WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI - A Podcast from the Institute for Healthcare Improvement

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WIHI - A Podcast from the Institute for Healthcare Improvement episodes

  • WIHI: From Here to CLER: Graduate Medical Education and the Clinical Learning Environment Review (CLER)

    Date: September 24, 2014

    Featuring:

    • Kevin B. Weiss, MD, MPH, Senior Vice President, Institutional Accreditation, Accreditation Council for Graduate Medical Education (ACGME)
  • Robin Wagner, RN, MHSA, Vice President, Clinical Learning Environment Review, ACGME
  • Maren Batalden, MD, Medical Director of Hospital Quality, Associate Director of Graduate Medical Education for Quality and Safety, Cambridge Health Alliance (CHA)
  • James Moses, MD, MPH, Medical Director of Quality Improvement, Boston Medical Center; Academic Advisor, IHI Open School for Health Professions


    • Whether or not you are directly involved in graduate medical education (GME), its priorities have implications for all of health care.

    A new Institute of Medicine (IOM) report released over the summer has reignited debate and discussion about the financing and goals of GME in the US. Given that Medicare is the primary funder, to the tune of $15 billion per year, the report’s authors call for greater accountability for all the government support, along with a change in priorities. For example, the IOM committee points to a disconnect between what the health care system desperately needs right now — more cost-conscious doctors capable of improving patient care, managing population health, and committed to primary care — and residency programs that remain overwhelmingly hospital-based and focused on medical specialties.
     
    This is not the first time we’ve heard calls to reform GME, or the first time we’ve seen efforts to respond by the accrediting body itself, the Accreditation Council for Graduate Medical Education (ACGME). They’re in the midst of rolling out a new set of residency training expectations that are more aligned with delivering value and helping patients achieve optimal health. The program is called the Clinical Learning Environment Review.
     
    Learn from our panel of experts as we explored the goals of CLER and the specific ways residents are being asked to contribute to patient safety, quality improvement, care transitions, supervision, duty management, and professionalism.
    1 hr 3 min
  • WIHI: Tread Water No More! Making Sense of Patient Experience Data

    Date: September 11, 2014

    Featuring:

    • Kevin Little, PhD, Improvement Advisor, Institute for Healthcare Improvement (IHI); Principal, Informing Ecological Design, LLC
  • Kristine KS White, RN, BSN, MBA, Faculty, IHI; Principal, Aerate Consulting; Co-founder, Aefina Partners, LLC
  • Kathy Klock, Senior Vice President, Human Resources & Clinical Support Services, Gundersen Health System
  • James Bonner, LMSW, Director of Patient Experience, Spectrum Health

    • Have you been poring over some patient survey or patient experience data lately? Chances are good you have. How did you make sense of what you saw? What actions are you taking as a result of what you learned? Not sure? Unclear what to make of the information or what to do with it? You are not alone! In fact, as the ways to learn about how patients experience their care and their caregivers have grown, so has the confusion about how to interpret the data and how to make the best use of it.

    We invited Kris White and Kevin Little to lead the discussion, both of whom are determined to pull listeners out of whatever morass of patient-generated information they might be drowning in. Kathy Klock from Gundersen Health System and James Bonner from Spectrum Health joined to discuss how their organizations are successfully navigating the patient experience data waters.
     
    Learn about a terrific set of guiding principles for appreciating and distinguishing among the wide range of methods health care organizations are using to decipher patient experience data and the comprehensive picture that emerges from patient surveys, focus groups, patient and family advisory councils, and much more.
    1 hr 4 min
  • WIHI: Preventing Financial Harm to Patients: The Costs of Care Initiative

    Date: August 21, 2014

    Featuring:

    Neel Shah, MD, MPP, Founder and Executive Director, Costs of Care
  • September Wallingford, RN, MSN, Brigham and Women’s Hospital; Director for Nursing Advocacy, Costs of Care
  • Christopher Moriates, MD, Assistant Clinical Professor, UCSF; Director, Center for Healthcare Value’s “Caring Wisely"; Director of Implementation Initiatives, Costs of Care​
  • Michele Rhee, Director of Program Initiatives, National Brain Tumor Society; Director of Strategic Initiatives, Costs of Care
    It's an all-too-familiar scenario: a doctor mapping out next steps at a medical appointment — perhaps prescribing new medications or ordering some tests —oblivious to the costs, including whether the patient might bear the brunt of them.  Some now consider this a form of harm that physicians, nurses, and others need to become more conscious of and do everything possible to prevent. That’s why we hope you’ll listen to this WIHI, where our guests discuss an innovative effort in the US to help caregivers make more high-value decisions that can protect patients from unnecessary care and expenses.
    Fortunately, more providers today appreciate that they have a role to play in reducing overall health care costs in the US — especially when entrenched habits and “business as usual” lead to ordering a lot of procedures of questionable value. But it’s newer to translate this awareness into honest discussions with patients about treatment options in the context of their specific medical benefits and any financial concerns. Doing this in a way that does not compromise care, proponents argue, is both essential and possible.
     
