WIHI - A Podcast from the Institute for Healthcare Improvement

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WIHI - A Podcast from the Institute for Healthcare Improvement episodes

June 27, 2017WIHI: Gaining Ground: Quality Improvement and US Medical Residency
Date: October 25, 2012
Featuring:
Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement (IHI)
Kedar Mate, MD, Assistant Professor, Department of Medicine, Weill Cornell
Medical College; Clinical Lead for Research and Development, IHI
James Moses, MD, MPH, Pediatric Director of Quality and Safety, Boston Medical Center; Academic Advisor, IHI Open School for Health Professions

Residency training in the US has long had the reputation of a rite of passage — a period when grueling hours on busy hospital floors are spent converting four years of medical school, and some clinical exposure, into real-time accountability for real patients who have sometimes serious and life-threatening medical conditions.

However, a changing health care system now demands that residents develop the skills not just to diagnose and treat patients who are ill, but to protect them from harm and to reduce their chances of being readmitted. Residents need to know about managing chronic conditions and how to help patients lead healthier lives.

These new goals present newly-minted MDs, and those who train them, with new challenges — among them, the need to work in teams and communicate with everyone, including patients and families, more effectively; the need to sleep after long hours on the job and to honor the requirement to take the time (and time off) to do so; the need to engage in effective handoffs to other providers and to help coordinate care across multiple health care settings.

It’s a tall order for the nation’s complex system of training doctors, and aligning what happens in residency programs with the ambitions of quality improvement is at an early stage. Why is this the case? What can be done to accelerate reforms? Where are promising new models starting to emerge?

This WIHI takes up these questions and more, with three outstanding guests who are directly helping to hasten the transformation of residency training in the US.

Drs. Don Goldmann, Kedar Mate, and James Moses are working with multiple organizations, including the Accreditation Council for Graduate Medical Education (ACGME), to better identify what’s needed, including building greater capacity among faculty in residency programs to teach and model improvement skills. Dr. Goldmann has a strong understanding of the structural barriers that must be addressed to make this possible. Dr. Mate has a unique and important view on the intersection between residency training and the growing field of hospital medicine, as well as innovations emerging from primary care practices on their way to becoming patient-centered medical homes. Dr. Moses has been instrumental in shaping the offerings of the IHI Open School for Health Professions to ensure they’re relevant and accessible to today’s residents.
Read the IHI 90-Day R&D Project report related to this topic.
1 hr
June 27, 2017WIHI: Navigating the Elections with a Clear-Eyed View
Date: October 12, 2012
Featuring:
Donald M. Berwick, MD, MPP, Former President and CEO, Institute for Healthcare Improvement; Former Administrator, Centers for Medicare & Medicaid Services
Chris Jennings, President, Jennings Policy Strategies (Washington, DC); Former Senior Health Care Advisor (Domestic Policy & National Economic Councils) to President Bill Clinton

We’re just weeks out from the November elections in the US and, depending on the outcome, health care reforms championed by the Obama administration will either continue unabated or possibly face some serious challenges — from a new President or a differently configured Congress. In the midst of this uncertainty, numerous individuals are keeping a close eye on the national policies and initiatives that have done the most of late to accelerate new payment schemes and the redesign of health care delivery, as well as expand insurance coverage.

IHI has two programs this fall to help you navigate this election cycle with a clarity of purpose that health care improvement requires more than ever in these tumultuous times: a WIHI with Dr. Don Berwick and Chris Jennings on October 12 and, on November 8, Out of the Blocks, an in-person, one-day conference in Washington, DC, featuring post-election analysis from Sen. Tom Daschle and Sen. Bill Frist, IHI President and CEO Maureen Bisognano, Virginia Mason CEO Gary Kaplan, and moderated by Don Berwick and NBC’s Nancy Snyderman, MD.

Because health care reform has become such a political flash point, it’s sometimes hard to find the “through line” for the improvement community in particular and the country as a whole. But Don Berwick says this is precisely what needs to happen. In this WIHI, he explains what “continuity of purpose” might entail in order to stay focused on a robust agenda that includes much greater attention to improving care across the continuum, reducing costs, and helping people and communities lead healthier lives. You can also count on Chris Jennings to summon his 25 years of experience as a health policy strategist to provide the freshest and most sanguine ways to think about reinventing health care in the US, even when political winds can, and often do, change directions.

