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: Leading Across the Continuum
Date: May 5, 2011
Featuring:
Maureen Bisognano, President and CEO, Institute for Healthcare Improvement
The last time WIHI sat down with Maureen Bisognano (September 9, 2010: "Leaders Never Stop Learning") she was newly ensconced as the head of IHI and everyone was getting a big dose of her undying optimism and passion for new designs to improve care that include input from patients and families every step of the way. Seven months later, Maureen is as committed to these principles as ever, in part because everywhere she travels she witnesses the benefits that true patient-centered care and true collaboration have on people’s lives — including the clinicians on the front lines.

And yet, it’s easy to understand why leaders of health care organizations today aren’t always so sure how to connect their own home-grown innovations to the high-stakes challenges cropping up on the larger stage. Will cultivating a robust system of patient advisors lead to better HCAHPS (satisfaction) scores? Greater fiscal stability? Will a unique partnership with a home care agency and the local senior center reduce unnecessary hospital readmissions enough to avoid losing out on reimbursements? If infection rates drop, along with endless backups in the emergency department, does this make the hospital a good candidate to form or be part of an accountable care organization (ACO)? If a clinical practice gets a “meaningful” electronic health record system up and running, and patients have new ways to see (and know) what doctors and nurses see (and know), will it make it easier to get certified as a medical home?

Leaders can’t just ask these questions today; they need to have some answers. They also need new ways to explain multiple priorities and simultaneous goals to their hard-working staff, as well as how all the efforts link to the larger aims of health care reform. Are there overarching frames that can help? Maureen Bisognano believes so. WIHI host Madge Kaplan talks with Maureen about her most recent travels, her learning, and her guidance for “leading across the continuum” of care.
59 min
June 27, 2017WIHI: Palliative Care = Quality Care
Date: April 21, 2011
Featuring:
Jennifer Temel, MD, Director, Fellowship Program at Massachusetts General Hospital (MGH); Clinical Director, Thoracic Oncology, MGH; Assistant Professor in Medicine, Harvard Medical School
Daniel Ray, MD, Medical Director, Medical Critical Care Program and Fellowship Director, Hospice and Palliative Medicine, Lehigh Valley Health Network
Allan Ramsay, MD, Medical Director, Palliative Care Service, Fletcher Allen Health Care; Professor and Associate Chair, Department of Family Medicine, University of Vermont College of Medicine

Sometimes when a researcher’s work gets published in an academic journal, intense media attention isn’t the full story. Since August 2010, when Dr. Jennifer Temel’s New England Journal of Medicine article was published, the findings have had a major impact on clinical leaders on the frontlines of palliative care. Just ask Dr. Allan Ramsay from Fletcher Allen in Vermont. He and his colleagues couldn’t pass around the NEJM article fast enough! For the first time, a prominent study showed that patients newly diagnosed with terminal lung cancer who received palliative care not only experienced less pain and better quality of life, they also lived longer.

The benefits of palliative care, and indeed the entire concept, have often been obscured by more intense debates and focus on hospice and what patients need at the very end of life. And, for understandable reasons. But palliative care, as a viable approach and a set of practices that can relieve suffering and improve daily life for patients facing life-threatening illnesses is gaining ground in outpatient and inpatient settings alike. As we witness this evolution in real time, this WIHI gets closer to researchers and clinicians shaping the programs and services. Some, like Dr. Daniel Ray at Lehigh Valley, have been working on building the professional skill sets and patient-centered processes for the past decade.

WIHI host Madge Kaplan talks with Drs. Temel, Ramsay, and Ray to learn from their expertise and get a better sense of palliative care as an integrated and integral part of the quality agenda. The trio is eager to help others in health care find ways to overcome real and perceived barriers, using evidence, education, and small tests of change.
1 hr 1 min
June 27, 2017WIHI: The Power to Detect and Improve: Revisiting the IHI Global Trigger Tool and Adverse Events
Date: April 14, 2011
Featuring:
David C. Classen, MD, MS, Associate Professor of Medicine, University of Utah; Active Consultant in Infectious Diseases, University of Utah School of Medicine; Senior Partner, CSC
Roger K. Resar, MD, Senior Fellow, Institute for Healthcare Improvement
Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement
Kathleen M. Haig, RN, Corporate Patient Safety Officer, OSF Health Care System

It’s safe to say that reducing harm is a priority at virtually every health care delivery organization today in the US. Few health care leaders waste time anymore defending high rates of hospital-acquired infections or medication errors. Progress is also notable in this country and other nations similarly focused on improvement, when it comes to significant reductions in infections associated with use of central lines, ventilators, resistant bacteria, or with events such as preventable patient falls.

