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: New Staffing Models for Primary Care
Date: October 10, 2013
Featuring:
Ed Wagner, MD, MPH, MACP, Director Emeritus, MacColl Center for Health Care Innovation, Group Health Research Institute
Trissa Torres, MD, MSPH, FACPM, Senior Vice President, Institute for Healthcare Improvement
Kirsten Meisinger, MD, Medical Director, Union Square Family Health Center, Cambridge Health Alliance
Thad Schilling, MD, Medical Director, Patient-Centered Medical Home, Harvard Vanguard Medical Associates-Medford (MA)

What does it take to be a high-functioning primary care practice today in the US? Some 30 sites of all shapes and sizes are in the midst of being studied in hopes of answering this very question. The Robert Wood Johnson Foundation and the MacColl Center for Health Care Innovation selected these practices because of their exemplary and innovative staffing models. Figuring out the best ways to delegate responsibilities and work as a team is one of the central needs for all primary care providers today, and midway through the project known as LEAP (Learning from Effective Ambulatory Practices) WIHI will get a look at the success factors that LEAP has identified thus far.

Dr. Ed Wagner of the MacColl Center is LEAP’s Project Director (along with Margaret Flinter, APRN, Phd) and he’ll be heading up the discussion on the October 10 WIHI: New Staffing Models for Primary Care. Dr. Wagner developed the Chronic Care Model, which was groundbreaking for office practices in the late 1990s and remains foundational to the creation of patient-centered medical homes today. Changing how providers and staff both divide up the work and share responsibility for every patient is a critical part of this transformation, and Drs. Kirsten Meisinger and Thad Schilling will use their time on this WIHI to share what they’ve been doing that’s earning their sites accolades and, most importantly, achieving better results.

IHI’s Trissa Torres is no stranger to primary care transformation. Prior to joining IHI, Dr. Torres helped pioneer new care models for the Genesys Health System in Michigan and developed the concept and role of “Health Navigators” to help patients build upon an office visit and identify further support in the community. We hope you will listen!
1 hr 10 min
June 27, 2017WIHI: Recognizing Person- and Family-Centered Care: Always Events at IHI
Date: September 26, 2013
Featuring:
Pat Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement (IHI)
Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement (IHI)
Kristina Andersen, BSN, RN, SMART Discharge Project Coordinator, Anne Arundel Medical Center
Cherry R. Shogren, MSN, RN, Director of Clinical Professional Development, UnityPoint Health (Des Moines, Iowa)

We have the Picker Institute to thank for some of our earliest understandings of patient-centered care. Besides coining the phrase itself, Picker was among the first to hold health care accountable for its actions according to principles such as listening to patients, respecting their knowledge and emotional needs, welcoming family and friends into the decision process, and more. To better learn what’s possible and measurable, in 2010 Picker developed Always Events — a set of reliable practices that should happen for all patients, all the time — and a recognition program to spotlight organizations committed to this level of transformation.

Picker handed over the reins of Always Events to IHI in January 2013, and now IHI is set to re-launch the program. You can get a first look at what’s in store on this WIHI. Martha Hayward and Barbara Balik have been hard at work developing guidelines that pick up where Picker’s efforts left off, in hopes of jumpstarting many more innovative approaches to patient engagement worthy of recognition. The SMART Discharge Protocol at Anne Arundel Medical Center in Annapolis, Maryland, is a strong example of the type of stand-out work IHI will be looking for. Kristina Andersen, the project’s lead, will be on hand to explain its components and the impact a better discharge process is having on emergency department use and readmissions.

What’s now thought of as patient- and family-centered care, or person- and family-centered care, continues to be a work in progress, as does better understanding of the impact patient engagement has on outcomes, safety, reducing waste, and overall quality across the continuum of care. The only way to pinpoint what’s most effective is to get involved in the work itself. That’s the spirit behind the re-launch of Always Events at IHI, and we hope you’ll listen to this WIHI and take part in the initiative.
58 min
June 27, 2017WIHI: On the (Virtual) Road with Mobile Clinics and Population Health
Date: September 12, 2013
Featuring:
Nancy Oriol, MD, Dean of Students, Harvard Medical School; Co-Principal Investigator, Mobile Health Map; Co-Founder, Family Van, Boston, MA
Leonel Lacayo, MD, Gastroenterologist, Glenwood Hospital; Co-Founder, Health Hut, Ruston, LA
Anthony Vavasis, MD, Director of Medicine, Callen-Lorde Community Health Center, New York City, NY; Co-Principal Investigator, Mobile Health Map; Board Chair, Mobile Health Clinics Association
Jennifer Bennet, BA, Executive Director, Family Van and Mobile Health Map
Niñon Lewis, MS, Director, Triple Aim Initiatives, Institute for Healthcare Improvement, Cambridge, MA

What’s the first thing that comes to mind when you spot a mobile health clinic? Good
people, probably volunteering their time, traveling to underserved neighborhoods to offer screenings, health education, and some helpful, friendly guidance on where to go for anything more serious or chronic that should be checked out? If this is your impression, it’s fairly accurate. Except for one thing. Nowadays, more and more mobile health vans are an integral part of the health care system… especially in cities and communities where traditional bricks-and-mortar health care services are linking up with innovative community outreach programs that, together, can better manage population health.

