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: Health Literacy: New Skills for Health Professionals
Date: November 17, 2011
Featuring:
Helen Osborne, MEd, OTR/L, President, Health Literacy Consulting; Author, Health Literacy from A to Z
Gail A. Nielsen, BSHCA, Director, Learning and Innovation, Center for Clinical Transformation, Iowa Health System; Faculty, Institute for Healthcare Improvement
Lisa M. Stevens, MSHSA, Director of Clinical Quality, Crusader Community Health

In its 2004 report, "Health Literacy: A Prescription to End Confusion," the Institute of Medicine defined health literacy as “the degree to which individuals have the capacity to obtain, process, communicate, and understand basic health information and services needed to make appropriate health decisions.” Seven years later, the field of health literacy has exploded into something far beyond this most basic description. There are legions of health literacy advocates and initiatives; innovative, creative, and culturally attuned resources; a much greater emphasis on empowerment and engagement rather than mere compliance; and a far greater understanding — helped along by research — of the health consequences of low health literacy.

We wouldn’t be able to recount such progress without the hard work of champions like Helen Osborne, who has just released the second edition of Health Literacy from A to Z: Practical Ways to Communicate Your Health Message. Helen discusses how this latest edition can serve as the backbone for any health care organization’s efforts to communicate and engage more effectively with patients of diverse backgrounds and health care fluency.

WIHI host Madge Kaplan also welcomes to the program former IHI Fellow and Iowa patient safety leader, Gail Nielsen, who has been working hard on health literacy for years, with a special emphasis on improving patient/provider partnerships, shared decision making, and care coordination. Together with Lisa Stevens, a quality expert from Illinois focused on cultural competency, Helen and Gail discuss where and how health literacy efforts stand to benefit from health care reform and what it’s going to take to close communication gaps that still remain for millions of Americans.
58 min
June 27, 2017WIHI: Organizing for Health: A Story from South Carolina
Date: November 3, 2011
Featuring:
Rick Foster, MD, Senior Vice President of Quality and Patient Safety, South Carolina Hospital Association
Kate B. Hilton, Director, Organizing for Health; Principal in Practice for Leading Change at the Hauser Center for Nonprofit Organizations at Harvard University
Landis Landon, President, Immaculate Merchant Services; Resident, Columbia, South Carolina

In August 2011, a very different sort of town hall meeting was held in Columbia, South Carolina. About 90 people who shared the zip code 29203 sat down to talk about the health issues they faced. The list was long: lack of dental care, colon cancer, breast cancer, diabetes, heart disease, stroke, mental illness, low birth weight babies, and more.

Any one of these issues is worthy of attention; indeed, in most parts of the US, you can find initiatives trying to either prevent or reduce the burden of specific diseases that affect specific individuals. But what if the approach was more comprehensive and more widespread — and, most importantly, engineered by the community itself? What if hundreds of people from across the community — representing businesses and insurance companies and local hospitals and municipal offices and professional schools — all decided to band together to turn things around?

That’s what the people decided in Columbia, South Carolina. WIHI host Madge Kaplan talks with some of the key leaders behind the effort — Rick Foster, Kate Hilton, and Landis Landon — who describe their groundbreaking mobilization.

Some of the concepts and goals underpinning the Healthy South Carolina campaign are quite familiar, such as increasing access to primary care and the community’s commitment to wellness. But what sets this initiative apart is the strategy they’re using to make any goal a reality. It starts with training some 300 leaders by the end of 2011. They’ll play several roles, but will focus in part on fanning out across Columbia, SC, to help individuals and neighborhoods develop wellness programs and policies. There will also be a major emphasis on improving everyone’s health literacy and communication skills. And every part of the community’s health care delivery system is pledging, along with insurers, to engage in serious discussions about how to improve access to primary care, reduce reliance on emergency departments for non-urgent problems, and reduce costs.