Madge Kaplan hosts this special pre-election WIHI... Whether you’re steeped in forming an accountable care organization or patient-centered medical home, innovating to improve the patient experience, hard at work on reducing avoidable readmissions, or engaged in any combination of these efforts and more.
1 hr
June 27, 2017WIHI: Pioneering ACOs: What Do We Know So Far?
Date: September 27, 2012
Featuring:
Elliott Fisher, MD, MPH, Director, Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice
Palmer “Pal” Evans, MD, former Senior Vice President & Chief Medical Officer, Tucson Medical Center (TMC)
John Friend, Vice President Business Development & Associate General Counsel, TMC Healthcare; Executive Director, Arizona Connected Care, LLC

One of the best-kept secrets about US health care this election season is the degree to which change and transformation are coming, no matter what happens in November. You won’t hear “global payment” or Medicare Shared Savings Program mentioned as often as “individual mandate” in the current political debate, but ask anyone leading a health care organization today which issue keeps them up at night, and it’s definitely payment reform. In general terms, the entire system is shifting from paying for volume – lots of procedures – to paying for value, or how well patients are cared for over time and across the continuum.

Accountable care organizations (ACOs) are one critical new reflection of this migration, and they’re being encouraged by public and private payers alike. What do we know about the more than 200 ACOs that have formed in the US thus far? It’s still early in the process, but some smart people are keeping a close eye on ACOs, and we’re going to be talking with a few of them on WIHI.

As Director of Population Health and Policy at the Dartmouth Institute for Health Policy and Clinical Practice, Dr. Elliott Fisher is leading a major study of the factors enabling ACOs to get up and running and to successfully implement new forms of care delivery. WIHI host Madge Kaplan welcomes Dr. Fisher to the show to share what he and his team of evaluators have learned thus far. He’ll be joined by leaders from Tucson Medical Center, one of the nation’s earliest adopters of the ACO concept. Dr. Palmer “Pal” Evans and John Friend from Arizona Connected Care both say that one of the biggest hurdles for newly forming ACOs is to let go of the notion that hospitals can and should run the show. That’s not where the future is headed, both say, and they’re learning this in spades in Arizona. They’re also learning how to build will and buy-in from mostly independent physicians, a situation that’s typical of most US hospitals.

There are plenty of uncertainties ahead, but Elliott Fisher, Pal Evans, and John Friend agree that ACOs or something similar are likely to be a feature of reform for the forseeable future. They share their perspectives and answer questions on WIHI.

For some background on Tucson Medical Center’s entrance into the ACO experiment, please take a look at these Commonwealth Fund case studies published earlier this year.
1 hr 2 min
June 27, 2017WIHI: Conversations as Cornerstones of End-of-Life Wishes
Date: August 30, 2012
Featuring:
Ellen Goodman, co-founder, The Conversation Project; Pulitzer-Prize winning columnist and author
Larry Weber, Chairman, W2 Group; Author, Everywhere: Comprehensive Digital Business Strategy for the Social Media Era
Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement

We have lots of meaningful conversations in the course of our lives, but topping the list has to be talking with family members and loved ones about our own — or their — wishes for care at the end of life. Despite the inevitability of death, for many of us this is the last conversation we either want to have or know how to have; it can be especially difficult to initiate. And yet, without these discussions, we or our loved ones run the risk of running headlong into a medical crisis and getting care we don’t want, and not getting the care we do.

Back in January, WIHI offered listeners a preview of a ground-breaking, grass-roots initiative aimed at changing this state of affairs. The Conversation Project — whose goal is that everyone’s end-of-life wishes will be expressed and respected — launched in August 2012 in collaboration with IHI, and some of its key founders and creators are back in the WIHI studio on August 30 to explain what the effort is all about and how you can participate.

From the get-go, Ellen Goodman’s vision has been that end-of-life conversations need to become normalized — and that the best place to have the conversation is at the kitchen table, not in the ICU. To support its public campaign, The Conversation Project has created a website that will act as ground zero for collecting and spreading stories, sharing tips and templates to help people get started, and facilitating the networking that’s crucial when trying to bring about cultural change. The latest social media tools (Facebook, Twitter, and YouTube) will be available to extend the reach and impact of what everyone is learning along the way.

