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: You Can't Improve What You Can't Evaluate
Date: April 19, 2012
Featuring:
Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement
Dale Webb, PhD, Director of Evaluation and Strategy, The Health Foundation, UK
Mary Dixon-Woods, BA, DipStat, MSc, DPhil, Professor of Medical Sociology, University of Leicester, UK
Gareth Parry, PhD, Senior Scientist, Institute for Healthcare Improvement

WIHI doesn’t need to travel all the way to Paris, France, to focus on challenges with the design and evaluation of improvement initiatives. But, four leading experts in this area are going to be sharing some of the latest thinking on this topic at the 17th annual International Forum on Quality and Safety in Healthcare in Paris.

WIHI host Madge Kaplan talks with these four presenters after their panel to share their observations with the WIHI audience. Here’s just a sample of what Don Goldmann, Dale Webb, Mary Dixon-Woods, and Gareth Parry want to cover:
Despite best intentions and commitment, improvement initiatives don’t always yield hoped-for results. Why does this happen?
It seems so obvious, yet it turns out to be much harder to spread successes in one setting to another even if, on the surface at least, the settings seem pretty similar. What can help this adaptation?
Everything seems to be running smoothly, but then problems with the design of the work are discovered late in the process. How can problems and design flaws be detected sooner?
Everyone is very excited about the results of some improvement work, but when it comes times to write it all up, there’s confusion and disagreement about which mechanisms are actually responsible for the changes. How can this be avoided?
One underlying theme is the need to integrate what one hopes to learn from an improvement initiative right from the start, and to build into the process a robust learning and evaluation system for every step of the way. These aren’t just abstract notions; you’ll hear from the WIHI guests about recent situations they’ve been part of or witnessed where “learning the hard way” has given rise to much better and clearer-eyed processes for the future.

Here are some other things the guests promise to discuss:
Developing a theory of change at the outset
Matching expectations to the intervention
Aspirational vs. evaluative goals
The conspiracy of enthusiasm
The importance of independent evaluation
The theme of this year’s International Forum is “Solutions for Tough Times,” and improvers in the US and globally face many challenges. Getting the nuts and bolts and the design right for improvement work couldn’t be more important and relevant.
1 hr 1 min
June 27, 2017WIHI: Going, Going, Green! Embedding Environmental Health and Sustainability into Health Care Delivery
Date: April 5, 2012
Featuring:
Gary Cohen, President and Co-Founder, Health Care Without Harm
John Messervy, AIA, Director of Capital and Facility Planning, Partners HealthCare, Inc.
Amy Collins, MD, Emergency Physician, MetroWest Medical Center; Chair, Go Green Committee, MetroWest

How green is your hospital? Green, as you know, has become shorthand for everything from recycling to the use of safer products to shrinking one's carbon footprint to preventing pollutants from spewing into the air. There are any number of urgent reasons for the health care sector to be examining its green practices. One of them is just the sheer amount of resources hospitals consume: in the US, that’s tons and tons of water and 836 trillion BTU of energy annually. These same hospitals dispose of 6,600 tons of waste per day. Fortunately, we can all now point to visible efforts at most hospitals to “think and act” a lot greener. But even these well-intentioned efforts have a tendency to stall or lose steam, too often dependent on staff volunteers and lacking a bigger, bolder vision that cuts across the entire organization and how it's run.
Aiming to build on existing progress and to make a giant leap forward on the environmental front, three organizations are now joining forces to launch what’s being dubbed the Healthier Hospitals Initiative. The new effort is anchored by some large hospital systems in the US whose green practices are already exemplary and demonstrate the wisdom behind linking environmental stewardship to efforts to improve safety and reduce health care costs. The Healthier Hospitals Initiative hopes to enlist some 1,000 hospitals in the broad-based campaign, focused on an agenda that includes increased use of safer materials and products for patients and staff alike; reduction of energy consumption and waste; and adoption of policies to ensure sustainability.
WIHI host Madge Kaplan welcomes three guests to the program. Gary Cohen is the co-founder and president of Healthcare Without Harm and Practice Greenhealth, whose work has helped lay the groundwork for this larger initiative. Dr. Amy Collins, who leads a number of efforts at MetroWest Medical Center in Framingham, Massachusetts, is helping MetroWest garner a number of environmental excellence awards. John Messervy founded the Partners Sustainability Initiative in 2008, and he has tremendous knowledge of the environmental engineering changes possible throughout a large hospital system.
1 hr 1 min
June 27, 2017WIHI: What Can You Learn in 90 Days? IHI’s Innovation Process
Date: March 22, 2012
Featuring:
Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement
Lindsay Martin, MPH, Executive Director for Innovation, Research & Development, Institute for Healthcare Improvement
Bela Patel, MD, Assistant Dean of Healthcare Quality and Division Director for Critical Care Medicine, The University of Texas Health Science Center

