WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI: Joy in Work: An Antidote to Today's Burnout in Health Care

Date: May 5, 2016

Featuring:

• Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI)
• Stephen Swensen, MD, MMM, FACR, Medical Director for Leadership and Organization Development, Mayo Clinic
• Kathy Kerscher, Team Leader of Operations Primary Care, Bellin Health
• Joanna D’Aflitti, MD, MPH, Associate Medical Director for Primary Care Quality and Innovation, Boston Medical Center

When we hear about physician and staff burnout these days, a lot of attention focuses on the pressures health care is under to deliver much, much better care, much more cost effectively. These pressures and expectations are impacting hospital systems, already busy office practices, and, very importantly, individual practitioners themselves who often feel they’re being asked to do more without the necessary resources. What can make the difference between having the tools and the support to manage new realities vs. being overwhelmed and drained? Plenty —​ and that’s why we hope you’ll listen to this WIHI.

 

Our panelists have been confronting the problems of burnout and staff frustration head on in their own organizations, and they came to WIHI to share what they’re learning. Joy in Work is a hugely important topic for the health care workforce and for the patients whose care can be compromised when staff aren’t at their best, but it is not about pizza parties and papering over the issues. Instead, it’s about finding new ways to remove day-to day barriers on the job; to improve the systems that are supposed to help with work flow but aren’t always delivering, such as electronic health records (EHRs); and to ensure that leaders at all levels are listening, really listening.

WIHI: The Opioid Crisis: How Health Care and the Community Can Act

Date: April 21, 2016

Featuring:

• Joseph Foster, JD, New Hampshire Attorney General, New Hampshire Department of Justice
• Joel Hyatt, MD, FAAFP, Emeritus Assistant Regional Medical Director, Kaiser Permanente, Southern California
• Lindsay Martin, MSPH, Executive Director and Improvement Advisor, Institute for Healthcare Improvement (IHI)
• Mara Laderman, MSPH, Senior Research Associate, IHI

The US is in the midst of a serious opioid addiction epidemic. Driven largely by an explosion of prescribed pain medications, the dramatic rise in addiction and deaths from overdoses (quadruple what they were in 1999, according to the Centers for Disease Control and Prevention) now has the attention of just about every sector of society that can play a role in addressing the problem. This includes innovative approaches coming from law enforcement, local, state, and federal health departments, drug treatment programs, community groups, and health care delivery.

 

While providers who write prescriptions for painkillers such as OxyContin are under particular pressure to do a much better job assessing a patient’s need for pain medication and risk of becoming addicted, it’s clear there’s no single or simple solution to the current crisis. That’s why IHI’s Innovation team has been scanning for the best practices that comprise a community-driven, integrated, and multi-sector approach. We discussed these elements and the response to the opioid epidemic on this WIHI.

 

Our guides included Lindsay Martin and Mara Laderman, two members of IHI’s Innovation team, and two people that IHI has learned a lot from; New Hampshire Attorney General Joseph Foster and Kaiser Permanente’s Joel Hyatt. Kaiser Permanente has been working hard to curb opioid prescribing in its system for several years, leveraging every means possible. The work is paying off in dramatic decreases in written prescriptions. In New Hampshire, hit hard by both a heroin epidemic and the opioid prescription crisis, Joseph Foster’s outlook reflects that of many in his government position. He’s attempting to engage the most effective and innovative strategies to impact public health and public safety.

 

WIHI: Breaking the Rules: Lessons from IHI’s Leadership Alliance

Date: April 7, 2016

Featuring:

• Saranya Loehrer, MD, MPH, Executive Director, North America Strategy and Operations, Institute for Healthcare Improvement (IHI)
• Helen Macfie, PharmD, FABC, Chief Transformation Officer, Certified Lean Leader, MemorialCare Health System
• Carolyn Candiello, Vice President, Quality and Patient Safety, GBMC HealthCare, Inc.
• Cate O’Connor-Devlin, RN, BSN, Administrative Director of Patient Throughput/Nurse Safety, GBMC Healthcare, Inc.
• Rhonda Holden, MSN, CENP, Chief Nursing Officer/Administrator Patient Care Services, Kittitas Valley Healthcare, Ellensburg, WA
• Cheryl Woodman, ND, MHSc, CHE Chief Strategy Officer, Women’s College Hospital (Toronto, Canada)

