WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Mindfulness and Patient Safety

Date: March 8, 2018

Featuring:

• Kate FitzPatrick, DNP, RN, ACNP, NEA-BC, FAAN, Chief Nursing Officer, University of Vermont Medical Center
• Teri Pipe, PhD, RN, Dean, College of Nursing & Health Innovation and Chief Wellbeing Officer, Arizona State University​

Part of the appeal of mindfulness​ is the simplicity of its central tenet: bringing awareness and focused attention to the present moment. Mindfulness also offers a measure of control when everything else feels out of control.

As stress-reduction and other health benefits of mindfulness become better known, clinicians are discovering that they, too, need new ways to deal with stress…often on the fly. Practicing mindfulness can be restorative in the middle of a hectic day, create mental space to be more tuned into patients, and reduce the likelihood of medical errors.

So, what does practicing mindfulness look like, in practice? On the March 8 episode of WIHI, Mindfulness and Patient Safety, we learned from two leading experts on how mindfulness can intersect with the health care workforce, their tasks, and their interactions with patients.

WIHI - Aging in Place with a Disability and Dignity

Date: February 22, 2018

Featuring:

• Sarah L. Szanton, PhD, ANP, FAAN, Associate Director for Policy, Center on Innovative Care in Aging, Department of Health Policy and Management, & Johns Hopkins Bloomberg School of Public Health
• Judith Kell, MPA, Manager, Pathways to Better Health, Mercy Health
• Gary Felser, ME, Construction Supervisor, Elder Services at Civic Works

One of the biggest challenges facing older patients with disabilities is that the care and support services needed to function optimally at home are often fragmented — and not always obtainable. Thi​s is especially true for low-income disabled adults whose home circumstances may not fit the bill, literally and figuratively, for what public insurers such as Medicaid and Med​icare will cover.

In a handful of communities in the US, a program called CAP​ABLE​ is demonstrating low-cost, practical ways to fill the void. The research into the health benefits and cost savings associated with CAPABLE are yielding impressive results. Learn how the model works and how it might be spread to other communities on this episode of WIHI: Aging in Place with a Disability and Dignity

WIHI: Practicing More Careful and Thoughtful Diagnosis

Date: February 8, 2018

Featuring:

• Gordon Schiff, MD, Associate Director, Brigham and Women's Center for Patient Safety Research and Practice; Quality and Safety Director, Harvard Medical School (HMS) Center for Primary Care
• Christine K. Cassel, MD, Executive Advisor to Founding Dean, Kaiser Permanente School of Medicine
• Bruce Lambert, PhD, Director, Center for Communication and Health, Northwestern University

We don’t like to think of the diagnosis process as causing as many problems as it’s trying to solve. But when the complaints are more chronic than acute, there’s growing concern that a plethora of diagnostic tests and procedures have raised expectations of always finding a precise answer or explanation. When that's not possible, or tests aren't recommended as the first line of attack, a provider's clinical observations and reasoning can seem less than satisfactory.

It’s this complexity of diagnosis and the difficulty of sometimes having to admit "there's no way to know for sure" that we explored on the February 8 WIHI: Practicing More Careful and Thoughtful Diagnosis. Our guests shared new thinking about better ways to engage with patients when diagnostic certainty isn't possible and how to create strong, trusting relationships that break from the mold of  “doing something” or “doing nothing at all.”

WIHI: What's in a Name? Health Care's Chief Quality Officer.

Date: January 25, 2018

Featuring: ​

• David M. Williams, PhD, Executive Director for Improvement Capability, Institute for Healthcare Improvement (IHI)
• Petrina McGrath, RN, MN, PhD, Executive Transition Lead: People, Practice and Quality, Saskatchewan Health Authority
• James Moses, MD, Chief Quality Officer and Vice President of Quality and Safety, Boston Medical Center

 Health care systems are under tremendous pressure to create and sustain transformative changes on multiple fronts: patient and worker safety, overall quality of care, moving from volume to value, and population health, just to name a few! The job of overseeing these efforts, and nurturing the culture and vigilance required to stay on track, is increasingly the province of the Chief Quality Officer or CQO.

 In many ways, the CQO functions as symbol, sense maker, and keeper of the flame for constant, unwavering, system-level change. The CQO also often marries quality aims with an organization's financial and strategic goals. He or she cannot spearhead these efforts alone, and field research suggests that having a designated CQO position sends the message to staff that leadership takes quality seriously.