Where do new ideas for how to improve health care come from? Sometimes they start with a hunch or an expressed need from health care providers; sometimes they’re unearthed by deciding to make a dramatic reduction in mortality in a resource-poor setting or by drawing a line in the sand on the wasteful practices of fee-for-service medicine.

Whatever the motivation or source — whether a hunch or a need or a challenge — even the best-sounding new improvement ideas need careful vetting and scrutiny and, if appropriate, a well-designed test to determine if an innovative approach to better patient care can make a difference in an actual health care setting. Not every new idea flourishes, but chances are it’ll die on the vine without an effective and efficient way to determine its potential contribution. This, in a nutshell, is the rationale behind IHI’s 90-Day Research and Development Process.

Now in its sixth year — and its 23rd 90-day wave of putting innovative ideas through a disciplined, evaluation pipeline — IHI’s R&D process has had its share of wins: improvement “bundles,” the Global Trigger Tool, the optimal elements of best stroke care, the early thinking and widely disseminated framework of the Triple Aim, and much more.

How is it possible to conduct R&D on a “shoestring”? What are the core components, the resources, and the steps necessary for an effective 90-day process? What kinds of innovations has IHI put to the test, which ones generated valuable learning, and, most importantly, what kinds of fresh approaches could your organization use to generate, evaluate, and — when viable — turn into effective improvement processes?

WIHI host Madge Kaplan welcomes two people who have helped shape and nurture IHI’s 90-day R&D process since its inception: Andrea Kabcenell and Lindsay Martin. They couldn’t be more passionate about the process and possibilities and necessity of R&D, and they share the nuts and bolts and the vision that could become part of your agenda, too. Rounding out the program is Dr. Bela Patel of The University of Texas Health Science Center and Memorial Hermann Hospital in Houston, Texas. Dr. Patel is in the process of jumpstarting R&D work based on what she recently learned at IHI’s Innovation College.
59 min
June 27, 2017WIHI: Highly Reliable Hospitals: The Work Ahead
Date: March 8, 2012
Featuring:
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement
Mark R. Chassin, MD, FACP, MPP, MPH, President, The Joint Commission and the Joint Commission for Transforming Healthcare
How many patient safety goals does it take to get the US health care system to function as safely and as reliably as it should? And, looked at through the lens of the Joint Commission’s program for hospitals, can 15 broad goals covering patient identification, medication safety, infection prevention, surgical error prevention, communication, and prevention of patient suicide add up to the safe and effective care that must become a hallmark of health care delivery and that patients deserve? The answer is, “Of course not.” Everyone, including the Joint Commission, knows that health care organizations today can’t possibly meet the Joint Commission’s goals, or any other benchmarks, unless they’re embedded in huge culture changes that comprise strong leadership, good communication skills, multidisciplinary teamwork, an engaged frontline staff, and an informed governing board. That's among the reasons why progress still remains far too slow at most of the nation’s hospitals, even if pockets of excellence are becoming more numerous.

For Dr. Mark Chassin, who heads the Joint Commission, the concept that he believes can and should become a game changer is “high reliability.” That means safe and effective processes that can be executed and sustained over long periods of time. Writing in the April 2011 issue of Health Affairs, Dr. Chassin states, “What has eluded us thus far…is maintaining consistently high levels of safety and quality over time and across all health care services and settings. The pockets of excellence coexist…with enormously variable performance across the delivery system. Along with some progress, we are experiencing an epidemic of serious and preventable adverse events.”