With that as a backdrop, we hit the (virtual) road with some of the leading innovators and researchers who are injecting new fuel and purpose into more than 2,000 mobile health clinics across the US. They’re doing this by mapping what’s taking place at a range of health clinics mounted on wheels, and also by carefully investigating health issues that can be impacted and maybe even better addressed by a mobile health van.

If we’re serious about improving population health, it’s critical to look hard at what’s
already “out there” that’s working or helping, and then determine how to strengthen its role. Mobile health clinics are increasingly one such trusted and effective resource in many communities. WIHI host Madge Kaplan and IHI’s Ninon Lewis invite you to find out the latest on mobile clinics from an expert panel of clinicians and researchers on the forefront of the issue.
53 min
June 27, 2017WIHI: Integrating Physical and Behavioral Health
Date: July 25, 2013
Featuring:
Benjamin Miller, PsyD, Assistant Professor and Director, Office of Integrated Healthcare Research and Policy, University of Colorado Denver
Brenda Reiss-Brennan, PhD, APRN, CS, Mental Health Integration Director, Primary Care Clinical Programs, Intermountain Health Care
Mara Huberlie, MA, Director of Project Implementation & Continuing Education, Greater Nashua Mental Health Center
Melissa Merrick, LCSW, CDC I, Administrator/BHC Clinical Supervisor - Medical Services Administration, Southcentral Foundation

The road to recognizing the impact of mental illness on the lives of patients and families, and society as a whole, has been an uneven one in the US. Even as battles are being won for benefit parity, and medications can now alleviate some of the worst suffering, the stigma of suffering from depression or some form of psychosis still has a lot of staying power. And most experts agree the supply of mental health professionals doesn’t begin to match the numbers of people in need of therapy and treatment. Against this backdrop, a new approach is emerging to bring mental health “in from the cold.”

This WIHI showcases leaders and organizations that are at the forefront of redesigning care for patients and populations in need of primary care and mental health services. By offering both, often in the same location, providers are more likely to help their patients connect the dots between body and mind, and improve underlying health problems in a more holistic fashion. Research has begun to demonstrate that this approach leads to improved chronic conditions and fewer trips to the ED.

However, just because something makes a lot of sense doesn’t mean there’s the infrastructure, the clinical training, or the payment system to effect these changes. That’s where places like Intermountain Health Care, Southcentral Foundation, and Greater Nashua Mental Health can be especially helpful: they’ve forged ahead with new models and hope that others can learn by their example. WIHI host Madge Kaplan leads the discussion of new ideas and thinking with Ben Miller, who has that big picture, and the expertise of Brenda Reiss-Brennan and Mara Huberlie.
58 min
June 27, 2017WIHI: Slowdown in the Growth of US Health Care Spending
Date: July 11, 2013
Featuring:
Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement; Former Administrator, Centers for Medicare & Medicaid Services (CMS)
David Cutler, PhD, Otto Eckstein Professor of Applied Economics, Harvard University, Harvard Kennedy School of Government, Harvard School of Public Health
Amitabh Chandra, PhD, MA, Professor of Public Policy and Director of Health Policy Research, Harvard Kennedy School of Government; Member, Congressional Budget Office’s Panel of Health Advisors

Is the rate of growth of health care spending slowing in the US? And, if so, to what do we attribute this momentous development? Momentous because a lot of health economists and policy makers believe there’s something to the decline besides the impact of the recent US recession. And, for the first time, there are indications that pressure from both public and private payers, reinforced by reimbursement reforms rolling out in the Affordable Care Act, may be making a dent in the growth of the country’s health care spending. It’s way too soon to cheer, but it isn’t too soon to gather some smart people together to try and tease out what’s going on.

Guest Don Berwick talks about some of the initiatives he helped shape and enact while at the Centers for Medicare & Medicaid Services (CMS), designed to move the system toward global budgets and shared responsibility for populations. Are these shared-savings programs starting to have a slowing effect on the growth of health care spending? Well-known economist David Cutler discusses his recent findings that there could be a $770 billion windfall coming for Medicare and Medicaid over the next decade, that wasn’t foreseen and wasn’t part of cost projections. Amitabh Chandra is watching recent spending trends closely, too, and helps us think through whether any of them are linked to greater efficiencies, less waste, and better ways to deliver care.

