WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: OpenNotes and the Electronic Medical Record

Date: December 17, 2009

Featuring: 

• Tom Delbanco, MD, Beth Israel Deaconess Medical Center, Harvard Medical School
• Mary Merkel, DO, Merrimack Family Practice, Dartmouth-Hitchcock Nashua

If you had the chance to look at what your physician wrote in your medical record about your last visit, would you take advantage of it? Would this make your relationship with your doctor or primary care provider more collaborative? More effective? These are just some of the important questions and issues bearing down on our health care system as an online universe and electronic medical records make shared viewing of what are often referred to as the “doctor’s notes” feasible. What’s contained in the notes and does transparency interfere in any way with their value?

WIHI: All Hospitals in Favor of Saving Money: Say “Patient Flow!”

Date: December 2, 2009

Featuring: 

• Eugene Litvak, PhD, President and CEO, Institute for Healthcare Optimization
• James M. Anderson, President and CEO, Cincinnati Children’s Hospital Medical Center
• Scott Hamlin, Senior Vice President of Finance and CFO, Cincinnati Children's Medical Center

 

Imagine this scenario: a hospital CEO, a chief surgeon, and an operations management expert decide there has to be something better than daily overcrowding in the emergency department, no vacant operating rooms, a lackluster occupancy rate, stressed staff, and patients waiting around to be seen. The trio, along with others in the hospital, decide they’re going to dig into the problem and apply the best improvement science available to turn things around. And they do.

 

Read the case study that explains how Cincinnati Children's redesigned perioperative flow.

WIHI: Getting Down to Business…and Health Care Reform

Date: November 19, 2009

Featuring:

• Helen Darling, President, National Business Group on Health
• Raymond J. Zastrow, MD, FAAFP, President, QuadMed, LLC

 

If you’re a US employer providing health care benefits to your employees, there’s no sitting still anymore or sitting on the sidelines and accepting whatever comes next. Even in the midst of possibly historic health care reform, insurance premiums continue to rise and take a far greater chunk out of a company’s bottom line; employees are being asked to pay more out of pocket, too.

 

In this environment, employers have become a lot smarter about what they’re purchasing. They’re paying more attention than ever to issues of quality and patient safety, and the degree to which health plans focus on wellness and primary care. In some instances, such as at QuadMed, employers are seizing the reins and building the type of integrated health care delivery system they believe should serve as a model for society as a whole. That’s what Dr. Raymond Zastrow describes on this WIHI, joined by Helen Darling in a timely discussion of the more sophisticated role they believe companies must play in reforming health care. What sorts of incentives can employers offer employees to improve their health without being punitive?

WIHI: New Ways to Reduce Diagnosis Errors

Date: November 5, 2009

Featuring:

• Gordon Schiff, MD, Associate Director, Center for Patient Safety Research and Practice, Brigham and Women’s Hospital
• Pat Croskerry, MD, PhD, Professor in Emergency Medicine at Dalhousie University, Halifax, Nova Scotia

 

It’s an all too familiar story: The initial diagnosis of a patient’s condition turns out to be wrong; or there’s an incorrect interpretation of a test result; or a patient never learns of a test result; or a physician relies too much on memory to form a diagnostic opinion, forgetting about other important clues. Each of these diagnosis errors can be traced back to a system failure or an overreliance on cognitive skills (ignoring decision supports), and often, both. Thankfully, many years’ worth of robust research on diagnosis errors is finally receiving greater attention, and is starting to lay the groundwork for improvement across the US and internationally.

WIHI: The Future of Nursing

Date: October 22, 2009 

Featuring:

• Donna Shalala, PhD, former US Secretary of Health and Human Services, President, University of Miami
• Sue Hassmiller, PhD, RN, FAAN, Director of the RWJF Initiative on the Future of Nursing, Institute of Medicine
• Pat Rutherford, RN, MS, Vice President, IHI

 

There may be a shortage of nurses in many parts of the US, but there’s no shortage of rethinking and redesign underway to strengthen the profession and to help nurses be more effective providers of quality patient care. Health care reform, along with a greater emphasis on primary care and prevention, are just some of the forces that point to a more prominent, satisfying, and critical role for nurses in the near future.

WIHI: Quality Care During Advanced Illness: What Do Patients Want That Works?