IHI’s Martha Hayward joins Ellen Goodman on WIHI to discuss how The Conversation Project can accelerate efforts to make health care more patient- and family-centered — and not just pertaining to end-of-life care, but with a myriad of health issues. WIHI host Madge Kaplan also welcomes Larry Weber from W2 Group, whose knowledge of social media and its potential to unleash social change has been a critical component of the development of The Conversation Project.
59 min
June 27, 2017WIHI: Minimally Disruptive Medicine
Date: August 9, 2012
Featuring:
Victor Montori, MD, MSc, Director, Mayo Clinic Healthcare Delivery Research Program; Professor of Medicine, Mayo Clinic.
Nilay Shah, PhD, Assistant Professor of Health Services Research, Mayo Clinic
Please note:
Dr. Montori will be offering a Special Interest Keynote on Minimally Disruptive Medicine on December 11, 2012, at IHI’s National Forum.
One of the most common phrases used to describe patients who are not taking their prescribed medications or following up on the recommendations of their health care providers is “non-compliant.” What if we viewed the behavior as an act of civil disobedience instead?

This provocative notion definitely got the attention of health professionals in the audience at IHI’s 13th Annual Summit on Improving Patient Care in the Office Practice and the Community (March 18-20, 2012). It’s the thinking of Dr. Victor Montori, a diabetologist and researcher at Mayo Clinic whose keynote remarks at the gathering were, in part, intended to shake up common and sometimes negative assumptions about patients with chronic diseases who don’t seem to be holding up their half of the bargain. Dr. Montori invites all of us to consider the work of being a chronically ill patient, and the burden of increased expectations to follow regimens that don’t easily fit into a patient’s daily life, social circumstances, preferences, and more.

What’s the alternative? Dr. Montori and colleagues call it “minimally disruptive medicine,” and WIHI invites you to learn more about this change of mindset and approach to chronic disease and what it can look like in practice. Host Madge Kaplan and Dr. Montori are joined by Nilay Shah, a health services researcher at Mayo Clinic. Both Drs. Shah and Montori argue that with the growth of patient-centered medical homes and numerous other initiatives that assume a greater role for patients and family members in managing chronic conditions, it’s a critical moment to examine what added workload this implies. The two argue that some of the burden on patients can be reduced if approaches to care are married with efforts to reduce unnecessary and costly over-treatment.

Think of it this way, says Dr. Montori: So-called “non-compliance” is actually an alarm system for a health care system that’s failing patients. The goal needs to be shifting and sharing responsibility for chronic disease with patients and families — not shifting the burden.

To learn a bit more about minimally disruptive medicine, check out the story of Susan and John.
1 hr 1 min
June 27, 2017WIHI: Triple Perspectives on Triple Aim in a Region
Date: July 26, 2012
Featuring:
Craig Brammer, Director, Beacon Communities, Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services
Shelley B. Hirshberg, MHSA, Executive Director, P2 Collaboration of Western New York; Project Director, Western New York Aligning Forces for Quality(AF4Q), Robert Wood Johnson Foundation
Carol Beasley, MPPM, Executive Director of Strategic Projects, Institute for Healthcare Improvement
Katherine Browne, MBA, MHA, Chief Operating Officer, National Program Director, Aligning Forces for Quality, Robert Wood Johnson Foundation

There’s a lot of interest in the Triple Aim in the US, Canada, and several European countries. And it’s no wonder. Ever since IHI conceived of the framework of the simultaneous pursuit of better health, better health care, and lower per capita costs, a whole array of strategies have opened up for health care improvers. Some of the most interesting and groundbreaking strategies have built as much on insights from outside health care as within.

And, just imagine if the various communities making headway with the Triple Aim started to think regionally? Well, many are and that’s the evolution this WIHI focuses on, tapping into three related but unique endeavors: IHI’s Triple Aim Initiative (with special focus on recent regional work), the Beacon Community Program (a project of the Office of the National Coordinator for Health Information Technology), and the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q).

These three efforts combined have already impacted nearly 200 communities, to the point where many now realize that thinking regionally is the logical next step. Among other things, a regional focus forces an examination of cross-cutting social issues that affect more than a single community — issues such as unemployment, education, transportation, and crime. One community’s solutions to the needs of an aging population, people with chronic conditions, and individuals with complex social problems might benefit the community next door. Further, a regional outlook necessitates building even broader coalitions, drawing on the expertise of health systems operating in multiple locations, state and municipal leaders, public health experts, urban planners, economic developers, and more.