 The CQO role is relatively new and still evolving​; in some organizations CQO-like responsibilities reside with an Executive Vice President, CMO, or CNO. Regardless of who is serving in this leadership position, it's important to ask: What do CQOs need to focus on most? We learned how some CQOs define their roles and priorities on the January 25 WIHI: What's in a Name? Health Care's Chief Quality Officer. ​​

 

WIHI: Opioid Crisis: Changing Habits and Improving Pain Management

Date: January 11, 2018

 

Featuring: 

• ​​Glenn Crotty, Jr., MD, FACP, Clinical Associate Professor of Medicine, West Virginia University; Executive Vice President and COO, Charleston Area Medical Center (CAMC)
• Robert B. Saper, MD, MPH, Associate Professor Family Medicine, Boston University; Chair, Academic Consortium for Integrative Medicine & Health
• Shane Coleman, MD, MPH, Division Medical Director, Behavior Services Division, Southcentral Foundation​
• Mara Laderman, MSPH, Director, Innovation, Institute for Healthcare Improvement (IHI)​​

As efforts continue to curb the opioid addiction epidemic in the US and reduce deaths from overdoses​, the underlying problem of overprescribing remains very much in the spotlight. There's growing evidence that clinicians writing prescriptions for Vicodin, Percocet, OxyContin, and the like are adhering to new, stricter guidelines, and doing a better job keeping track of their patients taking opioids. 

 

But with these changes in prescribing, experts and providers are now looking to alternative ways to treat chronic and severe pain, especially for people vulnerable to addiction. On the January 11 episode of WIHI, we talked to providers from West Virginia, Alaska, and Massachusetts about new processes to help providers make careful decisions about the use of opioids, including expanding the use of physical, traditional, and integrative medicine as alternatives to prescribing opioids. We were joined by IHI Director Mara Laderman, co-author of IHI's ​Addressing the Opioid Crisis in the United States white paper​,  who helped draw connections between improving pain managemnt and the other critical drivers of the opioid crisis in America. 

 

We looked at what these providers and organizations are doing to improve pain management and combat the opioid crisis and more on this episode of WIHI: Opioid Crisis: Changing Habits and Improving Pain Management. ​

WIHI: Discovering Your Way to Greatness

Date: December 21, 2017

Featuring:

• Steve Spear, DBA, MS, MS, Principal, The High Velocity Edge, LLC; Author; IHI Senior Fellow

WIHI is pleased to present a Special Edition Podcast, Discovering Your Way to Greatness, featuring author and operations expert, Steve Spear.

Steve Spear, DBA, MS, MS, is principal of The High Velocity Edge, LLC, which provides advisory services and has developed software that enables accelerated problem solving, particularly with distributed workforces. His book, The High Velocity Edge, has won numerous awards. Dr. Spear is a Senior Lecturer in MIT’s Management and Engineering schools, a faculty affiliate at Harvard Medical School and a Senior Fellow at the Institute for Healthcare Improvement. He is an internationally recognized expert on leadership, innovation, and operational excellence, and an authority on how select companies in various industries generate unmatchable performance by converting improvement and innovation from inspiration to repeatable, broad-based, skill-based disciplines.

WIHI recorded Steve Spear’s remarks on December 11, 2017, in Orlando, Florida, at the Institute for Healthcare Improvement’s 29th Annual National Forum on Quality Improvement in Health Care. Dr. Spear has a well-deserved reputation as an engaging speaker who equally draws on his own life experience and work with multiple industries to point out that better ways to do things are absolutely within reach. Solutions often reside in the new behaviors we’re willing to adopt. Steve Spear is passionate about improving health care so great care occurs as advertised, every time, all the time.  

The podcast is one hour; we highly recommend that you have the presentation slides (posted on this page) handy for reference as you’re listening. 

WIHI: The Careful and Kind Patient Revolution

Date: December 7, 2017

Featuring: 

• ​​Victor Montori, MD, Professor of Medicine, Mayo Clinic
• Maggie Breslin, MDes, Director, The Patient Revolution
• Kerri Sparling, Diabetes Advocate; Creator and Author, Six Until Me

When Dr. Victor Montori first started talking about Minimally Disruptive Medicine ​more than a decade ago, he shook the establishment. Dr. Montori, who works with patients with diabetes, had come to believe that shared decision making – an effort to help patients make informed decisions about managing their health problems – wasn't proving all that effective. Dr. Montori felt doctors and nurses weren't factoring in the burden of being a patient with a chronic condition, and the real life challenges – social, economic, or personal – of following prescribed treatment plans. It was time, he argued, for providers to look up from strict protocols and guidelines long enough to get curious about their patients' lives in order to minimize barriers to better health, not add to them. 