Date: October 8, 2009

Featuring: 

• Diane Meier, Director, Center to Advance Palliative Care
• Jim Conway, Senior Vice President, Institute for Healthcare Improvement

 

Between the care that patients and families want when faced with advanced illness, and what is often made available, “lies not just a gap but a chasm.” Those words, associated with the IOM’s groundbreaking blueprint, Crossing the Quality Chasm, are as apt a rallying cry as ever for transforming US health care, including what patients need at the end of their lives. Yet, patients and families often find themselves at odds with or abandoned by their medical providers at this stage of their care, forced to seek others who will respect their wishes.

WIHI: Run, Don’t Walk! The Urgent Need for Patient Safety

Date: September 24, 2009 

Featuring: 

• Don Berwick, Former IHI President and CEO
• Sorrel King, Author, Josie's Story, co-founder, Josie King Foundation

 

In the same year that IHI’s Don Berwick helped write the groundbreaking Institute of Medicine report, Crossing the Quality Chasm, outlining a prescription to rid the US health care system of errors, inefficiencies, and indignities, Sorrel King lost her 18-month old daughter at a major teaching hospital due to a medical error. Sorrel became a patient safety activist practically overnight and, in the process, gained the attention of people on the frontlines of patient care and improvement leaders like Don. Each has logged a lot of miles and spoken to a lot of audiences, and together they have a unique view of where we stand as a nation when it comes to safer care. Sorrel's new book, Josie's Story: A Mother's Inspiring Crusade to Make Medical Care Safe, chronicles a parent's journey to transform American medicine.

WIHI: Reducing Avoidable Visits to the Emergency Department

Date: September 10, 2009

 

Featuring:

• Roger Resar, MD, IHI Senior Fellow, Expert Lead on Reliability
• Robert Lowe, MD, MPH, Department of Emergency Medicine, Oregon Health and Science University

 

Emergency department overcrowding remains a serious problem in the US despite attention being paid to the issue and many attempts at innovative solutions. One weakness of current approaches may be an overemphasis on “medical” redesign at the expense of focusing on social factors and other community forces. Now some improvement teams are hard at work trying to build broader coalitions to tackle overreliance on the ED and to better appreciate the needs and outlooks of particular populations. WIHI host Madge Kaplan welcomes Roger Resar and Robert Lowe for a discussion of new ways to think about the use of the ED in the US and how a wider understanding can open up more creative and potentially lasting solutions.

WIHI: The Medical Home

Date: August 6, 2009

 

Featuring:

• Douglas Eby, Vice President of Medical Services, Southcentral Foundation, Alaska
• Jim Hester, Director, Health Care Reform Commission, Vermont

 

A chorus is calling for much better coordination and delivery of health care services across the continuum of care. That’s good news for patients with chronic health problems especially, who often benefit from a person, place, or that has the complete picture of their needs. The “patient-centered medical home” and “accountable care organization” are two important concepts and models that are emerging to jumpstart this system redesign and they’re now the basis for multiple demonstration projects across the country, including ones spearheaded by the Centers for Medicare and Medicaid Services (CMS).

 

Two leading experts on how and where the medical home and accountable care principles can make the biggest difference at this stage of development join WIHI host Madge Kaplan. Dr. Doug Eby, known for his innovative ideas with a customer-owned Alaska Native integrated health system is focused on something that’s adaptive, flexible, and built around the patient journey most of all. Jim Hester is knee-deep in health care reform in the state of Vermont where learning about and piloting an accountable care organization is now the stuff of law. The medical home and accountable care organization are also very much on the minds of those drafting health care reform bills in Congress.

WIHI: Next Waves of Health Care Reform

Date: July 23, 2009

 

Featuring:

• Paul O’Neill, former US Treasury Secretary
• Jim Conway, IHI Senior Vice President and IHI representative on the Massachusetts Health Care Quality and Cost Council

The US Congress and the Obama administration seem poised to pass major legislation to ensure that more of its citizens have health insurance and to slow the spending of one of the most expensive health care systems in the world. This dual (and sometimes “dueling”) agenda can only succeed, most experts agree, if principles of health care improvement and system redesign become part of not just Washington’s strategy, but that of the country as a whole. Where is the evidence that this is the direction we’re moving in? WIHI host Madge Kaplan has a lively discussion with Jim Conway and Paul O’Neill about the unfolding of health care reform and how leading ideas, proven methods, and institutions from the world of quality improvement and patient safety can broaden and deepen the agenda for change.

• Read the New York Times opinion piece by Paul O'Neill.
• Read Jim Conway's testimony on national health care reform to the Massachusetts Senate Committee.