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: Engaging Patients in Safety — Live from London and the International Forum on Quality and Safety
Date: April 18, 2013
Featuring:
Susan Hrisos, Senior Research Associate, Institute of Health & Society, Newcastle University (UK)
Jane O’Hara, MSc, PhD, Senior Research Fellow, Yorkshire Quality & Safety Research Group, Bradford Institute for Health Research
Martin Hatlie, JD, CEO, Project Patient Care; President, Partnership for Patient Safety; Co-founder, Consumers Advancing Patient Safety

It’s easy enough to say patients need to be engaged in all levels of their care, including being aware of best practices and anything that could inadvertently result in harm. But what does this actually look like day-to-day, especially in the high-stakes, busy environment of today’s highly complex hospitals? And what good does it do for patients and families to notice and speak up about things if there’s no one on the receiving end trained to respect and act upon the information?

With at least a decade’s worth of ideas and initiatives on patient engagement with patient safety as a backdrop, new research on what is and isn’t working in the UK — with broad application to the US and elsewhere — is in the spotlight on this WIHI. WIHI listeners got a first peek at new analysis presented at the 2013 IHI-BMJ International Forum on Quality and Safety in Healthcare by leading researchers at Newcastle University and the Bradford Institute for Health Research in England, Susan Hrisos and Jane O’Hara. Martin Hatlie, one of the leading voices and experts on patient engagement in the US, comments on the research and describes new models for effective patient/provider collaboration around safety that are emerging in the US.

Patient engagement in patient safety is here to stay. The only question is how this vital part of improvement can be more effective, and what skills patients and providers alike need to work together for the same goal.
58 min
June 27, 2017WIHI: Community Health Needs Assessments, Part 2: Lessons from North Carolina
Date: April 4, 2013

Featuring:
Dorothy Cilenti, DrPH, MPH, MSW, Senior Investigator, North Carolina Institute for Public Health; Clinical Assistant Professor, UNC Gillings School of Global Public Health
John Morrow, MD, MPH, Pitt County Health Director; Incoming President, North Carolina Association of Local Health Directors
Craig James, MPH, President and CEO, Highlands-Cashiers Hospital

One of the reasons it’s so hard to transform US health care into something that’s safe, value-driven, and patient-centered, but also focused on improving the health of the local community, is that the responsibilities and the responsible parties have grown up completely separately. For example, it is not a naturally occurring event for the local public health department to coordinate its efforts with local hospitals… except in cases of disease outbreaks or disaster. So, imagine how rare it is to sit down together to craft overlapping goals for population health or to hatch new initiatives to keep residents from needing expensive acute care. It helps to have a convener to bring parties together… which is why we examined one such coalition that has formed in North Carolina on this WIHI.

WIHI host Madge Kaplan invites you to hear what’s been going on under the auspices of the North Carolina Institute of Public Health (NCIPH), and the leadership of Dr. Dorothy Cilenti and her team. They’ve brought together local health directors like Dr. John Morrow of the North Carolina Hospital Association and hospital leaders like Craig James; leaders from community health centers; and many more, to lay the groundwork for the future of health and health care in the state. The effort has become especially relevant and pressing because of new federal requirements for nonprofit hospitals to engage in robust community health needs assessments, with help and input from other groups and agencies. These new IRS rules, and how to make them meaningful, were the focus of the March 21 WIHI, which we invite everyone to listen to as background and context for the April 4 discussion.

One of the more intriguing dimensions to the work in North Carolina is its explicit mission to create multiple “community health systems” throughout the state to build and model best practices for population health. The collaborative driven by NCIPH is also working on analyzing return on investment and economic impact to “create the business case for working collectively on improving community/population health.” We’ve got a great case study to learn more about on in this show. Please listen, and make your own work on population health and community health needs assessments all the richer.
58 min
June 27, 2017WIHI: Community Health Needs Assessments, Part 1
Date: March 21, 2013
Featuring:
Sara Rosenbaum, JD, Harold and Jane Hirsh Professor, George Washington University, School of Public Health
Kevin Barnett, DrPH, MCP, Senior Investigator, Public Health Institute
Jean Nudelman, MPH, Director, Northern California Community Benefit Programs, Kaiser Permanente Northern California Regions

When a US hospital’s not-for-profit status is in the news, it’s usually not a good thing. It typically means someone (often a politician) is questioning whether the hospital’s federal tax exemption is deserved because of business practices, high executive pay, too little charity care, or a perceived lack of commitment to the local community. Sometimes the allegations and heightened scrutiny have been fair, sometimes not. Either way, America’s hospitals have a brand new challenge on their hands: to take newly revised IRS rules governing a hospital’s not-for-profit designation and turn them into meaningful plans to improve, in partnership with other organizations, a community’s overall health.

