WIHI - A Podcast from the Institute for Healthcare Improvement

​Date: February 26, 2015

Featuring:

• Adebisi Alli, DO, MS, Chief Resident in Quality & Patient Safety, Department of Internal Medicine, Banner-University Medical Center, Phoenix VA Healthcare System

Thirty-two abstracts and 56 posterboards were shared at IHI’s 20th Annual Scientific Symposium this past December. At the end of the day, the audience voted three of these as the best for clarity of presentation and strength of research. We gathered the leaders of the teams behind the winning presentations to talk about their work on this WIHI.

IHI’s Senior Scientist Gareth Parry, who runs the Scientific Symposium, kicked off our discussion with some framing about the state of health and health care improvement science in the US and globally. He also set the stage for us to hear about the three winning presentations of exemplar initiatives: a multi-year effort at Seattle Children’s Hospital to improve the care pathways for children suffering from chronic asthma; the successful implementation of new processes at Cincinnati Children’s Hospital Medical Center to reduce discharge-related waits and delays for children with complex medical problems and illnesses; and the creation of a medical resident-led consultation team at a Veterans Administration Medical Center to increase the number of error reports submitted by residents and to ensure that safety concerns are addressed.

Date: February 12, 2015

Featuring:

There are lots of health care issues to speculate about in the coming year. Here in the US, the ongoing expansion of health insurance coverage is an ambitious work in progress that continues to face plenty of political and legal headwinds. And then there’s the still glaring and still growing $3 trillion national price tag of US health care. Some are encouraged that health spending is slowing, but do we have any strong evidence that improvements in the quality of care, safety, and IT, coupled with payment reforms that increasingly tie reimbursements to quality and value, are key factors?

Fortunately, our guests on this WIHI, Don Berwick and David Cutler, bring important improvement, policy, and economic perspectives to the table to help make sense of the current environment and what’s ahead.

Against the backdrop of the Affordable Care Act and other significant initiatives, our guests offered their assessments of recent progress with better care and lower costs, and where efforts need to continue to yield even bigger benefits. We also touched upon the following: global payments and the various payer-led financial carrots and sticks in play right now designed to improve health care delivery; the state of statewide reforms, Medicaid expansion, and community-led, population health-driven experiments; and the bright spots and storm clouds on the horizon with respect to policy makers, politicians, and the public where there are still major divides.

Date: January 29, 2015

Featuring:

• Catherine Craig, MPA, MSW, Independent Consultant; Faculty, Better Health and Lower Costs for Patients with Complex Needs, IHI

 A relatively small percentage of the US population accounts for the largest share of health care costs. Everyone knows who we're talking about, right? Well, not exactly. Broad assumptions (e.g., high utilizers of the emergency department) and sweeping generalizations often substitute for more robust inquiries and analysis designed to better pinpoint a hospital or clinic's patients with unmanaged, complex health problems. And, without this specificity, it's hard to know who will benefit most from additional supports and interventions.

​Date: January 15, 2015

• Jean Abbott, MD, MH, The Conversation Project, Boulder County; Faculty, Center for Bioethics and Humanity and Professor Emerita, Emergency Medicine, University of Colorado

Date: December 16, 2014

Featuring:

• Robert Wachter, MD, Professor and Associate Chair, Department of Medicine, University of California, San Francisco

WIHI is pleased to present a special edition podcast, featuring renowned hospitalist and health care safety expert, Dr. Robert Wachter. WIHI recorded Dr. Wachter’s remarks on December 10, 2014, in Orlando, Florida, at the Institute for Healthcare Improvement’s 26th Annual National Forum on Quality Improvement in Health Care.

Date: ​December 4, 2014

Featuring:

• Ed Wagner, MD, MPH, Director Emeritus, MacColl Center for Health Care Innovation; Senior Investigator, Group Health Research Institute

Achieving this level of capacity doesn’t happen overnight, and we discussed why it’s an essential aim on this WIHI. This topic is also the focus of the IHI Collaborative, Optimize Primary Care Teams to Meet Patients' Medical AND Behavioral Needs.  

Date: ​November 20, 2014

Featuring:

• Soma Stout, MD, MS, Executive External Lead for Health Improvement, Institute for Healthcare Improvement (IHI)

Date: November 6, 2014

Featuring:

• David Classen, MD, CMIO, Pascal Metrics; Associate Professor of Medicine and Consultant in Infectious Diseases, University of Utah School of Medicine

As the implementation of electronic health records (EHR) increases across healthcare, so has awareness of new patient safety risks that the technology has either introduced or exposed.  The very same EHR being counted on to improve communication, safety, and continuity of care across multiple settings and providers turns out to have features that can have the opposite effect. Getting a good handle on where the vulnerabilities lie is the first step toward coming up with solutions.

Some of the most prominent concerns include EHR systems that generate so many online warnings that clinicians and staff complain of “alert fatigue” and have come up with workarounds to avoid them. To save time, practitioners have also developed the habit of updating a patient’s EHR with a lot of copying and pasting, often forwarding medical information that no one has recently reviewed and that may contain inaccuracies. Computer programs that allow doctors to open up and work on multiple electronic patient records at the same time is another accident waiting to happen, according to some. When combined with being interrupted or distracted, it’s not hard to imagine all the mix-ups that can and do occur.

Date: October 23, 2014

• Robert S. Kaplan, MS, PhD, Senior Fellow and Marvin Bower Professor of Leadership Development, Emeritus, Harvard Business School

Public and private payers have begun targeting joint replacement for bundled payments and reimbursement tied to the quality of care, looking to include patient-reported outcomes. Health care providers who perform a lot of joint replacements have already been preparing to meet these new challenges. They’ve realized that there are multiple ways to improve the care experience for patients and save everyone money. For instance, reducing the amount of time patients spend in the hospital and setting up good supports for rehab at home can have a big impact on costs and how quickly people recover.

We covered some terrific innovations and “aha” discoveries on this WIHI. Robert Kaplan from the Harvard Business School explains the Time-Driven Activity-Based Costing (TDABC), a powerful way to capture and analyze every step and cost of the joint replacement process. IHI has been working with some 32 hip and knee replacement providers over the past year on TDABC and subsequent improvements as part of the IHI Joint Replacement Learning Community. We learn about them and their exciting work on this episode of WIHI.

Date: ​October 9, 2014

Featuring:

• Kelly McCutcheon Adams, LICSW, Director, Institute for Healthcare Improvement

With all the discussion going on about the integration of behavioral health with primary care in the outpatient setting, we don’t want to ignore what’s happening in the hospital for patients with psychiatric conditions and needs. Safety has been one of the major issues identified in recent years… safety for individuals in crisis, for the staff caring for them, and for family members. Those who’ve identified effective improvements are often the patients themselves.