Yes, it’s just the beginning stages and yes, it’s just one community. And no one knows whether this multi-year effort will succeed. Still, at a time when new models of better health, better health care, at reduced per capita costs, are badly needed, Healthy South Carolina is an initiative to root for, learn from, and watch.
1 hr 2 min
June 27, 2017WIHI: Safety Net Hospitals: Untold Stories of Quality Transformation
Date: October 20, 2011
Featuring:
Bruce Siegel, MD, MPH, President and Chief Executive Officer, National Association of Public Hospitals and Health Systems (NAPH)
Linda Cumming, PhD, Vice President for Research at the National Association of Public Hospitals and Health Systems (NAPH) and Director of the National Public Health and Hospital Institute (NPHHI), NAPH’s research affiliate
Steven R. Counsell, MD, Chief of Geriatrics and Medical Director for Senior Care, Wishard Health Services, Indianapolis; Professor, Indiana University School of Medicine; Director, Indiana University Geriatrics
Caroline M. Jacobs, MPH, MSEd, Chief Patient Safety Officer/Senior Vice President, Patient Safety, Accreditation and Regulatory Services, New York City Health and Hospitals Corporation

The usual way safety net hospitals wind up in the news in the US is when — faced with insufficient reimbursements and other reductions in funding — survival is questionable. The story angle becomes one of fiscal woes exacerbating and undermining the efforts of dedicated providers to deliver good care to mostly uninsured and underserved communities.

This situation and the necessity to address it remain quite real. But it often obscures another picture that's emerging in this critical sector of US health care: the ways in which safety net and public hospitals are innovating their way to greater stability. Even with financial constraints, they are improving care for patients, becoming leaders in quality and safety, and acting as mentors to other health care organizations interested in population health.

Denver Health, Contra Costa Health Services, Cambridge Health Alliance, and Stony Brook University Medical Center are just some of the names of places with visionary leaders and bold initiatives underway — so much so that they're gaining the attention of national policy leaders in search of new models of care to achieve health reform.

WIHI host Madge Kaplan speaks with Bruce Siegel and Linda Cummings of the National Association of Public Hospitals and Health Systems, who describe a comprehensive agenda for change that’s underway to support the ambitions of their members. In addition, Caroline Jacobs of the New York City Health and Hospitals Corporation and Steve Counsell of the Indiana University School of Medicine and Wishard Health Services provide some rich examples of what’s being achieved at their hospitals on the front lines of care.

The focus of this WIHI is especially timely as all of health care gears up to engage with greater numbers of low-income patients gaining insurance under health care reform. Who better to turn to for decades of experience but public and safety net hospitals?
1 hr 2 min
June 27, 2017WIHI: Family Caregiving, Caregivers, and Compassion
Date: October 5, 2011
Featuring:
Arthur Kleinman, MD, Esther and Sidney Rabb Professor of Anthropology, Professor of Medical Anthropology, Professor of Psychiatry, William Fung Director: Harvard University, Harvard Medical School, Harvard University Asia Center
Jeremy Boal, MD, Chief Medical Officer, North Shore–LIJ Health System; Professor of Medicine, Hofstra North Shore–LIJ School of Medicine
Dana R. Lustbader MD, FCCM, FCCP, FAAHPM, Section Head, Palliative Medicine, North Shore–Long Island Jewish Medical Center; Program Director, Palliative Medicine Fellowship, North Shore–LIJ; founding Director, Palliative Care Unit, North Shore University Hospital; Assistant Medical Director, New York Organ Donor Network
Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement

When we talk about caring for loved ones with serious illness, we usually focus on the problems and challenges most of all. And that makes sense. There is nothing easy or simple about family caregiving, and when it’s required of spouses and grown children the burdens can be especially high. Still, when you hear Arthur Kleinman describe what it was like to take care of his wife before she died, the words that jump out are honor, respect, and love ― even in the midst of grief, fatigue, and loneliness.

Kleinman, a psychiatrist and medical anthropologist, discovered that caregiving could be transformative, especially the further away he got from the fast-paced, high-tech world of cure and intervention that characterize so much of health care today. But there doesn’t have to be such a divide ― not if health care providers can become more comfortable talking with patients and families about serious illness, more familiar with the benefits of palliative and end-of-life care, and more capable of appreciating the power of compassion.