Dr. Chassin argues that one place to start on the path to high reliability is to conduct an honest self-assessment of an organization’s readiness. WIHI host Madge Kaplan welcomes Dr. Chassin to the program to dig deeper into the subjects of excellence and reliability. He’s joined by IHI’s Maureen Bisognano, a long-time champion of high reliability. Ms. Bisognano knows that the success of any initiative to improve safety and quality reliably, and over time, depends on creating and sustaining a culture of safety, from the board to the executive to the front lines. This culture is needed across the entire continuum of care, especially at crucial intersections where patients are most at risk. Ms. Bisognano also believes that a culture of safety must be accompanied by a culture of innovation that supports and encourages professionals to test out new ideas and harvest proven methods from wherever they are found.
1 hr
June 27, 2017WIHI: The Patient Will See You Now: New Technology for New Collaborations
Date: February 23, 2012
Featuring:
John Moore, MD, PhD Candidate, MIT Media Lab – New Media Medicine
David Judge, MD, Project Leader, CIMIT Ambulatory Practice of the Future; Instructor in Medicine, Harvard Medical School

New technologies by themselves cannot create more robust patient-provider partnerships. But, with a lot of ingenuity and thoughtful design, and a commitment to creating tools that help put patients more in charge of their health, technology can be a game changer. That’s the guiding principle behind some fascinating work under development at the MIT Media Lab, and that’s where this WIHI takes place for its first ever “live on location” broadcast.

If you’ve never heard of NewMediaMedicine, you’re in for a treat. Using a conceptual and software platform called CollaboRhythm, researchers are designing and testing tools that offer patients real-time data about their own chronic health conditions that can then be easily conveyed to a health care provider, enabling coaching and communication practically on the spot. It might sound glib to refer to primary care as a shared environment that can be tapped on an “as-needed basis,” thanks to a couple of smart phones, but in the health care world that NewMediaMedicine envisions, the best primary care will be transformed into something less like a single office visit and more like a daily engagement with one’s health goals, with expert advice available when necessary.

Joining WIHI host Madge Kaplan are two people who can explain it all. Dr. John Moore is a physician and technologist overseeing multiple projects at the Media Lab and in true “open source” fashion is eager to share what he and his colleagues are up to. Dr. David Judge’s work is closely aligned, thanks to the Ambulatory Practice of the Future at Massachusetts General Hospital, which opened its doors in July 2010. Dr. Judge talks about what it’s really like to offer a model of “continuous, customized, iterative, and well-informed care” in the environments most convenient for patients.

This special “on location” WIHI is taking place on the heels of the Media Lab’s third annual Health and Wellness Innovation sprint that took place at the end of January 2012. In addition to what’s in the testing phase now, find out what teams of students, health professionals, and innovators are imagining next.
1 hr 1 min
June 27, 2017WIHI: The Social Imperative to Demonstrate That Better Care = Lower Costs
Date: February 9, 2012
Featuring:
Donald Berwick, MD, MPP, Former Administrator, Centers for Medicare & Medicaid Services; Former President and CEO, Institute for Healthcare Improvement (IHI)
Gerard M. Shea, Assistant to the President for External Affairs, American Federation of Labor and Congress of Industrial Organizations (AFL-CIO)
Imagine this. You’re driving or walking or maybe even bicycling by your local hospital and you notice a big sign over the entrance that you’ve never seen before. Here’s what it says: “This hospital saved 5 Million Dollars in 2011 by improving patient care and reducing unnecessary procedures. We have returned the money to local employers, local unions, and the state.”

Sound preposterous? Hopefully not, because this is the kind of bold commitment and public declaration that Don Berwick and Gerry Shea would like everyone in health care to start thinking about, seriously. It’s just that urgent, they say, and they’ll explain why.

WIHI host Madge Kaplan welcomes Berwick and Shea to the program, fresh off Dr. Berwick’s 18 months implementing change at the Centers for Medicare & Medicaid Services (CMS), and building on Gerry Shea’s extensive knowledge of quality improvement and the promise of better care and lower health care costs for working Americans.

The problem is, we’re nowhere near there yet, especially where costs are concerned, and both Berwick and Shea believe one of the reasons is that there’s still too much of a disconnect between what better use of health care services and improvement initiatives can achieve, and what health care payers (Medicare and Medicaid, employers, individuals, etc.) are able to reap in return. As Berwick puts it, “Payers aren’t seeing it yet,” and this means that anyone footing the bill, and that’s pretty much all of us, continues to be squeezed in ways that society can’t afford.

