

None of these changes can come about overnight. IHI’s “virtual” Open School is starting to make a difference in the lives and skills of students across the health professions, and now the Lucian Leape Institute at the National Patient Safety Foundation has issued a groundbreaking report that lays out an important blueprint for change. Unmet Needs: Teaching Physicians to Provide Safe Patient Care may be the most important call for medical education reform since the Flexner Report in 1910. The principal authors of the report join Don Berwick and WIHI host, Madge Kaplan, for an important discussion of the key findings and recommendations in the report and a look at where reform of the sort called for can already be noted and applied more broadly.

Dennis O’Leary labels the current state of medical education as one of “producing square pegs for the delivery system’s round holes.” This is clearly not the future we want to embrace. This WIHI focuses on a timely conversation on one of the most important gateways to a better and safer health care system: medical education.

WIHI: The Health Care Tune-Up Show! Leading with Logic and Emotion

Date: ​March 18, 2010

Featuring: 

• Chip Heath, Co-author, Switch: How to Change Things When Change Is Hard
• Joe McCannon, Faculty and former Vice President, Institute for Healthcare Improvement

There are probably as many books out there on “change” as there are problems in need of solutions. But, just when you think you’ve read and heard it all, comes one of the most inventive approaches yet to getting things moving. Switch offers just the excuse we need right now to set down the almost unbearable burden of trying to do everything at once to fix health care. While we wonder what happens next with health care reform or any big system’s attempts at transformation, why not also focus on “bright spots” and the power of turning standard strategic plans on their heads and unleashing a very different kind of innovation?​

WIHI host Madge Kaplan welcomes Chip Heath and Joe McCannon to remind health care improvers everywhere of the resources and possibilities to improve patient care that are, in some instances, staring us in the face. There’s a lot in the behavioral psychology that Chip and co-author (and brother) Dan Heath are drawing from that will sound familiar to anyone who’s been bowled over by unexpected learning that results from small tests of change and PDSA cycles. Find out how those emotions matter more than you might think, especially if your aim is making a lot of small successes roll up into larger and more lasting change. That’s where Joe McCannon comes in. He successfully ran two of the biggest improvement initiatives yet in the US, involving thousands of hospitals. Turns out the Rider, the Elephant, and the Path were all engaged. Curious? Listen to this WIHI!

WIHI: Message to Managers: Crises Happen. Plan Ahead!

Date: March 4, 2010

Featuring: 

• Jim Conway MS, FACHE, Senior Fellow, former Senior Vice President, Institute for Healthcare Improvement
• Timothy McDonald, MD, Professor of Anesthesiology and Pediatrics, Associate Chief Medical Officer for Safety and Risk Management, University of Illinois-Chicago
• Richard Boothman, Chief Risk Officer, University of Michigan Health System

What should happen in the first hour or first day after an adverse or sentinel event in your health care organization? Wait for all the facts to come in? Sequester yourselves until all the talking points have been agreed upon and legal counsel gives the go ahead to say something? Not too long ago, guidelines like these would not have seemed outrageous or outside the norm. Indeed, a large percentage of organizations are still tempted to react defensively and protectively when anything unexpected happens on their turf. It’s understandable but the evidence is mounting that nothing good comes from this approach – not for patients, not for staff, and definitely not for the future health and vitality of the organization.

Who better to help us understand the brave new world of “effective crisis management” than Jim Conway, Timothy McDonald, and Richard Boothman: three national improvers, well versed in risk management, who are actively reframing the priorities to be patient-centered most of all. In the process, they’re pioneering and demonstrating models of transparency and accountability any institution would be proud to emulate. WIHI host Madge Kaplan welcomes the trio to the program to tell us what they’ve been learning and to find out from you, our participants, what’s working in your own organizations. One key to effective crisis management is being prepared with a response system that everyone is familiar with and knows how to activate – before bad things occur.

WIHI: Tipping the Scales: Fresh Ideas to Combat Obesity

Date: February 18, 2010

Featuring:

• David Kessler, MD, FDA Commissioner (1990-1997), Professor, UCSF School of Medicine
• Charles J. Homer, MD, MPH, President and CEO, National Initiative for Children’s Healthcare Quality
• Rachelle Mirkin, Executive Program Director, National Initiative for Children’s Healthcare Quality

Hardly a day goes by anymore, it seems, that doesn’t include new research findings about obesity and its health consequences. At the same time, headlines heralding the latest tactics to help Americans, especially, shed the excess pounds often compete for space with some of the most sophisticated advertising ever to lead us to precisely the foods wreaking havoc with our bodies and brains. The former head of the US Food and Drug Administration, David Kessler, identifies with those of us gaining and losing weight, like the seasons, and our seemingly insatiable desires for foods high in sugar, salt, and fat. That’s why he wrote the book, The End of Overeating, and he’s hoping his investigation adds to the understanding of the levers needed to turn the obesity epidemic around.​​