This WIHI discusses the very human “call to action” that family caregiving poses for all of health care today. WIHI host Madge Kaplan talks with Arthur Kleinman, two physicians from North Shore-Long Island Jewish (NSLIJ) Health System ― Chief Medical Officer Jeremy Boal and Intensivist and Palliative Care program director Dana Lustbader ― and IHI Vice President Andrea Kabcenell. In partnership with the Institute for Healthcare Improvement, NSLIJ is on the cusp of bringing a great deal more expertise and knowledge to bear on how their 15 hospitals, long-term care facilities, and home health agencies can better respond to and support patients and families facing serious illness. This is a perfect moment and opportunity to engage with this team in shared learning.

As Arthur Kleinman told The New York Times: “There is a moral task of caregiving, and that involves just being there, being with that person and being committed. When there is nothing that can be done, we have to be able to say, ‘Look, I’m with you in this experience. Right through to the end of it.’ ”
1 hr
June 27, 2017WIHI: Managing Medication Shortage: Best Practices for a Crisis
Date: September 22, 2011
Featuring:
Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement
Michael R. Cohen, RPh, MS, ScD, FASHP, President, Institute for Safe Medication Practices
Lynn Eschenbacher, PharmD, MBA, Assistant Director of Clinical Services and Director PGY-1 Pharmacy Residency Program, WakeMed Health and Hospitals

Medication safety has gotten a lot more challenging in the past year or so, due to circumstances health care providers can’t typically predict or control: a growing, critical shortage of prescription drugs, hundreds of them, including mainstay generics hospitals use to treat several forms of cancer. News organizations have begun to pay attention to the trend because of the tough decisions providers and patients now face when preferred treatments for certain types of aggressive leukemia or testicular cancer aren’t available.

A recent story on The PBS NewsHour offers one of the more comprehensive looks at the underlying industry practices, product decisions, and manufacturing problems that have led to the crisis—a crisis that’s enabled a gray market to now traffic in scarce supplies of certain drugs in order to offer them for sale at astronomically higher prices.

Against this backdrop, and while policy makers, members of Congress, and the US Food and Drug Administration seek both short-term and longer-term solutions, hospitals have no choice but to develop strategies and best practices that assume, for now, prescription drug shortages. WIHI host Madge Kaplan welcomes three people who have their fingers on the pulse of what’s going on and are actively working to help organizations effectively manage a complex situation. IHI’s Frank Federico, the ISMP’s Michael Cohen, and WakeMed’s Lynn Eschenbacher are three pharmacy-trained improvers who’ve tapped their expertise on medication safety to come up with new strategies that can enable hospital staff to stay on top of the fast-moving drug shortage problem on a daily basis. Learn how Lynn Eschenbacher’s hospital system in particular is effectively dealing with the crisis.

Additional information:
Read an article in Healthcare Executive about the drug shortages, written by Frank Federico, Bona Benjamin, and Michael Cohen.
We’d also draw your attention to a Premier healthcare alliance analysis of the gray market, which provides critical facts and guidance for hospital pharmacists and staff who purchase prescriptions.
57 min
June 27, 2017WIHI: Always Events: Raising Expectations for Patient Experience
Date: September 8, 2011
Featuring:
Lucile O. Hanscom, Executive Director, Picker Institute
Dale Shaller, MPA, Principal, Shaller Consulting Group
Martha Hayward, Lead for Public-Patient Engagement, Institute for Healthcare Improvement
Gaye Smith, Chief Patient Experience and Service Officer, Vanderbilt University Medical Center
Anthony M. DiGioia, MD, Founder, The Orthopaedic Program and Innovation Center, Magee-Womens Hospital of UPMC

Most of us are familiar with the National Quality Forum’s list of Serious Reportable Events in health care — often referred to as “Never Events.” There’s a wide consensus that everything from performing surgery on the wrong patient or wrong site, to a medication error-induced death, to a physical assault aren’t only tragic and harmful, they are not supposed to happen. Period. It’s a strong statement about patient safety and what the system as a whole should not be willing to tolerate. And, by extension, it’s a call to action to do better and to take care of patients differently so that terrible things do not occur.

