WIHI - A Podcast from the Institute for Healthcare Improvement

By WIHIMedicine Health & Fitness

WIHI - A Podcast from the Institute for Healthcare Improvement episodes

June 27, 2017WIHI: Bright Spots for Patients with Complex Needs
Date: March 27, 2014
Featuring:
John W. Whittington, MD, Lead Faculty, Triple Aim Initiative, Institute for Healthcare Improvement
Crispin Kontz, Manager, Support and Clinical Systems, Alberta Health Services (Edmonton, Canada)
Catherine Craig, MPA, MSW, Independent Consultant, Community Health Transformation, Care Coordination
Ann Lindsay, MD, Co-Director, Stanford Coordinated Care, Stanford Hospitals and Clinics
When Atul Gawande wrote in The New Yorker about high utilizers of the health care system in Camden, New Jersey – “hot spotters,” he called them – he attached faces and stories to the very real human drama and challenge of meeting the needs of some of the most complex patients among us. Since that article was published in 2011, interventions and initiatives to better support, care for, and partner with populations with costly and life-draining multiple illnesses and problems have grown in number and effectiveness. We touch base with some of the people spearheading this work on this WIHI.

Dr. John Whittington and a team here at IHI have been working with close to 140 organizations around the world for several years now on transforming how health care and communities engage with people with complex needs. Dr. Whittington has been relentless in harvesting the learning from this work. He has often collaborated with Catherine Craig, who brings deep experience about raising the health and the expectations of especially disenfranchised communities. Crispin Kontz has some fresh results and progress to share with us from Alberta Health Services in Canada. Dr. Ann Lindsay told us about a truly innovative new clinic she co-directs that’s been designed explicitly for individuals with chronic health problems and illnesses. Care coordination is its middle name. Imagine what we might learn from this model! Imagine, also, what can come from community coalitions, data sharing, co-designing with patients, greater use of community health workers, and more.

In the US, 5% of the population contributes to 50% of all health care costs. Most of us can recite this statistic as though it were immutable. But it need not be. Listen to our four outstanding experts about improving the health and the lives of complex populations.
59 min
June 27, 2017WIHI: How High? How Low? Shared Decision Making Amidst Shifting (Hypertension) Guidelines
Produced in collaboration with the Journal of the American Medical Association (JAMA)
Date: March 13, 2014

Featuring:
Craig W. Robbins, MD, MPH, Medical Director, Center for Clinical Information Services, Kaiser Permanente Care Management Institute
Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement
Peter Basch, MD, FACP, Medical Director, Ambulatory EHR and Health IT Policy, Medstar Health
Eric Peterson, MD, MPH, Director, Duke Clinical Research Institute; Professor of Medicine, Division of Cardiology, Duke University Medical Center

Hypertension is a hot issue, especially in the US, where an expert committee recently recommended that the available evidence does not support initiating treatment (largely medication) for people 60 years or older until their blood pressure climbs to 150 over 90. The decades-long consensus had been to initiate treatment at 140 over 90, which is still the recommendation for adults younger than 60. The reasons for this change are possibly as complicated as the guideline process itself, but one of the chief concerns of the majority on the Eighth Joint National Committee (“JNC 8”) is the risk associated with aggressive treatment of hypertension in older adults.

So, can we talk about this? We invite you to listen to this special WIHI produced in collaboration with the Journal of the American Medical Association. The discussion was constructive and forward-looking.

Some experts take exception to the committee’s findings and the process itself. Our guests are going to take all that into consideration, but, with your help, we’ll focus primarily on the best ways to approach changing and often-debated guidelines when working with patients to achieve optimal health. (The new guidelines for determining who should be put on statins to lower cholesterol are another case in point.)
1 hr 1 min
June 27, 2017WIHI: Mobilizing Skilled Nursing Facilities to Reduce Avoidable Rehospitalizations
Date: February 27, 2014
Featuring:
Laurie Herndon, MSN, GNP-BC, Director of Clinical Quality, Massachusetts Senior Care Foundation
David Gifford, MD, MPH, Senior Vice President, Quality and Regulatory Affairs, American Health Care Association
Annette Crawford, Administrator, Stafford Healthcare at Ridgemont
Marie Schall, Director, Institute for Healthcare Improvement
In the world of health care improvement, and in society at large, talking about skilled nursing facilities (SNFs) and long-term can be a tough subject. When a loved one moves in to a nursing home, they’re usually quite elderly, and it's often the last move they'll make of this kind before dying. So, whether because of this association or because other sectors of health care tend to get more attention, the hard work that’s going on to ensure that all types of SNFs, and nursing homes, deliver high-quality and patient-centered care, has been somewhat obscured. We’d like to help change this by zeroing in on one aspect of the work.