WIHI host Madge Kaplan welcomes Dr. Kessler to the program, along with two national leaders, Charles Homer and Rachelle Mirkin, who are helping to provide communities and health care providers with known best practices to combat obesity in children. If ever there was a frontline for effective strategies, it is with kids who are otherwise on track for a lifetime of chronic and serious illness. Forty billion dollars in increased medical spending in the US because of obesity, according to one recent analysis, gets our attention. But, if you’re wondering what’s working, where, to reverse this spiral, this WIHI features an urgent discussion about obesity and what experts are learning about best ways to focus interventions and efforts.

WIHI: Adverse Events and Their Aftermath: SOS from Clinicians

Date: February 4, 2010

Featuring:

• Albert Wu, MD, MPH, Professor, Johns Hopkins Bloomberg School of Public Health
• Linda Kenney, President and Executive Director, MITSS
• Susan D. Scott, RN, MS(N), CLNC, Coordinator, Patient Safety, University of Missouri Health Care

Whenever there's an adverse event or medical error in health care, clinicians are affected, too. As organizations develop more accountable and transparent ways to interact with families and patients who've been harmed, the emotional and professional needs of doctors, nurses, and staff — whether directly or indirectly involved in an incident — also need to be addressed. In a 2000 essay in the BMJ, Dr. Albert Wu coined the phrase “the second victim” to put a face to the health care personnel facing loss of confidence and isolation in the aftermath of a tragic event. Now, a decade later, Dr. Wu's courage in naming a problem and his willingness to openly discuss the “private hell” that can beset even the most talented caregivers have helped many hospitals and health care organizations acknowledge the needs of their staff and create systems to support them.​​

There's not nearly enough in place...yet...but Dr. Albert Wu, along with Linda Kenney of MITSS (Medically Induced Trauma Support Services, Inc.) and Susan Scott from University of Missouri Health Care, are among those leading the way with experience and solid recommendations that can benefit all health care organizations. WIHI host Madge Kaplan welcomes the trio to the program to discuss building reliable “aftermath safety nets” for clinicians and staff when adverse events occur.

WIHI: Gimme Housing, Not the ED: A New Campaign for Housing the Homeless

Date:  January 21, 2010

Featuring: 

• Rosanne Haggerty, Founder and President, Common Ground
• Becky Kanis, Director of Innovations, Common Ground
• Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine, NYU School of Medicine
• Joe McCannon, Faculty, Institute for Healthcare Improvement

 

Every winter in the US, volunteers fan out across most major cities to count the number of people residing in shelters and living on the streets. This annual census of the homeless serves many functions, but always reminds us of the complex web of economic, behavioral, and social factors that underlie life without any permanent housing for at least three million Americans at any given time.

 

Many of the people living on the streets and in shelters are well known to nearby hospital emergency departments (EDs). The health problems are typically chronic, sometimes life threatening, and usually part of a repeating pattern of addiction, mental illness, or disease that those who work in EDs can only begin to address. Underlying needs often go unmet.

 

Common Ground has a proven track record of creating housing for people on the streets. Now, as part of its effort to end homelessness, Common Ground wants to forge innovative relationships with hospitals to better target outreach and resources to some of the most vulnerable. WIHI host Madge Kaplan talks with two of the organization’s leaders, Rosanne Haggerty and Becky Kanis, who are actively laying the foundation for permanent, affordable housing for the homeless, as well as new, effective coalitions with the health care system to stop the revolving door in and out of the ED. Dr. Maria Raven is an expert on care coordination for complex patients, and Joe McCannon is helping Common Ground map out a new, national strategy.

WIHI: Patient Safety Officer: One Person’s Title, Everyone’s Responsibility

Date: January 7, 2010

Featuring: 

• Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement
• Doug Salvador, MD, Associate Chief Medical Officer/ Patient Safety Officer, Maine Medical Center

 

It’s hard to point to a position more central today for making good on the goals of hospital patient safety than that of the Patient Safety Officer (PSO). And yet, perhaps no job is more challenging due to the overarching responsibility for multiple players, layers, and departments in an organization. It’s one thing for The Joint Commission to require that every US hospital have a PSO; it’s quite another to build the systems and teams to make the prevention of errors and injury a living mantra, and everyone’s priority, each and every day. When the national discussion puts more of the spotlight on coordinating care, reducing costs, and reducing readmissions, it’s easy to get distracted. But, that would be a mistake.