WIHI held a timely discussion with three leading experts on the transformation of the decades-long “community benefit” law (largely focused on hospital support for indigent patients) into something more far reaching known as Community Health Needs Assessment, or CHNA. Section 9007 of the Affordable Care Act outlined the components of CHNA, chief among them a requirement for hospitals to conduct an evaluation every three years of the health status of the neighborhoods that surround their campuses, and then to use that information to develop strategies to reduce the community’s health risks. The new IRS rules also require greater transparency in the process and obligate hospitals to work in concert with community leaders and local public health experts.

The trio of Sara Rosenbaum, Kevin Barnett, and Jean Nudelman exemplify the ways in which policy and public health expertise, access to community health data, and the experience of health care providers can combine in powerful new ways to meet the demands of CHNA — and, more importantly, to meet the demands of better health and better health care at reduced costs (yes, the good old Triple Aim).
1 hr
June 27, 2017WIHI: No Excuses, No Slack! The Latest from the Front Lines on Hand Hygiene
Date: March 7, 2013
Featuring:
Gene H. Burke, MD, Vice President and Executive Medical Director for Clinical Effectiveness, Sentara Healthcare
Michael Howell, MD, Director of Healthcare Delivery Science, Director of Critical Care Quality, Beth Israel Deaconess Medical Center
Lisa L. Maragakis, MD, MPH, FSHEA, Director of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital
Scott A. Miller, MD, FACP, Vice President, Medical Affairs, Sentara Leigh Hospital
Tom Talbot, MD, MPH, Chief Hospital Epidemiologist, Vanderbilt University Medical Center

One of the cornerstones of infection prevention in any health care setting, including when someone is being cared for at home, is good hand hygiene. Much of the attention in recent years has focused on hospitals and their rates of hand hygiene compliance among staff. And rightly so. Among the biggest contributors to hospital-acquired infections are, inadvertently, health professionals themselves... and others who come in contact with patients.

The good news is that awareness of the necessity of strict hand hygiene compliance has never been greater… not just in the US, but in acute care settings globally. And this awareness has been coupled with practices that are being adhered to more reliably than ever before. But not everywhere, all the time; organizations that can tout rates as high as 95% are still the exception, not the rule, and good performers continue to face challenges closing the gap.

WIHI host Madge Kaplan gathered infection prevention leaders and clinicians from four organizations whose recent innovations with hand hygiene at their facilities represent what could be the best bet yet that 100% compliance is achievable. Sentara, Johns Hopkins, Vanderbilt, and Beth Israel Deaconess Medical Center all have fresh approaches that rely on new kinds of auditing tools to discern what really works; better surveillance, monitoring, and measuring; reengineering; constant education; and a laser-like focus on behavior and culture change.

What’s working in your organization? How are you getting your hand hygiene compliance rates to move upward? Compare and contrast your methods with those of our guests on this WIHI.
1 hr 1 min
June 27, 2017WIHI: Clinicians and Financial Staff Can Improve Quality and Lower Costs, Part 2
Date: February 21, 2013

Featuring:
Norman E. Dascher, Jr., FACHE, CEO of Acute Care – Troy and Vice President, St. Peter’s Health Partners, Northeast Health (Troy, New York)
Lucy A. Savitz, PhD, MBA, Senior Scientist, Institute for Healthcare Delivery Research, Intermountain Healthcare
Katharine Luther, RN, MPM, Vice President, Hospital Portfolio Planning and Administration, Institute for Healthcare Improvement (IHI)
Catherine Abbott, RN, MSN, Administrator, Performance Improvement, Hackensack University Medical Center (Hackensack, New Jersey)

Here’s the rub about reducing health care costs to improve your hospital’s bottom line: The “old” solutions of cutting back on staff and services are shortsighted at best. The best solutions require delivering better care and getting rid of wasteful practices. Even getting bigger to achieve efficiencies and economies of scale won’t help in the long run; the new world pays for value over volume. And value involves care coordination that follows patients wherever they go, including after they leave your hospital.