This WIHI looks at new developments with better coordination and communication between SNFs, local hospitals, and various community stakeholders, to reduce unnecessary transfers of patients to acute care settings. These avoidable admissions or readmissions can come from short-term-stay SNFs or long-term ones, from assisted living residences or rehab facilities.

Unpacking what’s behind unnecessary transfers and what better, safer, actions might be taken has been the focus of IHI’s STAAR initiative and is captured in one of a series of STAAR How-to Guides: Improving Transitions from the Hospital to Skilled Nursing Facilities to Reduce Avoidable Rehospitalizations.

Our guide on the learning and momentum everyone can build upon from STAAR was IHI’s own Marie Schall, who’s also the first to point to the rich activity and resources available from Laurie Herndon and the widely recognized INTERACT program.

Another huge resource is the American Health Care Association, which is mobilizing SNFs across the US to do their part to reduce readmissions within 30 days by 15% by 2015. David Gifford also spoke to these efforts.

And, then there’s the amazing example of Kitsap County in the state of Washington, where Annette Crawford’s SNF has played a leading role building a new kind of coalition across the continuum of care to ensure that patients get the right care in the most appropriate setting.
1 hr 1 min
June 27, 2017WIHI: Working Toward Health Equity
Date: February 13, 2014
Featuring:
Tessa Kerby, MPH, Manager, Measurement and Organizational Improvement, HealthPartners
Yvonne Coghill, OBE, Senior Program Lead – Inclusion and Coaching, NHS Leadership Academy
Dave Johnson, MBA, Regional Clinic Director in Primary Care, HealthPartners Medical Group
Donald A. Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement
Andrew Loehrer, MD, General Surgery Resident, Massachusetts General Hospital
In theory, quality improvement has the built-in capacity to reduce health care disparities and bridge gaps in outcomes and in the experience of care across race and ethnicity. After all, if you’re reliably implementing proven and effective care processes for patients suffering a heart attack, or having a stroke, or dealing with depression, or struggling with obesity, shouldn’t these interventions lift all boats? Would that it were that simple. Decades of research on health care disparities continue to point out how entrenched the problems are and how often even the most well-intentioned efforts miss the mark. However, we’re also now learning that where health care equity across race and ethnicity has improved, strategies have been truly pressure-tested and are multi-faceted.

What are some of these strategies, and what kinds of fresh thinking underpin them? Please listen to this WIHI on Working Toward Health Equity, to hear about progress that’s being made to reduce health disparities in ways that everyone can learn from. At HealthPartners, innovative and deliberate processes are dramatically closing gaps between white patients and patients of color undergoing breast and colorectal cancer screenings. Dr. Andrew Loehrer and colleagues are documenting powerful connections between insurance coverage and more equal access to certain surgeries. Yvonne Coghill and others at the NHS are demonstrating the critical need for a diverse workforce and, as important, making sure that diverse workforce is treated equitably and fairly. This, by any measure, helps ensure that all patients are treated fairly, too.