There are, of course, many ways to draw a line in the sand or to envision the health care system patients deserve and that providers want to work in. One of the most innovative in the last few years has been the Picker Institute’s development of a concept they’ve dubbed “Always Events®.” First conceived in 2009, Always Events®are activities and processes that should routinely be part of patient care and the patient and family experience, to ensure optimal communication, discharge, handoffs, transitions, health literacy, and more.

WIHI welcomes the Picker Institute’s Executive Director, Lucile Hanscom; consultant Dale Shaller, who has an extensive history developing benchmarks and measurement systems for patient-centered care; Martha Hayward, who has been working with IHI to help shape public and patient engagement, drawing on her own history as a patient and as a strong and effective leader in Massachusetts; and dynamic leaders from two organizations that have received Always Events Challenge Grants: Gaye Smith of Vanderbilt University Medical Center and Tony DiGioia of the University of Pittsburgh Medical Center (UPMC).

Dr. DiGioia’s groundbreaking improvements at UPMC are anchored in a first of its kind patient- and family-centered methodology. Picker’s support is helping to integrate these processes into the hospital’s transplant program. The grant-funded work at Vanderbilt, under Gaye Smith, is targeting better communication and collaboration between patients, family members, and providers to prevent patient falls during hospital stays.
1 hr
June 27, 2017WIHI: Payment Reform As We Speak
Date: July 21, 2011
Featuring:
Stuart H. Altman, PhD, Sol C. Chaikin Professor of National Health Policy and former Dean of The Heller School for Social Policy and Management, Brandeis University
Jeffrey Selberg, MHA, Executive Vice President and Chief Operating Office, Institute for Healthcare Improvement

What's the value of value-based purchasing? This is the term used for a new initiative of the Centers for Medicare and Medicaid Services (CMS) that is perhaps the government’s boldest move yet to tie hospital reimbursement to quality, focused initially on 13 measures, including patient satisfaction. The intent is pretty clear, but how likely is it that the new “carrot,” in the form of bonus payments starting in October 2012, will accelerate better patient care and usher in a new day of financial expectations?

IHI’s Jeff Selberg says the answer isn’t clear BUT, as a former hospital executive, he can’t imagine sitting on his hands waiting to see how things will play out. In other words, to Jeff, the handwriting is on the wall, and depending on how hospital leaders react, the money is either on the table or eventually being taken off the table and…most importantly, it’s not going to be put back. There is just no viable future, he says, for a health care system that’s hospital-centric, episode-centric, and procedure-centric. And it’s not just CMS that’s throwing down the gauntlet. So are employers and private insurers. The good news is that some health care providers are getting the message; Selberg hopes we can all learn from their example.

Stuart Altman doesn’t disagree. But the seasoned health care economist has been around too long, and in and out of government often enough, to know how hard it is to forge policy and payment reforms of the CMS value-based sort. Decades of doing things differently is a hard habit to break. On the other hand, like Jeff, Stuart wouldn’t advise hospitals to sit this one out, and he worries about serious unintended consequences for patients if the hospital system doesn’t develop new business models built upon delivering high quality most of all.

WIHI host Madge Kaplan welcomes Stuart Altman and Jeff Selberg for an interesting discussion.
57 min
June 27, 2017WIHI: Improving Health Care: The Global View
Date: July 7, 2011
Featuring:
Lord Nigel Crisp, Strategic Advisor on Global Health and Senior Fellow, Institute for Healthcare Improvement; Author, Turning the World Upside Down: The Search for Global Health in the 21st Century
Pierre Barker, MD, Senior Vice President for IHI improvement initiatives in South Africa, Ghana, Malawi, and India
Pedro Delgado, MSc, Executive Director for IHI large-scale health system improvement efforts in Europe and Latin America

Health care improvers in the US have so much on their plates these days, it can seem like a luxury to focus on what’s happening in other countries. That’s unfortunate because health care improvement has become a global endeavor, and nations of all sizes and stages of development are confronting strikingly similar issues.