    Asking doctors and nurses to become more accountable for the financial burdens they may be unwittingly imposing on their patients has been the work of Dr. Neel Shah, the founder of Costs of Care. Dr. Shah and the assembled panel for the August 21 WIHI walked us through the many ways patients and their caregivers can both become more cost-conscious and, together, make better decisions. It’s a different kind of partnership that, on the one hand, can ensure that recommended care is followed and feasible; and on the other hand, could prevent someone from medical bankruptcy.
    1 hr 2 min
  • WIHI: From Prehospital to In-Hospital: The Continuum for Time-Sensitive Care

    Date: July 24, 2014

    Featuring:

    • Kedar Mate, MD, Vice President, Institute for Healthcare Improvement
  • David Williams, PhD, Improvement Advisor and Founder, TrueSimple
  • Jonathan R. Studnek, PhD, NRP, Quality Improvement Manager, Mecklenburg EMS Agency (North Carolina)
  • Kevin Rooney, MBChB, FRCA, FFICM, Consultant in Anaesthesia and Intensive Care Medicine; Professor of Care Improvement, University of the West of Scotland


    • When it comes to reliability, it’s hard to beat the track record of paramedics and EMTs. Whether it’s speed, knowing just what to do in the event of an accident, serious injury, gun violence, or heart attack, or the amazingly calm and reassuring way  emergency responders go about their work, there are plenty of reasons to heap praise on this group of individuals. This also includes how patients are cared for during that ambulance ride to the hospital emergency department.

     
    Could our opinion of EMTs get even higher? Maybe so, now that emergency medical services (EMS) are becoming part of fully integrated health care systems and paramedics are being trained and equipped to initiate even more life-saving and beneficial treatments in the field. Our guides — Kedar Mate, David Williams, Johnathan Studnek, and Kevin Rooney — have a compelling story to tell about dramatic changes underway with EMS, not just in the US but globally. The very use of the term “prehospital” reflects new strategies and capabilities to respond more effectively to patients suffering heart attacks, strokes, and traumatic injuries.This is the evolution we explore on this WIHI.
    1 hr 3 min
  • WIHI: New Roles, New Routes for Managing Populations

    Date: June 19, 2014

    Featuring:

    • Trissa Torres, MD, MSPH, FACPM, Senior Vice President, Institute for Healthcare Improvement
  • D. Clay Ackerly II, MD, MSc, Associate Medical Director, Population Health and Continuing Care, Partners Healthcare; Assistant Chief Medical Officer, Non-Acute Services, Massachusetts General Hospital
  • L. Gordon Moore, MD, Chief Medical Officer, Treo Solutions (a wholly owned subsidiary of 3M)
  • Jennie Chin Hansen, CEO, American Geriatrics Society

    • If you’re wondering why health care quality and clinical leaders have been talking a lot more with their counterparts in finance or IT, look no further than the latest value-based contract they’ve likely just entered into with a payer. Within a hospital, these leaders may be putting their heads together to figure out how to deliver better care and better value for whole populations of patients. How might their data systems, for instance, help them better understand the utilization patterns and needs of everyone they see with Type 2 Diabetes? Or, within an accountable care organization (ACO) comprising a major hospital system, several physician practices, and a skilled nursing facility, how can the representative senior teams guide operations to reflect new, shared responsibilities and forge new ways to work together?

    It’s early going with these new types of arrangements, and no one has it all figured out. But as organizations from across the continuum of care get up to speed, they’re eager to share what they’re learning. On this WIHI, host Madge Kaplan welcomes IHI Senior Vice President Dr. Trissa Torres, a long-standing medical director, who has many years of experience from her work in Michigan developing greater collaboration between health care delivery organizations and surrounding communities to improve population health. At IHI, she is currently helping to frame the skill sets all leaders need to accelerate this type of change on a broader scale.