How to survive, and thrive, in this brave new world? This WIHI is the second installment of a focus this month on cost reduction strategies that marry the best ideas from quality improvement with sharpened-pencil, financial and business acumen. The discussion focuses on the work of two organizations — Northeast Health and Hackensack University Medical Center — and unpack how they, and some 58 other organizations that were part of IHI’s Impacting Cost + Quality initiative, are on track to save $43 million.

Can your hospital leadership commit to reducing costs at least two percent over the next five years, while maintaining or improving quality? If you can’t make that commitment today, what would get you on the path to making it? WIHI host Madge Kaplan, with the help of IHI’s Kathy Luther and three dynamic hospital leaders and experts — Norm Dascher, Lucy Savitz, and Cathy Abbott — promise you a bold and bottom-line discussion.

The following materials may also be of interest:
Leaders challenged to reduce cost, deliver more. Healthcare Executive. Jan/Feb2012
Eliminating Waste Without Hurting Quality. HFMA Leadership Magazine, May 2012
IHI Innovation white paper series: Hospital Inpatient Waste Identification Tool
IHI Innovation white paper series: Increasing Efficiency and Enhancing Value in Health Care
1 hr 1 min
June 27, 2017WIHI: Employers and Employees Can Improve Quality and Lower Costs: Stories from the Front Lines, Part 1
Date: February 7, 2013
Featuring:
Trissa Torres, MD, MSPH, Senior Vice President, Institute for Healthcare Improvement
Xavier Sevilla, MD, MBA, FAAP, Vice President of Clinical Quality for Physician Services, Catholic Health Initiatives
Lindsay A. Martin, MSPH, Executive Director and Improvement Advisor, Institute for Healthcare Improvement
Randy Van Straten, Vice President Business Health, Bellin Health; Executive Director Bellin Run

US employers have had a lot to say about health care costs the past several years. Large and small companies alike have openly complained about the apparently inexorable rise in health care spending, skyrocketing insurance rates, and the degree to which both trends have threatened bottom lines, restrained wages, and eroded benefits for employees.

Some of the most vocal businesses have been determined to remedy the situation by exercising their purchasing clout to get better deals from insurers and by shifting more costs and co-pays onto the workforce. The most enlightened have also ramped up their wellness programs. But these “solutions” are short-term at best, and efforts to encourage employees to get to the gym and adopt healthier lifestyles are proving insufficient. So, what to do instead?

This WIHI discusses what promises to be the next wave of employer engagement in improving health and controlling health care costs in the US. This involves taking a deeper dive into the underlying, often chronic health conditions affecting today’s employees. And, in a growing number of cases, partnering and learning from health care delivery organizations working on the very same issues — heavy health care utilization and high costs — with their own staff.

WIHI host Madge Kaplan welcomes IHI’s Trissa Torres and Lindsay Martin, who have the big picture of these exciting new developments. Also joining the discussion are leaders from Bellin Health Care Systems, Catholic Health Initiatives, and other places that are “walking the talk” with their own employees. Among other things, these providers are redesigning systems to deliver better care and better value to the community and all those paying the bills: employers, public and private insurers, and patients themselves.
57 min
June 27, 2017WIHI: A Partnership to Reduce Deaths from Sepsis
Date: January 24, 2013
Featuring:
John D’Angelo, MD, FACEP, Chairman, Department of Emergency Medicine, Glen Cove Hospital, North Shore-Long Island Jewish Health System
Martin E. Doerfler, MD, Vice President, Evidence Based Clinical Practice, North Shore-Long Island Jewish Health System
Darlene Parmentier, RN, MSN, MBA, Assistant Director of Critial Care and Telemetry, Glen Cove Hospital, North Shore-Long Island Jewish Health System
Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement
Diane Jacobsen, MPH, CPHQ, Director, Institute for Healthcare Improvement

Developing an infection can be complicated enough, but when the body's immune system reacts by going into overdrive in the form of sepsis, every second counts. The diagnosis needs to be swift and, if sepsis is confirmed, interventions in the form of fluids and antibiotics must be administered immediately. Because the global death rate from sepsis remains painfully high — tens of millions each year — stepped-up efforts to reduce mortality have been underway on a global scale for at least the past decade. And there is progress to report on multiple continents where many health care organizations have been working hard on sepsis, often as part of international initiatives such as the Surviving Sepsis Campaign and in concert with professional societies such as the Society of Critical Care Medicine.