These include how to care for aging populations, how to give individuals the tools to be shared decision makers and managers of their chronic conditions, and how to design systems that optimize communication and coordination across the continuum of care. Also, how to take advantage of the resourcefulness patients and communities themselves bring to the table.

On any given day, improvers on several continents are taking part in collaboratives and applying improvement methods to increase cancer screenings, improve maternal and child health, track the days a hospital’s ICU is infection-free, and more. The riches of new ideas and innovations now come as equally from South Africa as South Carolina… as generously from Jonkoping, Sweden, as Green Bay, Wisconsin.

Lord Nigel Crisp, Dr. Pierre Barker, and Pedro Delgado join WIHI host Madge Kaplan to discuss the maturing work in Ghana and South Africa, new improvement initiatives in Latin America, and what Nigel Crisp meant when he titled his recent book, Turning the World Upside Down.

There isn’t a country, anywhere, that can afford to stand still when it comes to rising health care costs, and this creates a tremendous opening for the international improvement community to demonstrate what’s possible when the focus shifts to quality, safety, and overall population health.
1 hr 2 min
June 27, 2017WIHI: New Models for Patients with Multiple Health and Social Needs
Date: June 23, 2011
Featuring:
Catherine Craig, LMSW, MPA, Director of Health Integration – National Programs, Common Ground
Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine, New York University School of Medicine
Geraint Lewis, MA, MSc, FRCP, FFPH, Public Health Physician and Senior Fellow, The Nuffield Trust, UK

There isn’t a health care provider anywhere in the US who hasn’t witnessed the disconnect between a patient with multiple health and social needs and the systems available to help that individual. The gap between what’s needed and what’s available (and what’s paid for) is often staggering. Stories abound of doctors and nurses and social workers painstakingly trying to patch together services that might function as an alternative to the hospital’s emergency department, get a prescription filled, get someone a hot meal… and on it goes. There are communities in the US and other countries that have worked for years to do things better but, wherever you go, patients with multiple illnesses combined with a lot of instability in their lives present challenges far beyond the capability and current design of most health care systems.

Nothing like a challenge! WIHI has been tracking some timely work and research that goes by such exotic names as “predictive modeling” and “virtual wards” — or is as basic as care coordination and supportive housing. WIHI host Madge Kaplan talks with key experts leading the way in these areas to discuss new ways to work with patients to address underlying needs and manage chronic health problems that lessen dependence on expensive health care services. The good news is that wherever new models are being tried, they’re making a real, tangible difference.

Related information to this WIHI program includes a new IHI white paper on innovations in care coordination, co-authored by Catherine Craig, and Atul Gawande’s article, “The Hot Spotters," from the January 2011 New Yorker.
1 hr 1 min
June 27, 2017WIHI: Integrity On and Off the Page: A Discussion with JAMA’s (Departing) Editor-in-Chief
Date: June 9, 2011
Featuring:
Catherine D. DeAngelis, MD, MPH, Editor-in-Chief, Journal of the American Medical Association
It's hard to imagine the Journal of the American Medical Association (JAMA) without its editor-in-chief, Cathy DeAngelis, who will be stepping down this July. Since 2000 Dr. DeAngelis, JAMA’s first woman editor, has steered the peer-reviewed publication in important new directions and successfully brought about greater scientific integrity across the medical research and publishing industry. Because of her efforts, as a condition of publication virtually all clinical trials in the US are now listed in a public registry. JAMA won’t consider industry-funded research unless it’s been independently vetted.

Dr. DeAngelis’ principled stands, along with her interest in the narrative side of practicing medicine, as well as health policy and reforming the status quo, have all made JAMA more accessible and “required reading” for a broader audience. And her own story — which began in a coal-mining town in northeastern Pennsylvania, and has included nursing, pediatrics, and teaching — is far from over! She is now preparing to return to the Johns Hopkins School of Medicine — this time around to start a Center for Professionalism in Medicine and the Related Professions.

WIHI host Madge Kaplan talks with Dr. DeAngelis, who shares her thoughts about the challenges facing all research scientists today, including those engaged with improvement science, and her passion for maintaining the integrity of taking care of patients.
59 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