    This WIHI also taps into the on-the-ground experience of Dr. Clay Ackerly, whose title at Partners Healthcare, Associate Medical Director of Population Health and Continuing Care, speaks to the new responsibilities he has and that are in store for leaders like him. Dr. L. Gordon Moore, with years of experience helping to redesign primary care, is now working with office practices to enlarge this vision to encompass population health.

    Rounding out the WIHI panel is the CEO of the American Geriatrics Society, Jennie Chin Hansen, whose pioneering work in San Francisco helped lay the groundwork for the comprehensive and integrated national program known as PACE. She understands well the needs of older patients, an increasing number of whom now receive their health care in hospitals, clinics, and community settings that are operating under shared savings agreements with Medicare.

    You will hear some good ideas to carry forward, including your own ideas and experiences which the panelists are very eager to hear about. You might also want to try out a population management assessment tool that IHI has developed.
    1 hr 2 min
  • WIHI: Making the Work of QI Less Draining and More Sustaining

    Date: June 5, 2014

    Featuring:
    • Chris Hayes, MD, MSc, Med, FRCPC, Harkness Fellow in Health Care Policy and Practice (IHI); Medical Officer, Canadian Patient Safety Institute
  • Uma R. Kotagal, MBBS, MSc, Senior Vice President for Quality, Safety, and Transformation, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center
  • Julie A. Holt, RN, MSN, CENP, Vice President, Patient Services, Cincinnati Children’s Hospital Medical Center

    • If a systems approach is our best shot at improving the safety and quality of health care, a systems approach might also help address the added time and complexity that’s often a feature of improvement work itself. There are growing signs that even the most dedicated improvement champions and clinicians are overwhelmed by what’s required to meet new standards, regulations, and reporting requirements; and, even more troubling, frontline staff are starting to resent and question the value of new quality initiatives and expectations. Add to this physician burnout, which has been a festering problem in the US since the 1990s, and the time is ripe for some solutions.
     
    How can organizations be mindful of the burden constant change places on frontline staff? What is "maximally adoptable improvement" and how can improvers better understand it? We explored all of these issues and this WIHI.
    1 hr 1 min
  • WIHI: The Patient-Centered Medical Home: Early Results, Tough Scrutiny

    Produced in collaboration with the Journal of the American Medical Association (JAMA)

    Date: May 22, 2014

    Featuring:

    Mark Friedberg, MD, MPP, Natural Scientist, Professor, Pardee RAND Graduate School
  • Christine A. Sinsky, MD, Medical Associates Clinic and Health Plans (Dubuque, Iowa); Director, American Board of Internal Medicine
  • Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement
  • Richard Baron, MD, President and CEO, American Board of Internal Medicine, ABIM Foundation


    The patient-centered medical home (PCMH) is getting a hard look this year. In a study published in JAMA in February 2014, the largest of its kind, researchers followed 32 primary care practices certified as PCMHs over a three-year period, and were unable to find any impact on overall health care costs or patients’ utilization of health care services, including emergency departments.

    To put it mildly, this was not welcomed news by the health care improvement community — especially those who are looking to PCMHs as one jewel in the crown of a redesigned primary care system that offers patients more integrated, coordinated, cost-effective care. Headlines such as “Medical Homes Haven’t Saved Money or Substantially Improved Care” and “Medical Homes May Not Be The Answer” suggested just the opposite.

     
    This is not the entire story. The state of Minnesota recently issued a report on its success with PCMHs. And, where focused work is underway elsewhere, the uptake of process improvements is encouraging. But the study in JAMA has functioned as a sort of wake-up call, which many experts, including champions of PCMHs, believe is timely and beneficial. On this WIHI, we pulled together some of these experts for an intensive look at the early results and critical next steps for the patient-centered medical home.

    1 hr 25 min
  • WIHI: Partnering with Patients for Safety: The Next Phase of Work and Commitment

    Date: May 8, 2014

    Featuring:

      • Tejal K. Gandhi, MD, MPH, CPPS, President, National Patient Safety Foundation and Lucian Leape Institute
  • Susan Edgman-Levitan, PA, Executive Director, John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital
  • Maureen Bisognano, President and CEO, Institute for Healthcare Improvement
  • Linda K. Kenney, Executive Director and President of MITSS (Medically Induced Trauma Support Services, Inc.)