WIHI's Communications Coordinator John Gauthier highlighted some of the key questions that listeners posed here in a blog post. Take a look and then listen to the broadcast to hear what our guests had to say.
59 min
June 27, 2017WIHI: The Ground Game of the Partnership for Patients
Date: June 27, 2013
Featuring:
Ann Hendrich, RN, PhD, FAAN, Senior Vice President, Clinical Quality and Safety; CNO; Executive Director, Patient Safety Organization (PSO), Ascension Health
Deborah Morris Nadzam, PhD, RN, BB, FAAN, Project Director, JCR Partnership for Patients Hospital Engagement Network
Katherine Luther, RN, MPM, Vice President, Institute for Healthcare Improvement
Libby Hoy, Founder and Chief Executive Officer, Patient & Family Centered Care Partners (Long Beach, CA)

When it comes to patient safety and reducing harm, one of the biggest challenges US hospitals face day-to-day is how to maintain a relentless focus on everything that needs to be improved and worked on, simultaneously. Building reliable systems, engaging leaders, insisting on a team-based culture, and ensuring that staff has the necessary improvement skills have become essential underpinnings at every organization. So has joining up with something larger — to keep the pressure on, commit to stretch goals, and benefit from coaching and continuous learning.

The Partnership for Patients, launched by the US Centers for Medicare & Medicaid Services (CMS) in April 2011, is attempting to be that “something larger” for some 3,700 hospitals that have signed on to reduce nine hospital-acquired conditions by 40% and hospital readmissions by 20% by December 2013. What does this sprint look like from the vantage point of the 26 Hospital Engagement Networks (HENS) that form the backbone of the initiative? On this WIHI, we check in with two HENS — Ascension Health and Joint Commission Resources, Inc. Ann Hendrich and Deborah Nadzam are our invaluable informants, along with Libby Hoy, who’s playing a crucial role embedding patient engagement into every hospital’s safety work. IHI’s Kathy Luther also shares her perspective on what we’re learning about reducing harm from this ambitious initiative.

At one level, the Partnership for Patients is about doing all the right things to protect patients from a list of hospital-acquired conditions and avoidable readmissions. But as you’ll find out on this WIHI, if the improvements are going to be lasting, hearts and minds have to change, too.
59 min
June 27, 2017WIHI: Large-Scale Change Across a Country: Learning from Scotland
Date: June 20, 2013
Featuring:
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement (IHI)
Jeffrey D. Selberg, MHA, Executive Vice President and Chief Operating Officer, IHI
Derek Feeley, Director General for Health and Social Care, Scotland; Chief Executive, NHS Scotland; Incoming Executive Vice President, IHI
Carol Haraden, PhD, Vice President, IHI

In September 2013, IHI will welcome one of Scotland’s most well-regarded health system improvement leaders to its executive ranks. Derek Feeley is currently Director General for Health and Social Care in the Scottish Government and Chief Executive of NHS Scotland. In this capacity, he has overseen and steered Scotland’s ground-breaking Patient Safety Programme. At IHI, Mr. Feeley will have executive-level responsibility for driving IHI’s strategy across five core focus areas: Improvement Capability; Patient Safety; Person- and Family-Centered Care; Quality, Cost, and Value; and the Triple Aim for Populations. His role will be international in scope, helping to steer IHI’s ongoing work on six continents in support of our mission to improve health and health care around the world.

How can the experience of Scotland and the leadership of Derek Feeley move this agenda forward? We explore this on WIHI. Along with Mr. Feeley, our guides include IHI President and CEO, Maureen Bisognano; IHI COO, Jeff Selberg; and IHI Vice President Carol Haraden, who has first-hand experience working with clinical and quality leaders in Scotland and England to drive significant change across both countries. In Scotland, hospital standardized mortality ratios (HSMR) have fallen by nearly 11 percent since 2008.

What went on in health care delivery in Scotland to achieve these results? How is Scotland sustaining the gains and exporting the learning to other countries, including the US? How does Scotland now intend to change the health trajectories for infants and young children? WIHI host Madge Kaplan hopes leads the discussion to answer these questions.
1 hr
June 27, 2017WIHI: Measure Up, (Blood) Pressure Down: 80% by 2016
Date: May 30, 2013
Featuring:
Jerry Penso, MD, MBA, Chief Medical and Quality Officer, American Medical Group Association
Phil Yphantides, MD, Hypertension and Diabetes Physician Champion, Sharp Rees-Stealy Medical Group
Ola Akinboboye, MD, MPH, FACC, Associate Professor or Clinical Medicine, Weill Medical College of Cornell University; Medical Director, Queens Heart Institute; President, Association of Black Cardiologists
Bob Mathews, President and CEO, MediSync

In order to improve health outcomes and slow health care spending in the US, much of which is fueled by millions of people with poorly managed chronic conditions, health care providers are rethinking how they engage with patients who are most at risk.