That’s the good news. The mixed news is that when independent researchers dig deep into patient charts and look for signs (or triggers) of adverse events using the IHI Global Trigger Tool (GTT) or something approximate — conducting reviews over a month, several months, even several years — they’re finding higher rates of harm than even the most committed improvers realize exist, especially if they’ve been relying on other, common detection methodologies. The latest findings to reinforce this gap in perception and facts on the ground have just been published in the journal, Health Affairs.

The article’s two leading authors, David Classen and Roger Resar, would like to help everyone make better sense of the mounting evidence that points to the power of the IHI GTT as a measurement and detection tool. WIHI host Madge Kaplan welcomes the two to the program, along with IHI Vice President Andrea Kabcenell and Kathleen Haig of OSF St. Francis Medical Center.

Drawing on our guests’ expertise, the goal of this timely WIHI is to explain why overall rates of adverse events haven’t been as affected by improvement strategies as many would have expected; how use of the IHI GTT can deepen understanding of where problems persist; what improvement strategies may best address areas in need of attention; and how it’s possible to work successfully with the GTT as part of an overall patient safety and harm reduction strategy — just ask OSF, which has seen marked improvement across their system and raised awareness with help from the regular, routine use of the GTT at seven hospitals.

We know everyone is working hard on multiple fronts to improve quality and safety. If efforts can become more targeted and effective, based on more robust detection methodologies, that’s a good thing.

Read the Health Affairs article.
1 hr 3 min
June 27, 2017WIHI: Reports from the Frontlines of Effective Crisis Management
Date: April 7, 2011
Featuring:
James Conway, MS, FACHE, Senior Fellow, Institute for Healthcare Improvement; Adjunct Faculty, Harvard School of Public Health
Anthony A. Armada, FACHE, President, Advocate Lutheran General Hospital, Advocate Lutheran General Children’s Hospital
Michael A. Fisher, President and CEO, Cincinnati Children’s Hospital Medical Center (CCHMC)
Uma R. Kotagal, MD, MBBS, MSc, Senior Vice President, Quality, Safety and Transformation, CCHMC; Executive Director, James M. Anderson Center for Health Systems Excellence
Michelle Hoppes, RN, MS, President, American Society for Healthcare Risk Management; Senior Vice President and National Director for Healthcare Risk Management and Patient Safety, Sedgwick Claims Management Services

When IHI published a white paper last year written by Jim Conway and three colleagues, there was little doubt that health care organizations were seeking guidance on the best and most transparent ways to prepare for and respond to serious medical crises. However, the September 2010 publication of Respectful Management of Serious Clinical Adverse Events, hit a nerve (in the best sense) that even the authors couldn’t have predicted: there have been thousands of downloads of the white paper from IHI.org, and dozens of organizations and health care providers have been eager to spread its guiding content far and wide.

Not only that, the compilation of tools and best practices — from having a plan ready to be implemented, to enacting the plan, to ensuring that everyone affected has what they need, when they need it — wound up serving as a resource for several hospitals facing unfortunate clinical occurrences. Leaders from two of the affected hospitals — Michael Fisher and Uma Kotagal from Cincinnati Children’s and Tony Armada from Advocate Lutheran — join Jim Conway to discuss what they learned, in real time, about the critical importance of making crisis management a part of every organization’s culture of quality and safety. Among other things, patient- and family-centeredness must anticipate those moments “when things go wrong.”

Michelle Hoppes also joins the program to offer her perspective and that of the changing world of hospital risk management to align with a respectful response to serious adverse events.
1 hr
June 27, 2017WIHI: Primary Care's (New) Pressures and Possibilities
Date: March 17, 2011
Featuring:
Karen Boudreau, MD, FAAFP, Senior Vice President, Institute for Healthcare Improvement; Medical Director, IHI Continuum Portfolio
Connie Davis, MN, RN, Geriatric Nurse Practitioner, IHI Faculty; ImpactBC Senior Faculty for Patients as Partners and Adjunct Faculty, University of British Columbia School of Nursing
John H. Wasson, MD, Professor of Community and Family Medicine, Dartmouth Medical School
Sheila Allison, Peer Coach, Patient Advisor, Patient Voices Network (BC, Canada); Volunteer Facilitator, University of Victoria Centre on Aging – Self-Management Program

Next to electronic health records (EHRs), there’s probably no other area of health care receiving as much attention these days as primary care. It’s easy to see why. Like EHRs, new and improved primary care models are considered ground zero for a system that’s better coordinated, integrated, and efficient. Hopes are high, especially in the US, that with a more robust and reliable infrastructure of primary care, there will be fewer dropped balls, fewer unnecessary referrals to expensive specialists, and less use of emergency departments for non-urgent care.

Sometimes it’s hard to assign one overarching phrase to all the activities now underway to help primary care practices make this strategic leap. That’s why WIHI host Madge Kaplan talks with four experts who have a good picture of what’s going on and, most importantly, can articulate today’s fundamental drivers for transforming primary care.