Our guides for the July 26 WIHI are Craig Brammer, Katherine Browne, Carol Beasley, and Shelley Hirschberg. The AF4Q effort alone has some 270 partners and a portfolio of projects, including health information technology, that point to what’s possible when one starts to act regionally as well as locally. We’ll be identifying other emerging regional “movers and shakers” as well.
1 hr 1 min
June 27, 2017WIHI: Essential Skills for Health Care Reformers and Improvers: Holding Tension and Learning Habits of the Heart
Date: June 20, 2012
Featuring:
Parker J. Palmer, Founder and Senior Partner, Center for Courage and Renewal; Author, Healing the Heart of Democracy
Jeffrey D. Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement

The health care improvement community has often benefited from the work and perspective of other industries. Taking a systems approach to improving quality and safety in health care owes much to the concepts and work that turned the tide on risks and defects and waste in aviation and manufacturing.

The quality improvement movement has also benefited from the wisdom of “outsiders” — individuals asked to look in at what health care improvement is trying to achieve and to tell us what we may be missing or what they see that we don't, because we’re just too close to the problems and the day-to-day solutions. Parker Palmer is just such a person, and he’s visited with the improvement community before; in 1997 he delivered a moving keynote at IHI’s National Forum about the challenges of being a dedicated health care professional.

On the eve of the Supreme Court issuing its decision on the Affordable Care Act, and with new policies and payment schemes and community-focus reshaping the very core of what it means to be an effective health care leader, WIHI thought this would be a perfect moment to invite Parker Palmer to speak with us again. IHI Executive Vice President and COO, Jeff Selberg, who knows Dr. Palmer’s ideas and writings well, helps lead the discussion, along with WIHI host, Madge Kaplan.

When one is committed to change, there are good days and bad, and successes can easily be followed by disappointments and setbacks. The challenge becomes how to hold the entire picture in a sort of “creative tension,” to avoid retreating from the public square, and to retain one’s openness and curiosity when things don’t go as hoped or planned. Parker Palmer is very aware of the tremendous pressures and challenges all health care leaders and professionals now face to forge a new kind of contract with payers and patients alike. It’s an exciting time, and a difficult one.
1 hr 3 min
June 27, 2017WIHI: Situational Awareness and Patient Safety
Date: June 7, 2012
Featuring:
Stephen Muething, MD, Vice President for Safety, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center
Anne Lyren, MD, Co-Leader, OCHSPS National Children’s Network; Strategic Advisor for Quality and Safety, Rainbow Babies & Children’s Hospital
Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement

It may seem obvious that anticipating problems makes a whole lot more sense than dealing with things after the fact. Especially if the problems could have been prevented. When it comes to patient care, this can of course mean the difference between life and death but, more often, the lack of attention to complexities that could arise leads to a lot of unnecessary complications and suffering and costs. But what exactly do the systems look like that focus ahead of time on risky situations and high-risk patients with the same degree of science and scrutiny as we’ve come to associate with studying failures, after the fact? Indeed, what if the entire emphasis shifted to doing everything possible to predict problems as a means of preventing failures in the first place? WIHI explored the road to becoming a “high reliability organization” with the Joint Commission’s Dr. Mark Chassin on the March 8, 2012, program, and we’re now returning to the issue based on the groundbreaking work going on at Cincinnati Children’s Hospital Medical Center.

We’re going to zero in on “situational awareness” and our guide will be Dr. Stephen Muething, who enjoys a well-deserved reputation for making the principles and practices understandable and within reach. To prepare for the WIHI, we invite you to check out the resources at the James M. Anderson Center for Health Systems Excellence at CCHMC. Dr. Muething will be joined by Dr. Anne Lyren, who’s part of a children’s hospital network in Ohio and nationally, committed to sharing data and best practices. Dr. Lyren will explain the critical role that daily huddles play with getting everyone on the same page and capable of responding to problems and crises as they’re developing, in real time. IHI’s Carol Haraden has been leading patient safety improvement initiatives all across the globe and, despite the progress, she’s the first to admit how much work still lies ahead. That’s one of the reasons Carol Haraden is so excited about the work at CCHMC, and in Ohio, where leaders have decided safety on any given day is not only job number one, it’s the product of the vigilance and preparation from the day before... and the day before that.

What does your organization’s commitment to high reliability and situational awareness look like?
1 hr 1 min
June 27, 2017WIHI: Testing,Testing! Is This Procedure Necessary?
Date: May 17, 2012
Featuring:
Daniel B. Wolfson, Executive Vice President and COO, ABIM Foundation
Steven Pearson, MD, MSc, FRCP, President, Institute for Clinical and Economic Review – Institute for Technology Assessment
Amanda Kost, MD, Acting Assistant Professor, University of Washington Department of Family Medicine
Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement
Karen Boudreau, MD, FAAFP, Chief Medical Officer, Boston Medical Center, HealthNet Plan; Former Senior Vice President, Institute for Healthcare Improvement and Medical Director for IHI Continuum Portfolio

Of all the sources of excessive health care spending, none may be higher on the list than the habit of ordering lots of expensive tests and procedures. This appetite for the best of what high-tech medicine can offer – whether warranted or not – is a big factor behind estimates that up to a third of health care spending in the US is wasteful and unnecessary. But everyone also has a story of someone, maybe themselves, helped by a diagnostic procedure. There’s no question that one person’s unnecessary test is another person’s lifesaver. So, how do we get closer to more appropriate use? And is there a more active role that physicians can play?

