WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Creating Age-Friendly Health Systems

Date: April 20, 2017

Featuring: 

• ​Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation
• Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement
• Lillian Banchero, MSN, RN, Senior Director, Patient Flow/Nursing Operations/Geriatrics, Anne Arundel Medical Center

​This spring, five health systems in the US are embarking on an initiative​ to discover how they can reliably deliver the best care to older adults. It’s not that they’re failing to provide high-quality care now — far from it. But even at exemplar institutions, best practices for older or elderly patients aren’t always top of mind, nor do practitioners always know how they might do things differently. Now, a small group of health systems is about to test some new, evidenced-based interventions that promise to model for the rest of the industry the types of changes needed.

IHI has the fortunate role of guiding this initiative for the next few years, thanks to support from The John A. Hartford Foundation. The Foundation has been pursuing ideal care for older patients for a while now, and has concluded that age-friendly health care should focus on four high-level goals: What Matters, Mobility, Medications, and Mentation.

We’d like you to learn what’s in store and consider your own improvement opportunities on this episode of WIHI, Creating Age-Friendly Health Systems.

WIHI: Who's Your Health Care Proxy?

Date: April 6, 2017

Featuring: 

• Kate DeBartolo, National Field Director, Institute for Healthcare Improvement (IHI) and The Conversation Project (TCP)
• Suzanne Salamon, MD, Associate Chief, Gerontology Division, Beth Israel Deaconess Medical Center
• Ravi B. Parikh, MD, MPP, Resident in Internal Medicine, Brigham and Women’s Hospital (Boston)
• Fiona McCaughan, RN, MS, Cambridge Health Alliance

None of us likes to imagine being unable able to speak for ourselves when it comes to our health care. But situations arise throughout our lives when we need a trusted person to communicate with doctors and nurses on our behalf. And, if we are facing care decisions near the end of life, a trusted proxy can play a crucial role ensuring our wishes are respected. So, does everyone have a documented health care proxy? In all likelihood, no, or not yet, which is why there are numerous efforts underway to close this gap.

 

The Conversation Project, a five-year-old grassroots initiative based at IHI, has just published a new, free resource it believes can help: How to Choose a Health Care Proxy & How to Be a Health Care Proxy. We learned more about this latest proxy kit and the issues surrounding choosing a health care proxy on the April 6 WIHI: Who’s Your Health Care Proxy?

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WIHI: What We're Learning about Patients with Complex Needs

Date: March 23, 2017

Featuring:

• Jose Figueroa, MD, MPH, Instructor of Medicine, Harvard Medical School; Associate Physician, Brigham and Women’s Hospital
• David Labby, MD, PhD, Health Strategy Adviser, Health Share of Oregon
• Marian Bihrle Johnson, MPH, Director of Innovation, IHI

There’s a lot of attention being paid to developing new models to care for and support patients with multiple, complex health problems. And, for good reason. It’s long been known that individuals with chronic, intertwined health and social issues make frequent use of expensive emergency departments or stay away from health care altogether until things get really bad. The motivation of providers to change this situation is strong. So is their desire to find out how others are addressing the problem, to avoid starting from scratch.

That’s where a newly available online resource comes in called The Playbook: Better Care for People with Complex Needs. Spearheaded by five foundations and developed by IHI, this episode of WIHI orients you to the Playbook’s rich offerings. For more information and context on the podcast, we encourage you to download the resources, chat, and slides offered below.

WIHI: The Right Care, Right Setting, and Right Time of Hospital Flow

Date: March 9, 2017

Featuring:

• Frederick C. Ryckman, MD, Professor of Surgery, Senior Vice President, Medical Operations, Cincinnati Children’s Hospital Medical Center (CCHMC)
• Uma R. Kotagal, MBBS, MSc, Executive Lead, Community and Population Health, CCHMC
• Pat Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement

Making sure patients get the right care, in the right place, at the right time couldn’t be a clearer set of aims. And yet achieving them isn’t so simple, especially at large health systems. It requires a number of underlyi​ng system improvements, including well-designed hospital flow. This has been a focus for health care for the past few decades, often prompted by bottlenecks and overcrowding in emergency departments (EDs). Things are getting better in some places, but there’s definitely a ways to go.