    • Health care is at a tipping point with respect to patient engagement – from something that’s “nice to do” (or even “the right thing to do”) to something that’s absolutely necessary. Research and experience are making it clear that no health care organization can operate in a reliably safe way without the involvement of patients and families. And without their involvement, any organization’s safety agenda is bound to encounter diminishing returns. Patients and family members offer extra eyes and ears to events unfolding around them, and have crucial knowledge about and perspectives on what kinds of changes will help them the most.

    To frame what a vision of patient engagement needs to encompass, and what an across-the-board implementation of that vision needs to embrace, The National Patient Safety Foundation’s Lucian Leape Institute (LLI) has just published a comprehensive report that lays it all out: Safety Is Personal: Partnering with Patients and Families for the Safest Care. The contents of the report and just how to make it actionable are the focus of this WIHI.

    1 hr 1 min
  • WIHI: Transforming Tensions and Tempers on Health Care Teams

    Date: April 24, 2014

    Featuring:
    • Neil Baker, MD, Principal, Neil Baker Consulting and Coaching
  • Nan Cochran, MD, President, American Academy on Communication in Health Care (AACH); Associate Professor of Medicine, Geisel School of Medicine and Dartmouth Institute for Health Policy and Clinical Practice
  • Calvin Chou, MD, PhD, FAACH, Professor of Clinical Medicine, UCSF; Vice President for External Education, AAC

    • The last thing a patient needs to experience at a hospital or a clinic is tensions between staff members. Yet, we've all been there and seen and heard things that make us wonder “who isn’t getting along with whom” or, worse, are we getting the best care when we can tell providers are just barely disguising their frustrations with one another? It's a fair question, especially since health care is being redesigned at all levels to be more of a team effort. Doesn't that mean that the team has to be cohesive and everyone needs to get along?
     
    For this WIHI, we brought together the expert group that spoke to a packed room about managing conflict on health care teams at IHI’s 25th Annual National Forum in December 2013. Neil Baker, a longtime IHI faculty member, has spent the past 30 years helping organizations and professionals deal with "people issues" that jeopardize patient safety and stall improvement work. Nan Cochran, the president of the American Academy on Communication in Healthcare, trains around conflict management and negotiation, and Calvin Chou focused on teaching medical students and residents humanistic clinical skills that are critical to communicating more effectively with patients.
     
    Listen and learn about the skills that can help health care teams understand and appreciate their differences and avoid the pitfalls and conflicts that cause disruption and harm for patients.
    1 hr
  • WIHI: Reclaiming Empathy — Best Practices for Engaging with Patients

    Date: April 10, 2014

    Featuring:
    • Helen Riess, MD, Director, Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital
  • Stacie Pallotta, MPH, Senior Director, Office of Patient Experience, Cleveland Clinic
    • Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement
    Empathy is not the same thing as sympathy. In the first instance, we feel seen and truly heard; sympathy tends to maintain a distance between two people, often deliberately so. One of the best explanations of the distinction, and why empathy can be so much more powerful, is an online video narrated by human vulnerability expert Dr. Brené Brown. And then there’s the Cleveland Clinic’s video about empathy, directed at health professionals. This moving reminder of the stories behind the faces of patients that pass through health care every day has been viewed on YouTube over a million times.

    Why the seemingly sudden need to draw the attention of doctors and nurses to the humanness of the patients before them? Is it because, as some fear, empathy is becoming harder and harder for health professionals to feel and express in the course their jobs? Could be, but there’s nothing inexorable about the loss of empathy in health care today. And, as we learned on this WIHI, there are effective ways to help today’s busy and often overwhelmed caregivers reconnect with their own feelings and the feelings of others, namely their patients.

    At the Cleveland Clinic, Stacie Pallotta is part of a team that’s looking at empathy as one important part of an overall strategy to improve patient experience. Dr. Helen Riess, who specializes in the neuroscience of emotions and has given a TEDx talk on the power of empathy, is turning her findings into “empathy education” for health professionals. She’s also found that if students’ empathy towards patients tends to erode over the course of their medical training, as evidence suggests, new research shows that additional training can either disrupt or reverse this process. 

    We hope you'll listen to this vibrant discussion on what caregivers can do to reconnect their emotions to the patients they care for.
    1 hr

About WIHI - A Podcast from the Institute for Healthcare Improvement

From the publisher's feed

WIHI is an exciting "talk show" program from IHI. It's free, it’s timely, and it’s designed to help dedicated legions of health and health care improvers worldwide keep up with some of the freshest…