IHI’s Dr. Don Goldmann joined our conversation to talk about how we move from an era of mountains of crucial and valuable research documenting lack of equity and health care disparities, to one that is solutions-focused and anchored by cultural competency in word and deed.
1 hr 3 min
June 27, 2017WIHI: SBAR: Structured Communication and Psychological Safety in Health Care
Date: January 30, 2014
Featuring:
Michael Leonard, MD, Safe & Reliable Healthcare LLC; Adjunct Professor of Medicine, Duke University School of Medicine
Audrey Lyndon, PhD, RNC, CNS-BC, FAAN, Associate Professor, UCSF School of Nursing
Jill Morgan, BSN, MBA, NE-BC,Nurse Manager, ICU, UnityPoint Health – St. Luke’s Hospital
Ansley Stone, OB Quality Coordinator, Carolinas HealthCare System

A few key concepts are ubiquitous in the world of health care improvement, and one of them is most definitely SBAR, an acronym for Situation-Background-Assessment-Recommendation. We have the Navy to thank and Kaiser Permanente’s Doug Bonacum and Suzanne Graham, along with Dr. Michael Leonard, for migrating this structured communication framework into the world of health care more than a decade ago. At its core, SBAR is a way for health professionals to effectively and succinctly convey critical information to one another to protect patient safety. Over time, SBAR has proven useful in a myriad of other ways as well. Still, how might we evaluate the utility of SBAR to advance today’s quality improvement and patient safety challenges? Has its singular power to “cut to the chase” eroded over time? These questions and more are discussed on this WIHI.

The good news about SBAR is that it’s become part of broader ambitions around safety and reliability in many organizations. But, as we’ll learn from Michael Leonard and Audrey Lyndon, folding SBAR into a larger agenda can mask weaknesses that have crept in with the tool itself. For instance, nurses may have an easier time speaking “up the medical chain of command” using SBAR, but Lyndon says many still struggle with making clear recommendations… the R part. And it’s not always clear if those on the receiving end of structured communication listen effectively. Lyndon suggests there may be a need for a corollary tool to confirm “message received.”

Jill Morgan and Ansley Stone are nursing and quality leaders who can’t imagine health care today without SBAR. They point to the critical role that SBAR plays in ensuring safe care for pregnant women undergoing labor and delivery, and in drawing attention to any patient or staff situation that requires immediate attention and decision making. What’s your experience with SBAR? How might it be strengthened for safety work over the next ten years? How can SBAR become a solid communication tool for improved handoffs or enhance newer processes, such as daily safety huddles, to achieve what Michael Leonard calls “psychological safety” among all staff? Listen to the rich discussion with WIHI Host Madge Kaplan and guests.
1 hr 1 min
June 27, 2017WIHI: Violence Prevention and Community Health
Date: January 16, 2014
Featuring:
Gilbert Salinas, MPA, Director of Patient and Community Relations, Rancho los Amigos National Rehabilitation Center, Kaiser Safety Net Fellow, Institute for Healthcare Improvement
Thea James, MD, Emergency Medicine, Boston Medical Center; Director, Violence Intervention Advocacy Program
Rachel A. Davis, Managing Director, Prevention Institute
Kaile Shilling, Coalition Director, Violence Prevention Coalition (Los Angeles)

We’ve just come through a holiday season that’s bitter sweet for some — including families that have lost a loved one because of gun violence. Some incidents garner headlines more than others, due to the sheer magnitude of what’s transpired, the ages of the victims, the incredible shock to an otherwise quiet day in a quiet neighborhood, and the tragic consequences. For those in the trenches of working to reduce gun violence day to day — more often in communities and in health care systems all too familiar with gun-related deaths and injuries — every event stands out and has a story behind it.

How can health care organizations, the very ones that often receive the victims through the doors of their EDs, be more effective partners and leaders further upstream? How can gun violence prevention become part of emerging strategies to encompass and focus on better population health? The January 16, 2014, WIHI: Violence Prevention and Community Health is going to highlight some exemplar thinking and initiatives now gaining traction, that everyone can learn from.

Rachel Davis and Kaile Shilling each have their finger on the pulse of multiple efforts and coalitions that are right now taking a comprehensive preventive, public, and population health approach to reducing violence of all sorts. Dr. Thea James is responsible for close to a decade’s worth of pioneering work at Boston Medical Center that’s spread nationally, to help youth adopt better responses to high-risk situations, and to help medical staff deliver “trauma-informed care.” Gilbert Salinas, currently a Kaiser Permanente Safety Net Fellow at IHI, has garnered national attention for his work in Los Angeles, and with former Surgeon General David Satcher on a seminal 2001 “Report on Youth Violence.” Gilbert will also discuss a hospital-based intervention program he’s helped nurture, known as “Caught in the Crossfire.”