Hypertension is a case in point. Left untreated, individuals are on track to develop heart disease, strokes, and more. Yet the US Centers for Disease Control and Prevention (CDC) estimate that 30 million Americans with high blood pressure aren’t receiving the proper care. The reasons are complex and multifaceted. That’s why the American Medical Group Foundation decided six months ago to harvest the best hypertension interventions and innovations from leading medical group practices, and spread the learning via Measure Up, Pressure Down, a three-year national campaign. This WIHI looks at how the initiative is progressing.

Each guest has a unique perspective on the issues surrounding hypertension, as well as experience transforming group practices to deliver the right care to the right patient at the right time. Our guests agree that access to primary care is an important factor in untreated high blood pressure, but they assert that this tends to obscure other defects in the system. That’s why the campaign planks, described in a detailed toolkit, focus on eliminating “dropped balls” and map out ways medical groups can more reliably and accurately engage with the patients with high blood pressure they do see.

Learn about an effort that promises to impact both health care delivery and population health.
1 hr
June 27, 2017WIHI: Reliable Practices for Responding to Natural Disasters: Lessons from Long Island Jewish and Hurricane Sandy
May 16, 2013
Featuring:
Mark P. Jarrett, MD, MBA, Chief Quality Officer, North Shore-LIJ Health System
Mark J. Solazzo, MBA, Executive Vice President and Chief Operating Officer, North Shore – LIJ Health System
Joseph Cabral, MS, Senior Vice President, Chief Human Resources Officer, North Shore-LIJ Health System

Hurricane Sandy first struck the Caribbean and then the entire East Coast of the United States at the end of October 2012. The storm smacked into New York and New Jersey especially hard, impacting millions. The story of how the largest health care system in the region, North Shore–LIJ, operated throughout to ensure patients and staff were protected and supported, under fierce circumstances, is one that communities and hospitals everywhere can learn from. This WIHI features three leaders from NS-LIJ who were responsible for every kind of decision imaginable before, during, and after the storm.

Some of the decisions included transferring hundreds of nursing home residents out of harm’s way, taking in patients from other hospitals, assisting at area shelters, buying up fuel for ambulances, and opening up a resource center for hospital staff whose homes and neighborhoods had been torn apart and flooded. One of the back stories to NS-LIJ’s response is the degree to which it was built upon critical lessons learned during Hurricane Irene, a year before. In 2009, there was the H1N1 outbreak. In each instance, the health system did things well, and saw where it fell short; now that Hurricane Sandy has come and gone, this same type of assessment continues.

Health care organizations and first responders must prepare for many types of crises and disasters. Reflecting on the recent Boston Marathon bombings, which killed three and seriously injured over 200 (NEJM, April 24, 2013), authors Arthur Kellermann and Kobi Pelag write, “The best way hospitals can prepare is to base their response on a strong foundation of daily health care delivery.” So, routine and reliably safe practices, guided by continuous quality improvement, is lesson one for emergency planning. WIHI host Madge Kaplan invites you to learn more in this timely discussion.
1 hr 1 min
June 27, 2017WIHI: Home for Life, Aging, and Aging in Place
Date: May 2, 2013
Featuring:
Sharon King, Principal, Starfield Consulting Ltd.
Mimi Toomey, MA, Director of the Office of Policy, Analysis and Development at the Administration for Community Living (ACL), US Department of Health and Human Services

With the aging of the population in many countries, where are the best ideas going to come from to help older people remain in their communities, and among the friends and families — and other seniors — they know best? How can we shift mindsets and models from ones that include endless and expensive health care interventions to a vision that factors in the role that supportive people and support services can play further upstream — to reduce isolation and loneliness, to ensure good nutrition and management of chronic health issues, to prevent avoidable hospitalizations?

This WIHI takes a stab at some answers. In South Georgian Bay, a community along the Severn River in Ontario, six organizations have come together to create a web of resources called Home for Life, focused on the growing population that’s over 65. Anchored by volunteers, a 211 system to initiate and engage services, and a “back to the village” vision that also includes empowering older individuals with computers and new technologies, Home for Life isn’t just another in a long string of well- intentioned social service initiatives. WIHI guest Sharon King, one of its creators, believes Home for Life should be studied, measured, and monitored for its effectiveness. She’s hopeful they’re on to something in Canada that can be adapted elsewhere.

How does this look to Mimi Toomey from her perch at the US government’s Administration for Community Living? With over 25 years of experience developing policies to support aging populations, is this the kind of “break the mold,” more cost-effective experimentation that communities in the US need to tap into, too? Do we have similar examples popping up that we need to learn more about? Probably so. If we’re going to get out from under headlines and reports that focus exclusively on aging as unaffordable for society most of all, we need fresh ideas and compassionate innovation.
56 min

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…

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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