It started from a very human place. Hospital staff found a way for a new mom recovering in the ICU, and her infant in the NICU, to visit with one another in the aftermath of a difficult birth. When the mom and dad were asked later on about their hospital experience, they singled out this breaking (or bending) of the rules that ensured mother and newborn had time together even while both were in intensive care. That got the hospital, MemorialCare Health System, asking some new questions: What are the rules that both staff and patients continue to run up against? Why do some rules persist, interfering with a more optimal care experience, even after they’ve been relaxed or retired? Are some rules misinterpreted, and still others more like myths that live on just because “we’ve always done it this way?"

 

The answers were revealing — and got others thinking, too. MemorialCare is part of IHI’s Leadership Alliance; when Alliance members heard about MemorialCare’s experience, they decided to find out what was happening in their own organizations. They did this with a campaign in January 2016 they dubbed “Breaking the Rules.” We learned about the campaign and how Leadership Alliance members came up with nearly 400 rules in need of a second look on this WIHI.

WIHI: The New World of Co-producing Health and Health Care

Date: March 24, 2016

Featuring:

• Maren Batalden, MD, MPH, Associate Chief Quality Officer and Associate Director of Graduate Medical Education for Quality and Safety, Cambridge Health Alliance
• Kathy Sabadosa, MPH, Senior Research Director, Dartmouth Institute for Health Policy and Clinical Practice
• Sarah Myers, MPH, RN, Executive Improvement Director, ImproveCareNow, Cincinnati Children’s Hospital Medical Center
• Julie Bass, DO, Medical Director, Pediatric Inflammatory Bowel Disease Program, Children’s Mercy Hospital (Kansas City, MO)
• Jamie Hicks, RN, Lead Parent of Patient & Family Advisory Council, Children’s Mercy Hospital IBD Program
• Christina Gunther-Murphy, Executive Director, Institute for Healthcare Improvement (IHI)

When we say patients and clinicians should be “co-producing health and health care,” do we really mean it? Dr. Maren Batalden from the Cambridge Health Alliance certainly hopes so. In fact, in her recent article on the subject, she and her co-authors assert that a form of co-production already exists in health care today — in the natural give-and-take between patients and providers around treatment and care decisions; and in the assets that patients and practitioners each bring to the table. But we have yet to realize the full promise of co-production —​ the opportunity to optimize this “collaboration” to achieve much better health and health outcomes. In other words, when patients and providers consciously work together, toward common goals, all kinds of possibilities open up.

 

Co-production does require a paradigm shift and for medical staff, letting go of seeing themselves as the sole engines and creators of the “product” known as health care. In fact, Dr. Batalden and her co-authors argue, health care isn’t a product at all, but a service which both “sides” engage in and have an opportunity to shape. At its most basic level co-production is an exciting new way to frame mutually respectful, helpful relationships, including among clinical staff. Dr. Batalden says it best: “Health care is not a product manufactured by the health care system, but rather a service which is co-created by health care professionals in relationship with one another and with people seeking help to restore or maintain health for themselves and their families.

 

These are the conversations and concepts that make up the excellent March 24 WIHI: The New World of Co-Producing Health and Health Care.

WIHI: A New Framework for Safety in Ambulatory Care

Date: March 10, 2016

Featuring:

• Mark Jarrett, MD, MBA, MS, Chief Quality Offer and Senior Vice President, Northwell Health
• Fran Ganz-Lord, MD, FACP, Director of Ambulatory Quality & Medical Director, Northwell Health Premium IPA Network and Northwell ACO
• Ann Lewis, CEO, CareSouth Carolina
• Tejal Gandhi, MD, MPH, CPPS, President and CEO, National Patient Safety Foundation, Lucian Leape Institute, Certification Board for Professionals in Patient Safety
• Jennifer Lenoci-Edwards, RN, MPH, CPPS, Director, Patient Safety, IHI

What comes to mind when you think about patient safety in the ambulatory setting? Infection rates? Probably not. The issues are of course quite different in outpatient care, and that's one reason it's not always obvious to practitioners and staff which of their many daily activities might inadvertently contribute to patient harm. Activities such as failing to follow up on patient referrals, or to communicate test results. Or getting frustrated with the EHR and creating workarounds.