WIHI host Madge Kaplan talks with panelists, who offer a lot of great, actionable ideas for preventing and reducing gun violence.
1 hr 3 min
June 27, 2017WIHI: Patients as Partners in QI Research
Improvement Research Meets Patient Experience: Can Applying the Science of Improvement Accelerate Patient-Centered Outcomes?
Recorded live at the 19th Annual Scientific Symposium on Improving the Quality and Value of Health Care in Orlando, Florida
Date: December 9, 2013

Moderator: Madge Kaplan, Director of Communications, Institute for Healthcare Improvement

Panelists:
Christian Farman, RN, Ryhov County Hospital, Sweden
Peter Margolis, MD, PhD, Professor of Pediatrics, Director of Research, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, OH
Libby Hoy, Founder, Patient and Family Centered Care Partners, CA

A key development in person- and family-centered care is the growing opportunity for patients to collaborate with improvement scientists on research designed to impact patient experience. No longer just an idea, the ways in which this partnership is currently being explored — and what can make it more possible — was the focus of a panel at the 19th Annual Scientific Symposium on Improving the Quality and Value of Health Care. The Symposium was held on December 9, alongside the 25th Annual IHI National Forum on Quality Improvement in Health Care.

Peter Margolis, Christian Farman, and Libby Hoy bring unique and complementary perspectives to the roles that patients and families might play, including being part of research funding proposals right from the start. The US government’s Agency for Healthcare Research & Quality (AHRQ) and Patient-Centered Outcomes Research Institute (PCORI) have begun to institute this level of inclusion as a requirement for some of their grants. The good news is that skilled and active patient and family advisors, now working with researchers, are able to share what a true collaboration looks like.

We hope you find this Special Edition WIHI Podcast interesting and helpful as you move forward with your work. Tell a colleague about this podcast, too!
1 hr 5 min
June 27, 2017WIHI: New Leadership Skills for Better Health and Health Care
Date: November 21, 2013
Featuring:
Gary R. Yates, MD, President, Sentara Quality Care Network; former Senior Vice President and Chief Medical Officer, Sentara Healthcare
Lee Sacks, MD, Executive Vice President & Chief Medical Officer, Advocate Health Care; Chief Executive Officer, Advocate Physician Partners
Derek Feeley, Executive Vice President, Institute for Healthcare Improvement
Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement

IHI has been doing a lot of thinking of late about leaders and leadership… in particular the skills, behaviors, and outlook necessary to steer today's health care organizations toward a very different future. A new IHI white paper (working title: High-Impact Leadership) will be out before the end of the year that captures this complex transition. Among other things, it offers a new framework for leaders who are not just responsible for making change manageable, but enthusiastically supported by all staff. You can get an early look at the new leadership framework on the Nov. 21 WIHI: New Leadership Skills for Better Health and Health Care. One of the goals of this WIHI is to clarify the relationship between the growing focus on population health and the shift from volume to value, and the corresponding leadership skills required to address these challenges.

At Advocate Health Care, Dr. Lee Sacks has been hard at work learning by doing, with the help of other physician leaders. He explains in concrete terms what his team’s leadership practices look like day to day, including those needed to lead an Accountable Care Organization (ACO). Sentara’s Dr. Gary Yates spent his time on WIHI outlining key leadership behaviors that signal to staff how change is going to come about and what’s expected of everyone. If leaders want to alter the perception that they alone have all the answers, hashed out in some corner office, they must become a regular, approachable, and authentic presence throughout the organization. Discussions in the hallways talking with staff, and learning from patients and patient stories, need to become the norm.