IHI’s work on hospital flow dates back to the early 2000s. That’s when we and hospital teams started learning about the ways most hospitals scheduled their operating rooms, practically ensuring backups and delays there and in EDs because of the frequent mismatch between planning for emergency surgeries and elective ones. We check in on progress and the issues still bedeviling improvers ― along with the latest on what sorts of changes are necessary on the March 9, 2017, WIHI: The Right Care, Right Setting, and Right Time of Hospital Flow.

WIHI: Claiming the Edge with Quality Improvement in Communities

Date: February 23, 2017

Featuring:

• Ninon Lewis, MS, Executive Director, Institute for Healthcare Improvement (IHI)
• Soma Stout, MD, MS, Executive External Lead for Health Improvement, IHI
• Greg Vandenberg, Director of Giving and Community Engagement, USVenture, Inc.
• Susan Hannah, Head of Improvement Programmes – Early Years Collaborative & Raising Attainment for All, Scottish Government
• Renee Boynton Jarrett, MD, ScD, Founding Director, Vital Village Community Engagement Network

What do communities in Northeast Wisconsin, Scotland, and Boston have in common? More than you might think. Increasingly, they share a view of what it takes to build coalitions and collaborations that can change the trajectory of people’s lives and health… for the better. And in all three locations, the methods and tools of quality improvement (QI) to tackle socioeconomic issues ― not just health status ― are proving to be a game changer.

Increasingly, we’re recognizing that health care needs to look beyond its walls to better understand and influence the upstream issues impacting health. What we don’t always appreciate is that some communities focused on reducing poverty or creating early childhood pathways to school readiness are now applying the same improvement methodology that’s helped health systems improve care. This increasingly shared mindset bodes well for the creation of more sophisticated alliances across sectors to address many of the underlying contributors to poor health.

To illustrate what this looks like on the ground, the February 23 WIHI shines a light on three community initiatives: the Children and Young People Improvement Collaborative in Scotland  the NE Wisconsin Poverty Outcomes and Improvement Network Team (POINT); and Vital Village (part of SCALE) in Boston. You’ll hear about the role of funders; the enormous difference a broad coalition of stakeholders can make; that relationships matter right along with good leaders; and that improvement skills ―​ knowing how to develop driver diagrams, how to conduct small tests of change, and what and how to measure ―​ can not only be taught, they can move the dial.

WIHI: Practicing Respect and Preventing Harm

Date: February 9, 2017

Featuring:

• Patricia E. Folcarelli, RN, MA, PhD, Interim Vice President, Health Care Quality, Beth Israel Deaconess Medical Center (BIDMC)
• Lauge Sokol-Hessner, MD, Attending Physician; Associate Director, Inpatient Quality, Silverman Institute, BIDMC
• Erica Dente, Patient Family Advisor, BIDMC
• Frank Federico, RPh, Vice President, Institute for Healthcare Improvement (IHI)

Most of us know what it feels like to have an interaction with someone that can feel rushed, incomplete…maybe even abrupt or downright rude. When that’s the type of encounter patients have with health care providers and staff, it cannot only be upsetting but have other consequences: patients may lose confidence in those overseeing their care, withhold information, and generally withdraw from the treatment process.

One major health system has decided it’s high time we track and label these situations for what they are: emotional harm. They shared with the WIHI audience what led them to become far more proactive about the lack of respectful and dignified engagement with patients; how they hear about and track incidents and complaints; and what strategies they deploy to address the most common offenses.

Find out why they happen, and what steps can be taken to prevent and respond to emotional harm on the February 9 WIHI: Practicing Respect and Preventing Emotional Harm.

WIHI: The Next Wave of Patient Safety

Date: January 26, 2017

Featuring:

• Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI)
• Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, IHI

What are your plans to improve patient safety in 2017? Are they hospital-specific or do they extend across the continuum of care? Are they proactive or reactive? Is the work part of an overall system of safety, knitted together by an engaged staff, a thriving safety culture, and continuous learning? However you answer these questions, IHI is heading into the new year more determined than ever to help hospitals and health systems make greater gains in reducing harm to patients, anchored by a renewed focus and new framing.