Sheila Allison’s work with Patient Voices Network in Canada represents the best of what patients and families can bring to the table to ensure that primary care redesign is truly patient-centered. Committed to improving chronic care, Connie Davis has been helping build bridges between clinicians, patients, and families for years. Drs. Karen Boudreau and John Wasson, who often work with Connie, round out the WIHI panel with their keen knowledge of how critical it is for clinical and quality leaders to “get primary care right” — especially as health care becomes less and less hospital-centric and more community oriented.

There are plenty of wrinkles, lots of noise, and head-spinning agendas surrounding primary care. This WIHI will help you get a handle on what you should be spending your time on and why.
56 min
June 27, 2017WIHI: Health Care’s Newest Improvers: Patient and Family Advisors
Date: March 10, 2011
Featuring:
Kristine White, RN, BSN, MBA, Vice President, Innovation and Patient Affairs, Spectrum Health System
Cindy Sayre, MN, ARNP, Director, Professional Practice and Patient- and Family-Centered Care, University of Washington Medical Center
Dorothea Handron, EdD, APRN, Faculty Emeritus, College of Nursing, East Carolina University; Patient-Family Advisor, University Health Systems of Eastern North Carolina
Brandelyn Bergstedt, Coordinator, Patient and Family Advisor Program, Evergreen Hospital Medical Center
Martha Hayward, Executive Director, The Partnership for Healthcare Excellence; Founder, Women’s Health Exchange; Member, Dana Farber Cancer Institute Patient Advisory Council

Here’s the first thing one discovers when planning a program about Patient and Family Advisory Councils (PFACs): there are now hundreds and hundreds of them at hospitals all across the US, and they’re a growing phenomenon internationally. In fact, there are so many outstanding examples of patients and family members rolling up their sleeves to improve the health care system, alongside quality leaders and clinicians, that it’s not easy to choose just a handful of examples to highlight.

WIHI host Madge Kaplan has assembled a terrific panel that is sure to leave you inspired and with a much clearer sense of what PFACs do and how they’re contributing to the redesign of health care today. Learn from Kristine White, Cindy Sayre, Dorothea Handron, Brandelyn Bergstedt, and Martha Hayward — each of whom represents, first, a new attitude among health care executives to fully embrace the insights and experience of patients and families; and, second, a growing sophistication among people once thought of as “outsiders” as they tackle some of health care’s most intractable problems.

Whether it’s how patients and family members feel welcomed (or not) when they walk through the door of a hospital, access to loved ones in the ICU, reliable communication with providers, or prevention of infections and medication errors, there is hardly an issue that PFACs are not involved in helping to solve or improve.

Learn how to develop and support PFACs at your organization, what makes for an effective council, and how to create clear guidelines and expectations.
59 min
June 27, 2017WIHI: The Newest Innovator on the Block: Center for Medicare and Medicaid Innovation
Date: February 24, 2011
Featuring:
Rick Gilfillan, MD, Acting Director, Center for Medicare and Medicaid Innovation
Most of us are familiar with the various demonstration projects the Centers for Medicare & Medicaid Services (CMS) has sponsored over the years. This year CMS is taking the notion of figuring out “what works” when it comes to better patient care to an entirely new level, with the launch of the Innovation Center at CMS.

Rick Gilfillan, fresh from helping to redesign payment methods at the Geisinger Health System to align with quality outcomes — and gaining national recognition as a result — is now applying his passion for improvement to the country as a whole. As the Innovation Center ramps up, Dr. Gilfillan is eager to keep everyone up to date with what’s on the broader agenda and what’s most immediately in store.

WIHI host Madge Kaplan talks with Dr. Gilfillan, who explains the strategy behind the Innovation Center and the prospects for seeding much more robust work with both new payment and service delivery models. Dr. Gilfillan is not alone in believing that a lot of great models exist already. The challenge comes in first harnessing these best practices and then spreading them. It’s this last issue that he has been hearing about in spades; the need to diffuse new models quickly and effectively has never been greater and requires a national learning network and infrastructure that currently doesn’t exist, but can be created.
1 hr 5 min
June 27, 2017WIHI: A Legible Prescription for Health Care
Date: February 10, 2011
Featuring:
Pauline Chen, MD, Columnist, The New York Times; Author, Final Exam: A Surgeon’s Reflections on Mortality
Every now and again, a physician begins writing a regular column for a publication and you find yourself hooked before you know it. Part of it has to do with our being offered a way to better understand “how doctors think” and what they think about.

In the case of Pauline Chen, what stands out is her frank honesty about what works and what isn’t working in medicine, not only affecting patients, but the ways physicians interact with one another, and with other practitioners. Many of Dr. Chen’s columns spring from her day-to-day experiences — from confronting assumptions about patients that physicians hold onto to confronting one’s own loss of confidence after making a mistake.

