WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: How to Speak Up for Safety

Date: November 17, 2016

Featuring:

• Joanne Zee, BScPT,  MSc, MCPA, Senior Clinical Director, Brain and Spinal Cord Rehab Program, Toronto Rehab, University Health Network (Toronto, Canada)
• Brenda Kenefick, Director, Lean Process Improvement, University Health Network
• Gregg Meyer, MD, MSc, Chief Clinical Officer, Partners Healthcare System (Boston, MA)

We’d like to think that robust safety cultures are so common in health care organizations today, everyone is comfortable pointing out missteps and discrepancies to their colleagues and even getting better at bringing them to the attention of their supervisors. Not so fast.

 

Consider this scenario: A patient is being discharged from the hospital and you, a staff person, notice that the discharge nurse has been called away from the bedside and left the patient’s chart on a table where anyone can view it. Here’s another one: You observe a doctor not washing her hands before entering a patient’s room. And, there’s this: You spot the same equipment, a monitor, in a hospital hallway for several weeks in a row. There’s no note on it, and you and your colleagues, who also notice the machine, never inquire if there’s something wrong with it or why it’s been sitting there for so long.

 

So, what do these situations have in common? Well, in each there’s an opportunity to speak up, or speak to someone about behavior or a situation that’s problematic, especially where patient safety is concerned, and you don’t. How come?

That's what we looked into on the November 17 WIHI: How to Speak Up for Safety. 

WIHI: Building Systems of Safety

Date: November 3, 2016

Featuring:

• Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement
• Allan Frankel, MD, Principal, Safe and Reliable Healthcare

Hundreds of hospitals in the US, Canada, Europe, and elsewhere have made significant progress reducing incidents of harm related to hospital-acquired infections, pressure ulcers, surgical errors, and more. At the end of September, when the Centers for Medicare & Medicaid Services (CMS) announced a new initiative to improve patient safety, it reported that the US hospitals that took part in its prior program saved some 87,000 lives. CMS now wants to build on those results. That’s all good news, but there's more work to be done.

 

Carol Haraden and Allan Frankel, who between them have worked with hundreds of hospitals on improving safety, point to a few factors as sources of concern: research in the US using Trigger Tool methodology, which suggests that overall rates of harm remain stubbornly high despite all the hard work; ongoing challenges health care is having building safety across the continuum of care; and increasing preoccupation with meeting certain targets due to payments or penalties for performance. Haraden and Frankel argue that the last item in particular has shifted the focus away from communication and handoff failures, two major underlying contributors to patient harm.

 

So, what’s the alternative? Systems of safety, culture change, reliability, and a continuous learning system. These are not just theoretical concepts; they’re grounded in a lot of keen observations and careful work over many years — and they're the focus of this episode of WIHI.

WIHI: Engaging and Supporting Family Caregivers

Date: October 20, 2016

 

Featuring:

• Jennifer Wolff, PhD, Associate Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine
• Meg Kabat, LCSW-C, CCM, National Director, Caregiver Support Program, US Department of Veterans Affairs
• Rebecca A. Stametz, DEd, MPH, Senior Director, Clinical Innovation, Geisinger Institute for Advanced Application
• Carol Levine, MA, Director, Families and Health Care Project, United Hospital Fund
• Christina Gunther-Murphy, MBA, Executive Director, IHI

A lot has been said and written over the years about the important role family caregivers play on behalf of loved ones with various health conditions and disabilities. But acknowledgment of the estimated 42 million family caregivers in the US alone hasn’t always translated into needed support. All sorts of groups and agencies have done their best to help family caregivers navigate health care, locate resources, and, importantly, find one another. But, notably, outreach from the health care system itself has often been the missing link. That’s starting to change, and it was the subject of this WIHI.

Some of the pressure is coming from family caregivers and policy advocates alike. They’re drawing attention to the growing number and complexity of medical tasks family caregivers are being asked to perform for patients at home. According to one major report, nearly half of family caregivers now routinely manage multiple medications, help with assistive devices, prepare special diets, provide wound care, use monitors, and operate specialized medical equipment.

 

As this level of care has shifted from hospital to home, advocates say clinicians and staff need to do a much better job ensuring that family caregivers have the time, skills, and information needed to fulfill expectations. This message is now resonating with health care providers like never before. Especially as they are held accountable for avoidable hospital readmissions, this means making sure discharged patients do well (and their conditions are well managed) in any setting, including the home.  