 

IHI's patient safety leads have been doing a lot of thinking about the need for a new safety framework suited to ambulatory care in order to better highlight the unique fault lines and improvement priorities for this setting. Components of this framework and how they’re being tested and applied, as well as real-world examples from Northwell Health and CareSouth Carolina, are explored on this WIHI.

WIHI: Making Data Work for Quality Improvement

Date: February 25, 2016

 

Feauturing:

• Leonard D’Avolio, PhD, Assistant Professor, Brigham and Women’s Division of General Internal Medicine and Primary Care; CEO and Co-founder, Cyft
• Kedar Mate, MD, Senior Vice President, Institute for Healthcare Improvement

If you’re going to measure, as we know health care improvers must do, you’re going to generate data. But in a world where there increasingly seems no end to what can be tracked and quantified and analyzed, there’s a real danger of creating a lot more data than you truly need. It’s great to have the data, and electronic health records are making it easier to obtain and store tons of information, but now what? How can it be put to good use? Will it make patients safer and healthier? Will it help determine where the gaps are? Reduce visits to the ED? Increase visits to primary care? If you’re starting to wonder what you’re doing with all your data, you might want to listen to this WIHI. 

 

Our guide for this discussion is someone who’s been doing a lot of thinking, and advising, and writing on the growing focus in health care on data, and the hype that may be getting in the way. Len D’Avolio has spent the past dozen years working to make data useful for hundreds of health systems, health plans, and foundations. He uses the phrase “data thinking” to describe a process that can ensure whatever data you’re generating or mining has a clear purpose and context. Len unpacked this process and connected it to some strong organizational examples and experiences. IHI’s Kedar Mate  joined Len to underscore the need for improvers to “measure what matters” and addressed the challenge of top-down mandates driving agendas and data collection, in the absence of clear plans for how to make the best use of data.

WIHI: Morality Matters: How to Reset the Mission of Quality Improvement

Date: February 18, 2016

Featuring:

•  Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement
• Jessica Berwick, MD, MPH, Internist, Beth Israel Deaconess Medical  Center (Boston)

What is the “true north” for the health care quality improvement movement? What are the questions leaders and champions of quality and safety initiatives must periodically ask themselves as a natural part of the process of seeking dramatic change? If you’re IHI’s founder and President Emeritus and Senior Fellow, Don Berwick, the questions, and the answers, are often moral ones. Don is known for reminding improvers at critical moments that whatever they’re working hard on must, finally, come back to the patients themselves and principles of service and healing relationships. When the vision starts to go blurry in a miasma of metrics and measures and monitoring, Don argues, we lose our way.

In December, Don took to the podium at IHI’s National Forum in Orlando and delivered a keynote calling for what he labeled a “moral era” for the health care quality improvement movement — Era Three. In the keynote, Don outlined five developments from earlier eras that he believes have started to obscure the improvement movement’s sense of purpose: excessive measurement; complex (pay for performance) incentives; preoccupation with money; and professional prerogative. Increasing attention to five activities in Era Three, broadly defined, can help: improvement science; transparency; civility; listening (to patients, family members, and staff); and rejecting greed.

During this WIHI, Don was joined by his daughter, Dr. Jessica Berwick, an internist at Beth Israel Deaconess Medical Center in Boston, who shared the perspective of a relatively new physician navigating many of the competing forces Don describes in his speech.

WIHI: New Tools and Thinking for Shared Decision Making

Date: January 28, 2016

Featuring:  

• Victor Montori, MD, Professor of Medicine, Mayo Clinic; Director, Late Stage Translational Research, Mayo Center for Clinical and Translational Science
• Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement (IHI)
• Kasey Boehmer, MPH, Health Services Researcher, Knowledge and Evaluation Research (KER) Unit, Mayo Clinic
• Dave Paul, Secretary, KER Unit Patient Research Advisory Group, Mayo Clinic

 

If you work in primary care today, odds are good that you’re seeing patients with multiple chronic conditions. Individuals with combinations of diabetes, high blood pressure, arthritis, and depression are rapidly becoming the norm in outpatient offices and clinics. And even if a provider and patient work together to choose the right medications and agree on making some lifestyle changes that will improve health, the best-laid plans often fall apart. Labeling patients “noncompliant” has been a tempting response but, many argue, is pejorative and tends to obscure what’s really going on – especially if one starts to better appreciate the unique and day-to-day burdens of being a patient with chronic disease.