The ABIM Foundation is betting there is a way to bring the ordering of tests and procedures into better balance AND that doctors are key to making this happen. This is the premise behind the ABIM Foundation’s new campaign, Choosing Wisely. Nine medical societies are on board (with eight more joining in the fall), and they’ve each identified five procedures that tend to be overused and that should trigger discussions to ensure that they’re really needed and of value. The American Academy of Family Physicians, for example, has a list that begins with thinking twice before immediately ordering imaging for low back pain.

WIHI host Madge Kaplan has assembled a great group of experts: The ABIM Foundation’s Daniel Wolfson will explain the campaign. Karen Boudreau will help us think through the role of family practitioners, while Steven Pearson will contribute some of the latest and sharpest thinking about evidence-based medicine and comparative effectiveness. Amanda Kost got to put on her “choosing wisely” shoes a bit ahead of the game by being part of the National Physician Alliance’s Promoting Good Stewardship in Medicine project. She’ll provide some key frontline learning on best practices that can help wean doctors and patients alike from reaching for the most expensive solution, first. Finally, IHI’s Don Goldmann, will discuss how Choosing Wisely aligns with other national initiatives and why it’s crucial that the medical profession take a leading role with health care reform.

Whether or not you’re directly in the role of ordering tests or procedures, we invite you to consider that we all have a part in making health care more effective and affordable – in other words, of true value to patients.
1 hr 3 min
June 27, 2017WIHI: "Pursuing the Triple Aim" Book Discussion with the Authors and Innovators
Date: May 3, 2012
Featuring:
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement, Co-author, Pursuing the Triple Aim
Charles Kenney, Writer and Journalist, Co-author, Pursuing the Triple Aim
Alide Chase, Senior Vice President, Medicare Clinical Operations and Population Care, Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals
Anthony M. DiGioia, MD, Renaissance Orthopaedics; Medical Director, Bone and Joint Center, Magee-Womens Hospital and PFCC Partners – Innovation Center of UPMC
George E. Kerwin, FACHE, President and Chief Executive Officer, Bellin Health
Patricia A. McDonald, Vice President, Technology and Manufacturing Group and Director of Product Health Enhancement Organization, Intel Corporation
Diane K. Miller, MBA, Vice President, Virginia Mason Medical Center, Executive Director, Virginia Mason Institute
Rebecca Ramsay, RN, MPH, Director, Care Support Manager, CareOregon
Brian H. Rank, MD, Medical Director, HealthPartners Medical Group, HealthPartners, Inc.
Marci Sindell, Chief External Affairs Officer, Atrius Health and Harvard Vanguard

It isn’t always easy to tell the story of improving health care in the US. An awful lot of the answers and promising solutions fly under the radar screen and get drowned out by politics and policy debates. That’s why Maureen Bisognano and Charlie Kenney decided to move about the country this past year and capture just a small sample of the innovation underway that promises to move health reform forward… even as national debates rage on.

What the organizations featured in Maureen and Charlie’s new book, Pursuing the Triple Aim: Seven Innovators Show the Way to Better Care, Better Health, and Lower Costs, share in common is this clear-eyed view that the status quo is not sustainable and that new models to simultaneously improve health, improve health care, and reduce per capita costs aren’t just needed, they’re needed urgently.

The organizations whose stories you can read about in the new book and that you’ll hear about on WIHI are currently in the trenches and represent a leading spear of change, tackling some of the hardest issues ever for health care. All the people associated with the work are eager to share whatever they can with as many as they can. WIHI host Madge Kaplan pulls together the program’s first ever audio “book party” with enough time to hear from all the contributors and also ask questions and engage in discussion.

A special note to improvers in other countries and around the globe: many of you have been part of IHI’s Triple Aim prototyping initiative for the past several years or have crafted initiatives of your own. Work outside the US is also critical and vital to everyone’s learning and everyone is encouraged to participate in this WIHI discussion.
1 hr 24 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