So, what can dedicated legions of health professionals, already deeply immersed in improvement work, do differently or better? Berwick started to lay this out on December 7, 2011, at IHI’s National Forum. Berwick and Shea both say that one area ripe for review is the conceptual and often actual way in which health care organizations separate their quality and “lean” strategies, when these should be one and the same. Implementing greater efficiencies has everything to do with safety and better care, the two say. Getting this right would speed things up and generate greater savings. The question then becomes, where should the money go?
59 min
June 27, 2017WIHI: Have You Had "The Conversation"? Helping Loved Ones Discuss End-of-Life Preferences
Date: January 26, 2012
Featuring:
Ellen Goodman, Columnist, Author, founding member of The Conversation Project
Ira Byock, MD, Professor, Dartmouth Medical School; Director of Palliative Medicine, Dartmouth-Hitchcock Medical Center
Bernard “Bud” Hammes, PhD, Director, Medical Humanities and Respecting Choices®, Gundersen Health System
Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement

Most of us, if asked, say we care a great deal about will happen to us when we’re at the end of our lives. And yet, because we’d also rather focus on just about anything but death and dying, especially if we’re young and healthy or aging well, we’re all vulnerable to what can transpire by default: spending our last few days in an ICU, even if that’s at odds with our needs and preferences. The reasons for this disconnect are complex but often stem from the fact that individual and family decisions come late, are hashed out during a crisis, and in the very setting — a hospital — that promises high-tech and high-intervention cures for just about everything.

This scenario is slowly starting to change. There are now numerous efforts, some medically-based and many more that are grassroots, successfully promoting alternative perspectives and practices so that people who’d prefer to die at home can do so, and benefit from pain management and comfort over costly and heroic measures. But when you get right down to it, “dying well” is quite personal and, as such, needs to start in a personal place: by having a conversation with the people you’re closest to about how you want to die and how they, surviving friends and family members, can feel okay carrying out your wishes. Equally important: initiating or being open to that conversation, perhaps several conversations, when the circumstances aren’t so fraught and there’s time to digest and reflect and integrate the information.

All of this and more are what’s behind a new initiative getting underway in 2012 called The Conversation Project (TCP), which will be discussed on the January 26 WIHI. In collaboration with IHI, award-winning columnist and founding member Ellen Goodman and the project’s team members seek to create a cultural movement with one basic goal: to help every American say what they want at the end of life so that family members and medical providers have the guidance they need to respect those preferences. To get there, TCP wants to normalize discussions that can at times feel “too big to broach” by encouraging loved ones to talk to one another when circumstances aren’t so charged — when everyone is healthy — and the environment is more conducive to a good exchange. Around the kitchen table, for instance, rather than the hospital bed.

To launch a national campaign to bring about this change, Ellen Goodman and members of TCP have turned to many, many experts on death and dying, palliative care, and successful partnerships with patients and families, including two outspoken champions of change on the clinical and community side: Dartmouth’s Ira Byock and Gundersen Health System’s Bud Hammes. With IHI’s Martha Hayward also on board, WIHI host Madge Kaplan invites you to get an early look at a unique initiative in the making from the architects themselves. Increasingly, that’s going to become all of us —having “The Conversation” and telling others how it went and what we learned in the process. It’s hoped that many will benefit, including health professionals who often find themselves at a loss for words, brought up short by their training, and caught in the cross hairs of their own and others’ conflicting emotions and wishes.
1 hr 3 min
June 27, 2017WIHI: Removing Barriers to Care with Medical-Legal Partnerships
Date: January 12, 2012
Featuring:
Barry Zuckerman, MD, Chair, Department of Pediatrics, Boston University School of Medicine; Founder, National Center for Medical-Legal Partnership
Robert Kahn, MD, MPH, Associate Professor of Pediatrics and Director, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center
Carol Beasley, MPPM, Director of Strategic Projects, Institute for Healthcare Improvement

Let’s face it. If someone mentions the words “medical” and “legal” in the same sentence, the next thing we imagine we’ll hear about is a lawsuit. Picture this instead: empowered, proactive social workers, collaborating with health care providers, lawyers, and legal experts, to ensure that the health of indigent patients isn’t undermined by unsafe housing, lack of food, or lack of access to benefits and entitlements. Some people refer to this type of outreach as “preventive law” because it’s directly related to preventive health measures we now recognize are crucial to help people head off disease or better manage chronic conditions.