  

There’s a lot of work underway on multiple fronts to advance shared decision making, but one of the freshest, most innovative voices is that of Dr. Victor Montori, who lead the conversation on this program of WIHI, "New Tools and Thanking for Shared Decision Making." Dr. Montori, who’s already carved out the idea and practice of Minimally Disruptive Medicine, still wants to provoke. He talks about the need for a patient revolution and says “health care has to compete with life.” And “life” in the case of a patient can mean anything from not being able to afford medications, to not having the time to take them, to not being able to focus on one’s own health because of stresses at home or another family member’s health crisis. 

 

WIHI: Realizing “What Matters” (to Patients and Families)

Date: January 14, 2016

Featuring:

• Beth Hennessey, RN, MSN, Executive Director of Integrated Care Management, Sutter Center for Integrated Care
• Paula Suter, RN, MA, Director of Clinical Care, Sutter Center for Integrated Care
• Geraldine Marsh, Improvement Advisor for Older People’s Care, NHS Greater Glasgow and Clyde Healthcare Improvement Scotland
• Jennifer Rodgers, Chief Nurse, Pediatrics and Neonates, NHS Greater Glasgow and Clyde Healthcare Improvement Scotland
• Christina Gunther-Murphy, Executive Director, Institute for Healthcare Improvement (IHI)

A few years ago, IHI and others began suggesting to providers that instead of routinely asking patients “What’s the matter with you?” they should begin asking “What matters to you?” Ever since, many have been struck by the richness and the value of what they learn when they ask this apparently simple question. So much so, champions of this concept in the improvement community are now working hard to spread the practice. And they’re demonstrating how to reliably embed it into routine habits of providing more patient-centered care.
 
IHI has been tracking these developments, and we’d like to share what we’re finding out with this WIHI. We headed out to the West Coast of the US (Sutter Health) and across the pond (NHS Scotland) for terrific examples of what’s possible when clinicians are genuinely curious about a patient’s priorities at any single encounter, over the course of an illness, or when dealing with a chronic disease.

 

Read the related blog post: A Simple Question to Put Patients in the Driver's Seat

WIHI: Personal Mastery for Transformational Leadership

Date: December 17, 2015

Featuring:

• Neil Baker, MD, Neil Baker Consulting and Coaching LLC; Faculty, Institute for Healthcare Improvement (IHI)

WIHI is pleased to present a Special Edition Podcast, featuring Neil Baker. WIHI recorded Dr. Baker’s remarks on December 8, 2015, in Orlando, Florida, at the Institute for Healthcare Improvement’s 27th Annual National Forum on Quality Improvement in Health Care.

 

The broadcast is 1:12 long; we recommend that you have the presentation slides, along with the other materials listed below, handy for reference as you’re listening. During his Forum session, Dr. Baker orchestrated four one-minute table conversations among attendees; you might consider engaging co-workers in similar table conversations while listening, using the handouts for guidance. All the elements, including the audio, are posted below. 

 

Neil Baker works with health care organizations to enhance leadership and team impact. His signature contribution to this field is his adept way of using any work situation, even the most complex and difficult, as an opportunity to achieve immediate impact on the quality of work relationships. We might spend our entire working lives striving to become better colleagues and leaders and more effective team members; what Dr. Baker offers are effective ways to interrupt unproductive “reactive” patterns to get back on the right track.

 

Neil Baker developed his approaches over 30 years as a leader, speaker, consultant, and executive coach. His past positions include serving as Director of Psychiatric Inpatient Services at the University of Colorado Health Sciences Center in Denver, Colorado; Medical Director of Quality at Group Health Cooperative in Seattle, Washington; and faculty and Improvement Advisor for ten years for the Institute for Healthcare Improvement (IHI) in Cambridge, Massachusetts. Currently, in addition to his consulting practice, he serves as faculty for the leadership track he created for the IHI/Project ECHO collaborative on improving access and office efficiency in primary care.