In the US, where 25 percent of the 750,000 people who develop sepsis each year die, North Shore–Long Island Jewish (NSLIJ) Health System has reduced its sepsis mortality rate significantly. North Shore–LIJ is now in the midst of a strategic partnership with IHI to maintain and further these gains, and key learning has begun to emerge. WIHI host Madge Kaplan explores this progress on reducing deaths from sepsis with three clinical leads from North Shore–LIJ and two improvement leaders from IHI. Early detection and intervention are key, but in order to execute best practices reliably, changing the culture and engaging the leadership of the organization have proven essential. At North Shore–LIJ, focusing on the emergency department has also been foundational to testing best practices and spreading them to the rest of the hospital system.

Don't miss this very important discussion about a critical problem that everyone in acute care needs to be aware of and working on. Patients and families are getting engaged too.
1 hr 1 min
June 27, 2017WIHI: Navigating New Care Teams with Nurse Practitioners
Date: January 10, 2013
Featuring:
Susan B. Hassmiller, PhD, RN, FAAN, Senior Advisor for Nursing, Robert Wood Johnson Foundation
Daryl Lynch, MD, Vice Chair Ambulatory Medicine, Children’s Mercy Hospitals and Clinics (Kansas City); Director, Division of Adolescent Medicine
Cathy Rick, RN, PhD, FAAN, FACHE, Chief Officer, Office of Nursing Services, US Department of Veteran Affairs (VA)
Patricia Gerrity, PhD, RN, FAAN, Director, Eleventh Street Family Health Services of Drexel University; Associate Dean for Community Programs, Drexel University College of Nursing and Health Professions

As we roll into 2013, the health care improvement community has a lot on its plate. Just for starters: reducing avoidable hospital readmissions, building community coalitions to improve population health, building active partnerships with patients and families, achieving meaningful use of electronic health records, and redesigning primary care. Each entails massive changes in thinking and strategy in order to achieve the larger aim of moving health care from a volume-based to a value-based system, focused on helping everyone lead healthier lives.

So what does the health care workforce have to do with meeting these challenges? Plenty. Caregivers must increasingly see themselves as change agents, and leaders must tap the strengths and talents of all their clinical staff in new and innovative ways.

WIHI host Madge Kaplan is pleased to kick off the new year with a discussion of how nurse practitioners or advanced practice nurses are being deployed and woven into new, interdisciplinary, team-based delivery designs. Our guides are four individuals who are engaged in both pioneering and common-sense solutions to patient needs in ways that match the right caregivers with the right patients and the right needs.

At the Robert Wood Johnson Foundation, Susan Hassmiller has a bird’s eye view of where and how nurses across the US are contributing at the top of their education and training; Cathy Rick, at the VA, is overseeing the implementation of a new national strategic plan to better align nursing services with new systems of care for some six million veterans who use the VHA; Patricia Gerrity directs a nurse-managed community health center in North Philadelphia; and, in addressing the health needs of teenagers, physician Daryl Lynch has created deep and effective collaborations with nurse practitioners.

There are challenges to getting the care team right, and disagreements over roles and functions. But as you’ll learn from this WIHI, there’s also a new spirit of forging ahead given the growing emphasis on primary care in a rapidly reforming health care system.
1 hr 1 min
June 27, 2017WIHI: Reality Knocks with Reducing (Hospital) Readmissions
Date: November 15, 2012
Featuring:
Patricia Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement; Co-Principal Investigator, STate Action on Avoidable Rehospitalizations (STAAR)
Elizabeth H. Bradley, PhD, Professor of Public Health (Health Policy and Management), Yale School of Public Health; Faculty Director, Yale Global Health Initiative
Leora Horwitz, MD, MHS, Assistant Professor, Internal Medicine, Yale University School of Medicine

Of all the improvement issues facing health care, reducing avoidable hospital readmissions may well be the one that finally breaks down traditional silos — and allows promising changes to realize their full impact. Why? In order to prevent patients from bouncing back into the hospital, front-line staff must create robust care coordination strategies across multiple health care settings, as well as the home and the community — taking a fundamentally broader view of the patient journey and the reforms needed.