WIHI: Improving Patient Experience: What's Working, What's Not

Date: October 6, 2016

Featuring:

• Martha Hayward, IHI Faculty and Patient Advisor
• Cody Mullen, Doctoral Candidate/Associate Instructor, Indiana University– Purdue University at Indianapolis
• Robert Doherty, Senior Vice President, Governmental Affairs and Public Policy, American College of Physicians
• ​Cheri C. Wilson, MA, MHC, CPHQ, Public Speaker and Trainer — Diversity and Inclusion, Cultural and Linguistic Competence, Health Equity

Are patients and family members feeling more positive about the experiences they’re having in the US health care system? Are they feeling more connected to their care teams? With so much attention being paid to improving patient satisfaction scores, and with patient-centered care so central to just about every health care organization’s strategic goals and mission, you’d think the answer would be a resounding yes.

But the picture is decidedly mixed, according to recent surveys and many champions of person- and family-centered care (PFCC). Research and anecdotal evidence suggest that too many patients continue to have negative health care experiences — even when providers feel that they’re making improvements and actively engaging patients.

We explored the disconnect and the dynamics of the patient experience on the October 6 WIHI: Improving Patient Experience — What's Working, What's Not.

WIHI: What's Next for Electronic Health Records

Date: September 22, 2016

Featuring:

• John D. Halamka, MD, MS, International Healthcare Innovation Professor at Harvard Medical School, Chief Information Officer, Beth Israel Deaconess Medical Center (BIDMC)
• Laurance Stuntz, Director, Massachusetts eHealth Institute
• ​Jill Duncan, RN, MS, MPH, Executive Director, Institute for Healthcare Improvement (IHI) 

What do we want from electronic health records? Well, it all depends on who you ask. If you ask health care providers — doctors, nurses, and other practitioners — be prepared: they often have long lists of frustrations with the very tools that promised to make taking care of patients a lot more reliable, safe, and efficient. Patients often have a difficult time navigating new online portals, too. That's not to say EHRs haven't made many things better, and there's certainly no going back. But what about fixing those daily headaches and workarounds with EHRs we're now hearing so much about, and designing or redesigning the software so it better matches what health care practitioners and patients need? Is the vendor community listening?

 

The IHI Leadership Alliance  has spent the past year learning about the discontent with EHRs and has compiled a series of observations and recommendations in hopes of instigating important changes. Members of the Leadership Alliance also sat down with vendors and officials from the US Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) this past spring to discuss widespread concerns. Among them: the digital transformation in health care has lacked sufficient input from the provider community to inform design; and pressure from government has put too much focus on regulatory compliance and documentation, which has led to rushed efforts to digitize paper records in health care most of all.

 

So, now what? What changes are possible and likely in the near term? That's what our guests sought to understand on the September 22 WIHI, "What's Next for Electronic Health Records?"

WIHI: How Health Care Can Accelerate Health Equity

Date: September 15, 2016

Featuring:

• Ronald Wyatt, MD, MHA, Patient Safety Officer and Medical Director, Office of Quality and Patient Safety, The Joint Commission
• Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement
• Anurag Gupta, MPhil, JD, Founder and CEO, Be More America
• Abigail Ortiz, MSW, MPH, Director of Community Health Programs, Southern Jamaica Plain Health Center
• Alex Anderson, Research Associate; Co-Chair, Diversity and Inclusion Council, IHI

What might be possible if health care organizations across the US made a commitment to work to achieve health equity in their communities in dramatically new ways? This is something IHI, in collaboration with partners who've been wrestling with health inequities for years, have been looking into in search of fresh solutions. The results of this exploration are captured in a new IHI White Paper and make up the discussion featured on the September 15 WIHI: How Health Care Can Accelerate Health Equity.

 

So, how might your health care system or hospital or clinic build on work you’re already doing or take things in a new direction? Our guests offer suggestions and lay them out as part of a new framework that includes making health equity a strategic priority at the highest levels and throughout your organization. A good starting point can be conducting a comprehensive health equity self-assessment. In addition to sharing an overview of the framework, we focused on steps your organization can take to reduce implicit or “unconscious” bias among providers and staff. Unexamined and implicit bias at the point of care because of someone’s race, gender, ethnicity, economic status, disability, and more can undermine the best efforts to reduce treatment and outcome disparities. It’s not easy to surface and talk about these issues, but it’s crucial.

WIHI: 100 Million Healthier Lives: From Vision to Reality

Date: July 28, 2016

Featuring:

• Marianne McPherson, PhD, MSPH, Director, 100 Million Healthier Lives Implementation
• Soma Stout, MD, MS, Executive Lead, 100 Million Healthier Lives
• Laura Brennan, MSW, Co-Chair, 100 Million Healthier Lives Leadership Team
• Drew Martin, MS, Leadership Team, 100 Million Healthier Lives
• Shanika L. Blanton, Ph.D., Director of Curriculum Development and Assessment, Ra-messut Academy of Higher Learning, Chicago Chapter

The goal, when you first hear it, is daunting: We will help 100 million people live healthier lives by 2020. One hundred million. Not 1 million. Not 10 million. Not even 50 million. But 100 million. In a way, it sounds abstract, something someone hangs on a wall and then looks at for inspiration every once in a while.