 

Fast forward to 2017 and Dr. Montori is more convinced than ever that health care providers need to learn from patients and not the other way around. And to appreciate the circumstances in patients' lives that can compete with managing a chronic condition. This outlook is fundamental to the work of the KER Unit​ Dr. Montori founded at Mayo, the more patient-driven shared decision making​ he now promotes, and a new effort he's dubbed "a patient revolution for careful and kind care." The latter is the focus of a new website​ with recommended reading, tools, and activities.

 

Dr. Montori and his colleagues joined us to discuss this revolution on the December 7 WIHI: The (Careful and Kind) Patient Revolution.

WIHI: Health Care Innovation and R&D - Taking Stock at Ten Years

Date: November 9, 2017

Featuring:

• Lindsay A Martin, Founder, I-Squared Consulting Group; Instructor, T.H. Chan School of Public Health, Harvard University
• Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement (IHI)
• John Whittington, MD, Senior Fellow, IHI; Lead Faculty, IHI Triple Aim ​

The health care quality improvement movement has rallied around some significant innovations over the years, many of which have had a lasting impact. The failure of most hospitals to make real progress on reducing hospital-acquired infections led IHI to launch the 100,000 Lives Campaign​ in 2004. The IHI Open School​ was launched in 2008 to fill in for what too many medical educators were failing to do: incorporate quality and safety into their health professions educational curricula.

Frustration with the slow pace of change is often grist for innovation. Ten years ago IHI chartered an R&D team to engage in a regular, rigorous process of examining and testing new ideas and models for their potential to further QI and improve health and health care. To acknowledge the anniversary, we took a look back at some of what's been catalyzed by IHI's Innovation team, IHI innovations that predate the team's work, and where we still need new approaches. This and more on the November 9 episode of WIHI: Health Care Innovation and R&D - Taking Stock at Ten Years.

WIHI: A New Emergency Checklist for Office-Based Surgery

Date: October 26, 2017

Featuring:

• Fred E. Shapiro, DO, Chair, ASA Committee on Patient Safety and Education; Founder, Institute for Safety in Office-Based Surgery
• ​Alexander Hannenberg, MD, Faculty, Safe Surgery Program, Ariadne Labs; Chief Quality Officer, American Society of Anesthesiologists
• Jennifer Lenoci-Edwards, RN, MPH, Executive Director, Patient Safety, Institute for Healthcare Improvement

These days, no one thinks twice about getting a mole removed or undergoing cataract surgery outside of a hospital. Heading to an office practice or an ambulatory care center for what's considered "minor surgery" tends to be more convenient for the patient and often more cost effective. According to recent figures, upwards of 20 million outpatient procedures are performed in the US each year — everything from cosmetic to knee to eye surgeries. As the numbers rise, so do concerns about safety.

While serious harm, including deaths, remains uncommon in outpatient settings, adverse events can and do occur. When anesthesia is part of the surgical procedure, clinicians and staff need to know about the complications that might arise requiring immediate, lifesaving steps.

What are the complications? What are the specific steps? It's all laid out in a new checklist on this episode of WIHI: A New Emergency Checklist for Office-Based Surgery.

 

 

WIHI: QI Takes on Veteran and Chronic Homelessness

Date: October 12, 2017

Featuring:

• Jake Maguire, MA, Principal, Community Solutions, Built for Zero
• Beth Sandor, Principal, Community Solutions, Built for Zero
• Nate French, Senior Improvement Advisor, Community Solutions
• Ninon Lewis, MS, Executive Director, Institute for Healthcare Improvement

On any given night of the year, the nation's homeless veterans number around 40,000; another estimated 84,000 fit the definition of chronically having no place to live.

Frustrated by the seemingly entrenched situation, a group called Community Solutions​has been using tools and methods and campaign-style momentum adopted from IHI and the health care quality improvement movement to decrease homelessness in the US. Their improvement science approach coupled with a strategy called Built for Zero​ is leading to impressive results.

Community Solutions has taken a rigorous, relentless, real-time, data-driven approach — including careful tracking of individuals by name, and the engagement of a wide range of social services and supports — and they're demonstrating that homelessness can be dramatically reduced. On this episode of WIHI, Jake Maguire, Beth Sandor, and Nate French from Community Solutions  describe communities how they have increased their monthly rates of housing homeless individuals by an average of 266% over four years.