Fresh from his NHS Scotland leadership perch, IHI’s Derek Feeley has been thinking hard about what’s applicable and relevant to the US context and in many other countries seeking better health for their citizens. He, along with Andrea Kabcenell, discuss how leaders can better manage and prioritize all the tasks necessary to succeed.
1 hr
June 27, 2017WIHI: Improving Safety and Satisfaction in Ambulatory Care
Date: November 7, 2013
Featuring:
Gordon Schiff, MD, Associate Director, Brigham Center for Patient Safety Research and Practice, Brigham and Women's Hospital
Nicholas Leydon, MPH, Director, PROMISES Project, Massachusetts Department of Public Health
Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement (IHI)
Damian Folch, MD, Family Practice and Lifestyle Medicine (Chelmsford, MA)

We don’t typically associate the ambulatory care setting with serious lapses in quality that threaten patient safety. Much of the improvement in recent years targeting outpatient care has focused on access, waiting times, communication, and coordination of care. But these areas ripe for change have often obscured others that, if not handled well, can have even more dire consequences: the ordering of tests, the timely handling and communication of results, and the overall process of making a diagnosis in response to a patient’s symptoms or complaints, including making referrals to specialists.

This WIHI explores what’s been learned from a three-year initiative known as PROMISES, charged with reducing malpractice risk in the ambulatory setting by making care safer, more efficient, and more reliable.

The WIHI panel will be headed up by the lead researcher for PROMISES, Dr. Gordon Schiff, who’s also the lead author of a recently published article in JAMA Internal Medicine ("Primary Care Closed Claims Experience of Massachusetts Malpractice Insurers") that found that the lion’s share of malpractice claims in Massachusetts primary care practices relate to allegations of misdiagnosis stemming, in part, from dropped balls with test results. This finding matches national trends, which is why the work of PROMISES, centered on making improvements at 16 sites, should resonate with many.

Dr. Damian Folch worked on improvements at his practice in Chelmsford, MA, and he and other sites were coached by Improvement Advisors, including Nicholas Leydon. Because it’s rarely a matter of one thing that’s been missed or that can go wrong, IHI’s Frank Federico will help us understand why a systems approach is critical to managing the many things that transpire in the ambulatory setting, including careful tracking of prescribed medications.

This WIHI promises to be rich with results and real-world experience, and it will offer you ways to get involved to help shape and spread further change. Could your team use a PROMISES Patient Safety Curriculum? Would you like to explore becoming a Primary Care Patient Safety Innovator? Listen to the discussion on this WIHI.
1 hr
June 27, 2017WIHI: Who’s Conversation Ready? How Health Care Can Respect End-of-Life Wishes
Date: October 24, 2013

Featuring:
Kelly McCutcheon Adams, LICSW, Director, Institute for Healthcare Improvement
Lauge Sokol-Hessner, MD, Attending Physician, Beth Israel Deaconess Medical Center (BIDMC)
Kate Lally, MD, Medical Director of Palliative Care, Kent Hospital and Medical Director, VNA of Care New England
Donna L. Smith, MD, MBA, Medical Director of Virginia Mason Clinics at Virginia Mason Medical Center

For over a year, building on others’ great work, IHI has been engaged in two groundbreaking initiatives to reduce the confusion and improve the circumstances that surround end-of-life care for most Americans in the US. The Conversation Project, founded in collaboration with IHI, is a grassroots effort to encourage and enable every one of us to discuss our wishes regarding end-of-life care with our friends and loved ones, long before there’s a medical crisis. The second initiative, Conversation Ready, is designed to capture the ways in which health care organizations can effectively respect and respond to these wishes. Ten organizations have been working with IHI to share and refine their best practices, and this WIHI checks in on what they’ve learned so far.

Three clinical leaders from notable health care systems were on hand for this WIHI, along with IHI’s Kelly McCutcheon Adams. You’ll hear about an effort underway at BIDMC to embed a system of “4 Rs” into all patient engagements: Reaching out to learn a patient’s end-of-life preferences and values, followed by processes to Record and reliably Retrieve and Respect the information. Care New England has a number of innovations underway, including the designation of a “conversation nurse” who ensures that the goals of patients and families stay at the forefront of all end-life decision making. At Virginia Mason Medical Center in Seattle, the electronic medical record is becoming an effective home base for important and visible information about preferences regarding end-of-life care.
1 hr 2 min

About WIHI - A Podcast from the Institute for Healthcare Improvement

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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…

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WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI - A Podcast from the Institute for Healthcare Improvement episodes

About WIHI - A Podcast from the Institute for Healthcare Improvement