 

But the goal (and the work to get there) is very concrete.

 

For nearly two years, the “unprecedented collaboration of change agents across sectors” convened by the Institute for Healthcare Improvement has been changing the world in meaningful ways. Hundreds of communities around the world are working with kids, veterans, and elders on move-the-needle priorities like nutrition, mental health, and equity — the price of admission to 100 Million Healthier Lives.

 

We explored the first two years of the project and looked forward to its future on the July 28 WIHI, 100 Million Healthier LIves: From Vision to Reality.

WIHI: Five Practical Strategies for Managing Successful Improvement Projects

Date: June 30, 2016

Featuring:

• Karen Baldoza, MSW, Executive Director, Institute for Healthcare Improvement (IHI)
• ​Christina Gunther-Murphy, MBA, Executive Director, IHI
• Julianna Spranger, University of Wisconsin Health Improvement Coach

You have a great idea for an improvement project to reduce infection rates at your organization. You and your team have created a meaningful aim, crafted a useful set of measures, and brainstormed several creative change ideas to test in the coming months. There’s support from leadership, energy from staff, and excitement around every corner. You’re ready to go!

 

Except for one thing — now you need to successfully manage the project.

 

Managing a quality improvement project is a critical skill for anyone interested in making care — and systems — better where they work. But for many in health care, project management is not a full-time job. In fact, there’s a sizable gap between coming up with a great idea for a project and guiding a team to successful, meaningful improvements. Bridging that gap is what we discussed on this WIHI.

 

Whether you're about to manage your first improvement project or your 50th, whether you manage teams of four or teams of 40, this episode of WIHI will show you the strategies you can test and use immediately, examples you can share with colleagues, and valuable tools you can bring to your next quality improvement project.

WIHI: Nurturing Trust: Addiction and Maternal and Newborn Health

​Date: June 2, 2016

 

Featuring:

• Helen Bellanca, MD, MPH, Associate Medical Director, Health Share of Oregon
• Nancy Goler, MD, Regional Director for Early Start, Kaiser Permanente Northern California
• Daisy Goodman, CNM, DNP, MPH, Perinatal Addiction Treatment Program, Dartmouth Hitchcock Medical Center
• Marian Bihrle Johnson, MPH, Director of Innovation, Institute for Healthcare Improvement (IHI)
• Jeffrey Rakover, MPP, Research Associate for Innovation, IHI

Addiction is always a complex challenge, but when a woman using substances is pregnant, suddenly two lives are at stake. Despite the difficulty of the situation, people in a position to help can increase the odds of a healthy pregnancy and good birth outcome. That’s the underlying principle behind numerous efforts in the US to reach out to pregnant women with drug dependency and to integrate treatment for addiction with perinatal care.

Such models are getting more attention because of the current opioid crisis and an alarming rise in neonatal abstinence syndrome. We discussed three particularly promising initiatives with the innovators who developed them on the June 2 WIHI: Nurturing Trust: Addiction and Maternal and Newborn Health.

 

Update: Hospitals & Health Networks covered the June 3rd WIHI. 

WIHI: Health Care in Motion: Making Sense of a Moving Picture

​Date: May 26, 2016

Featuring:  

• Don A. Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement
• David M. Williams, PhD, Executive Director, Institute for Healthcare Improvement

Last month, researchers at Johns Hopkins called upon the US Centers for Disease Control and Prevention (the CDC) to rethink how it classifies the country’s “leading causes of death.” The authors argue that deadly medical errors, conservatively estimated at over 250,000 annually, should be included in the rankings — which would make medical errors the third leading cause of death in the US, just after heart disease and cancer. It’s a provocative idea AND it raises the question: What difference would this make? Would it accelerate efforts to reduce preventable patient deaths? Would it make the problem more prominent and more intolerable, adding urgency to research and public policy?

IHI's Chief Scientific and Medical Officer Don Goldmann joined us on this WIHI to take a look at the current state of quality improvement and the new value-driven initiatives that have health care organizations undertaking unprecedented levels of financial risk and undergoing rapid transformation. He was joined by IHI's improvement guru, Dave Williams, to engage the audience on why it can be so hard for the US health care system to measure patient-reported outcomes, the proliferation of measures, and whether "value-based" payment can work.