Doctors and nurses on the front lines have understood for years the role that social conditions play in improving or worsening health. Also, what happens when problems brewing at home, such as domestic abuse, don’t rise to the surface during a routine medical visit? Fifteen years ago, Dr. Barry Zuckerman founded a program at Boston Medical Center to address a swarm of issues affecting the health of low-income children. Six years ago, this initiative became the National Center for Medical–Legal Partnership, focusing on anyone, at any age, in need of the combined power of medical and legal intervention. The effort and the framing caught on and there are now over 200 programs like Zuckerman’s across the US, one of them in Cincinnati.

WIHI host Madge Kaplan welcomes Dr. Zuckerman and Dr. Robert Kahn of Cincinnati Children’s Hospital Medical Center to explain and explore the ingredients of an effective medical-legal partnership and how the efforts to date are making a difference in patients’ health and their lives. At Cincinnati Children’s, key prompts to get at social determinants of health are built right into the electronic health record. This helps screen for health-undermining circumstances — for instance, a landlord’s lack of attention to a faulty refrigerator — that might benefit from legal attention. This is just the type of thing Carol Beasley is keeping an eye on as she continues to help spearhead the work of the IHI Triple Aim initiative. When the goals are improving the experience of care, improving the health of populations, and reducing per capita costs, it’s increasingly essential to form coalitions and partnerships that integrate legal and social service expertise with health care expertise.
57 min
June 27, 2017WIHI: Heard at the Forum: New Ideas and Learning from IHI's 23rd Annual National Forum
Date: December 15, 2011
Featuring:
Jeffrey D. Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement (IHI)
2011-2012 IHI Fellows
Every December, nearly half the people who attend IHI’s National Forum in Orlando, Florida, do so for the very first time. They join with the “regulars” and the “veteran” conference-goers and immerse themselves in intense learning and networking over four packed days. By the time it all winds up, everyone is eager to return to colleagues back home to share new ideas and initiate new improvement strategies. Some of IHI’s best informants wind up being our fellows, most of whom have never attended the Forum before. At the Forum, they fan out to cover as much ground as possible so that they can spread the learning among themselves and beyond.

That’s the spirit behind WIHI’s December 15 program, “Heard at the Forum.” The 2011-2012 IHI Fellows and IHI’s Executive Vice President and COO Jeff Selberg join WIHI host Madge Kaplan to talk about what they learned from IHI’s 23rd Annual National Forum: stand-out results; new improvement strategies; new ideas about leadership; the growth of the quality improvement movement internationally; the necessary and new role patients are taking on in designing better care; new thinking about navigating the complexities of the health care environment in the US; the opportunities embedded in health care reform; and more.

This rich round-up from the Forum will be beneficial for the entire improvement community, whether or not you attened this year’s event. WIHI participants who have their own favorite conference stories, session “take-aways,” and memorable quotes from the keynotes, also add to the discussion for everyone’s benefit.
57 min
June 27, 2017WIHI: Night Talks and Nocturnists: New Interventions for the Hospital at Night
Date: December 1, 2011
Featuring:
David Gozzard, FRCP, FRCPath, MBA, Consultant in Quality Improvement, North Wales, UK; Former Consultant Haematologist
Christine White, MD, MAT, Assistant Professor, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center
Win Whitcomb, MD, MHM, Medical Director of Healthcare Quality, Baystate Health

Although most hospitals are open for business 24/7, patients are well aware that days, nights, weekends, and holidays are not created equally in hospitals. There’s a history of assigning fewer medical and nursing staff during these times, creating a host of challenges for improvement leaders seeking to ensure safe and reliable care regardless of what the clock says. And there are real consequences: a study published in JAMA in 2008 found that patients who had heart attacks in the hospital at night and on weekends were less likely to survive than if they’d arrested during “normal business hours.”

Innovative solutions to close this gap in care are cropping up in several corners. In the US, the growing number of and reliance on hospitalists is giving rise to a particular type of hospitalist, known as a “nocturnist,” who specializes in after-hours care. In the UK, attention to patient safety as well as work hours for medical staff have spawned an increasingly widespread practice of interdisciplinary “night teams.” And, many hospitals are focusing on night times and weekends as part of their overall efforts to improve handoffs between nursing shifts and medical residents, who, in the US, now have shifts of their own they must adhere to in order to comply with ACGME regulations.

So, the road to ensuring that patients get the same kind of care, no matter the time of day or night, is definitely still under development. Guests Drs. David Gozzard, Christine White, and Win Whitcomb join WIHI host Madge Kaplan to share how they are contributing to the solutions for providing reliable, high-quality care.
56 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