However, doing the right thing — keeping patients out of the hospital — often hurts a hospital’s bottom line. So far, anyway. In the US, the Centers for Medicare & Medicaid Services (CMS) has now imposed fines on some 2,200 hospitals for higher-than-average readmission rates, as part of new federal policy. This latest move won’t make the financial piece any easier, but it does put hospitals on notice that there’s “nowhere to run, nowhere to hide.” If you want to reduce readmissions, you have no choice but to fundamentally redesign what you’re doing now.

What are the most promising ideas and strategies to look to and build upon? This WIHI convenes some important leaders and thinkers on reducing readmissions and care coordination that, between them, have a comprehensive view of what’s working, what’s challenging, and where we go from here. Elizabeth Bradley and Leora Horwitz are among the co-authors of an article in the Journal of the American College of Cardiology published in August 2012 that examines the all-too-persistent gap between best intentions and uneven execution of known best practices. Drs. Bradley and Horwitz discuss the study findings and what can be done to help health care organizations follow through on their own robust policies. In her role as Co-Principal Investigator of IHI’s STAAR initiative, Pat Rutherford has been deeply involved with hospital leaders and officials in three states that have taken to heart the challenge of reducing readmissions, with results to show for it. Pat Rutherford also carefully tracks the work of multiple initiatives in the US, including Project BOOST, Project RED, and Hospital to Home (also known as H2H).

WIHI host Madge Kaplan welcomes Dr. Bradley, Dr. Horwitz, and Pat Rutherford to the show, to share their crucial and timely insights and learning. These improvement leaders are keenly aware of the ways in which policy and reimbursement changes surrounding readmissions are giving hospitals that want to do the right thing a jolt.
1 hr 3 min
June 27, 2017WIHI: OpenNotes: Doctors and Patients Are on the Same Page
Date: November 1, 2012
Featuring:
Tom Delbanco, MD, Richard and Florence Koplow–James Tullis Professor of General Medicine and Primary Care, Harvard Medical School
Robert D. Harrington, MD, Professor of Medicine, University of Washington; Medical Director, Harborview Medical Center HIV clinic; Associate Section Chief of Infectious Diseases, Harborview Medical Center
Richard Martin, MD, FAAFP, Department Director of Community Practice Service Lines (CPSL), Scranton and Monroe Counties; Director of Care Continuum, Geisinger Health System
Michael Meltsner, AB, JD, Matthews Distinguished University Professor of Law, Northeastern University School of Law, Boston, MA
Some changes in medicine are easier to contemplate than others. For a long time the notion that patients should be able to view what doctors write about them, following a visit, was unthinkable. It was a kind of “patient don’t ask, doctor don’t tell” policy. However, the growth of electronic health records, increased pressure for transparency, and the need to improve communication and understanding between patients and providers in every way possible are all tugging at information once considered off limits.

Despite the fear that “physician notes” have a tendency to be brief, even glib, and might unintentionally insult or alarm the reader, some health systems, like Dartmouth Hitchcock, have been successfully offering patients easier access to these notes, along with the entire electronic health record, for several years. [See the December 2009 WIHI: OpenNotes and the Electronic Medical Record.]

Still many more health systems have been on the fence, waiting for evidence that there’s value in doing so — and that the benefits outweigh the risks. Now that evidence seems to have arrived, and this WIHI digs into the experience of more than 13,000 patients and 100 primary care doctors who were part of a pilot study.

The findings appear in the October 2, 2012, issue of the Annals of Internal Medicine, reporting on a one-year experiment with what have come to be called “open notes” at three major health care organizations: Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System in Pennsylvania, and Harborview Medical Center in the state of Washington.

WIHI host Madge Kaplan welcomes lead author of the study, Dr. Tom Delbanco, one of the key innovators behind OpenNotes and their trial use at BIDMC, and two clinicians who helped lead the pilots at Geisinger and Harborview. By making notes accessible to patients in their own practices, both these clinicians came to better understand shared decision making and the ways in which transparency, rather than offend, increases trust. Michael Meltsner shares what mattered to him when he faced serious illness. A distinguished law professor, Meltsner’s “A Patient’s View of OpenNotes” also appears in Annals, and captures the brave new world of patient expectations and the need to level the playing field.
1 hr

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