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Who better to explain all this than IHI President and CEO, Derek Feeley, and IHI President Emeritus, Don Berwick. Derek was eager to talk about six principles that organizations can use to guide their safety work going forward. Among them: Shifting from a mindset of preventing things from going wrong to making as many things as possible go right; and inviting patients and families into the process of co-producing safety as opposed to keeping their input at arm’s length.

 

What are some ways to translate this deepening perspective into action? How do you stay focused on patient safety when so many other performance expectations in health care demand your attention?  ​

WIHI: Improving the Rate of Recommended Care: Looking Back and Looking Ahead

Date: January 12, 2017

 

Featuring:

• Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement
• Elizabeth A. McGlynn, PhD, Vice President, Kaiser Permanente Research

A little over 13 years ago, a team of researchers reported in the New England Journal of Medicine that adults in the US receive only about half the care that’s recommended to prevent, treat, and manage some 30 leading causes of illness and death. The study, by then RAND Corporation health care analyst and lead author Beth McGlynn, acted as a call to action, challenging providers to do much, much better at incorporating evidence-based practices.

 

Has the situation improved? Not nearly enough, according to a study first published online in 2016 in the Journal of the American Medical Association’s JAMA Internal Medicine. Why that's the case is the focus of the January 12 WIHI: Improving the Rate of Recommended Care. In the spirit of January, we looked back and looked ahead with Beth McGlynn and Don Berwick, two health care luminaries who have devoted their careers to the uptick of evidence-based care and improving quality in health care. 

WIHI: Moving Upstream to Address the Quadruple Aim

Date: December 15, 2016

Featuring:

• Rishi Manchanda, MD, MPH, Chief Medical Officer, The Wonderful Company; President & Founder, HealthBegins 

WIHI is pleased to present a Special Edition Podcast, featuring Rishi Manchanda of HealthBegins, discussing why it’s important for health care to “move upstream” to address the social determinants contributing to many patients’ poor health today. Dr. Manchanda also argues that if frontline providers are asked to address upstream factors like poor housing or job insecurity, they need to have the resources and the knowledge and the active partnerships to draw from. Otherwise, they’re at risk for burnout and anything but joy in work. This is why Dr. Manchanda and some others suggest we consider expanding the IHI Triple Aim to the “Quadruple Aim” to include critically important job satisfaction.

WIHI recorded Dr. Manchanda’s remarks on December 5, 2016, in Orlando, Florida, at the Scientific Symposium, held in conjunction with the Institute for Healthcare Improvement’s 28th Annual National Forum on Quality Improvement in Health Care. 

The podcast is over an hour long; we highly recommend that you have the presentation slides (posted on this page) handy for reference as you’re listening. At the conclusion of Dr. Manchanda’s remarks, IHI’s Dr. Don Goldmann moderates a brief Q&A. 

WIHI: Measures That Matter: Whole System Measures 2.0

Date: December 1, 2016

Featuring:

• Lindsay A. Martin, MSPH, Executive Director and Improvement Advisor, Institute for Healthcare Improvement (IHI)
• Alide Chase, MS, Senior Fellow, IHI
• Jeff Rakover, MPP, Research Associate, IHI

The health care quality improvement movement in the US is in the midst of an important discussion and debate about reducing measurement burden and homing in on measures that really matter. Against a backdrop of hundreds of improvements that are being tracked and reported on by thousands of health systems in the US alone, guidance on which measures are most important to the pursuit of better care, better health, and lower cost couldn’t be more timely.

 

The Institute for Healthcare Improvement (IHI) has a longstanding interest in measures that health and health care leaders, including hospital trustees, can make sense of and track. Strong examples of this focus are two IHI White Papers: Whole System Measures(published in 2007) and A Guide to Measuring the Triple Aim (published in 2010). Now, IHI is pleased to introduce the field to Whole System Measures 2.0: A Compass for Health System Leaders, a brand new IHI White Paper we discussed on the December 1 WIHI: Measures That Matter: Whole System Measures 2.0.