Here’s an excerpt from her May 2010 New York Times column, "When Patients Share Their Stories, Health May Improve":
"Devastated, I withdrew my needle and quickly took steps to confirm, then care for, his punctured lung. But a few days later in the ICU when one of the heart surgeons asked me to place a central line in another patient, I couldn’t help but hesitate. He repeated himself and then I confessed. I had lost my nerve with this once seemingly straightforward procedure."

WIHI host Madge Kaplan and Pauline Chen discuss a whole host of topics, starting with language and the ways in which certain words and formal ways of describing a patient’s condition create distance rather than any sort of bond. Dr. Chen also wonders about the human barriers inadvertently created between doctor and patient when the best infection prevention precautions are in place. And is there a danger of giving too much weight to what patients score or say in satisfaction surveys?
1 hr 1 min
June 27, 2017WIHI: Alert to Change: New Models for Residency Work Hours
Date: January 27, 2011

Featuring:
Christopher P. Landrigan, MD, MPH, Director, Sleep and Patient Safety Program, Brigham and Women’s Hospital
David B. Sweet, MD, FACP, Program Director, Internal Medicine Residency, Summa Health System
James F. Whiting, MD, Surgical Director, Maine Transplant Program and Surgical Residency Program Director, Maine Medical Center
Don Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement

Rules are rules, but efforts to limit the number of hours medical residents can work before getting rest and sleep have not gone down easily in the US. The latest set of regulations from the Accreditation Council for Graduate Medical Education (ACGME), focused especially on first-year residents, is scheduled to go into effect in July 2011.

Amid ongoing debate about research tying long hours spent taking care of hospital patients to impaired judgment and an increased likelihood of making errors (or harming oneself), and what are fair and appropriate remedies, a growing number of residency programs are forging ahead. They’re redesigning schedules and handoff processes not only to comply with ACGME rules, but to adopt systems that are more team-based and that promise to better protect the health and safety of patients and providers alike.

There’s no magic, one-size-fits-all solution, but WIHI host Madge Kaplan welcomes a group of experts to shed light on trailblazing ideas and system redesigns that everyone engaged in training health professionals can learn from. At Summa Health System, for example, where Dr. David Sweet heads up the residency program, 16-hour limits are the organizing principle for all trainees. And that’s led to innovations that are gradually achieving greater buy-in and improved care. Dr. James Whiting is working hard to get ahead of the curve in Maine, and other residency programs that are actively linking training to patient safety are also highlighted.

Dr. Chris Landrigan has made a major contribution to the research concerning sleep and safety, and both he and Dr. Don Goldmann are keenly aware of the ways in which educational programs for residents, including access to faculty, have historically evolved around open-ended work schedules. There are big challenges ahead. But now, there are also models that can be studied and innovations that can be introduced.
1 hr
June 27, 2017WIHI: The Power of Specialty Care – and the Necessity to Use It Wisely
Date: January 13, 2011

Featuring:
Neil Baker, MD, IHI Faculty and Improvement Advisor; Improvement Consultant, Neil Baker Consulting
Lawrence Shapiro, MD, Managed Care Medical Director, Palo Alto Medical Foundation

Here’s something most clinical and quality leaders agree with: a lot of specialty care isn’t always necessary or beneficial. What’s more, there’s tremendous variation across the US in the use of specialist services — variation that tends to be driven by the volume of what’s available, not the health needs of a community’s residents.

Meanwhile, in the trenches of decision making and with state-of-the-art interventions available to diagnose and treat diseases of all sorts, doctors and patients want what’s best, and potentially lifesaving. We applaud the oncologist who’s carefully helping a patient with cancer weigh treatment options; we respect the cardiologist who’s prescribing someone who’s had a heart attack the best medications to prevent a recurrence; we want the C-section for the pregnant woman who might lose her baby otherwise.

It’s in this context that Doctors Neil Baker and Lawrence Shapiro and others are hard at work creating a framework to help providers get closer to an appropriate use of specialty services — to reduce unnecessary health care costs and to deliver better care to patients. Neil Baker is the co-author of a 2010 IHI white paper, Reducing Costs Through the Appropriate Use of Specialty Services, that lays out a six-step process for generating good data about current practice patterns, analyzing the information, and making agreed-upon changes.

In this model, physicians (including those making referrals to specialists) are partners and problem solvers in their areas of expertise, not passive recipients of external rules. Just ask Lawrence Shapiro. The work that’s been underway at the Palo Alto Medical Foundation in California is case in point of what’s possible.

Improving when, why, and how specialty care is tapped also intersects with robust work going on across the country, and globally, with shared decision making — where patients, too, better understand their options and the benefits, or not, of obtaining specialty care. WIHI host Madge Kaplan delves into a topic that is not rocket science in terms of solutions, but deserves plenty of attention and requires the best minds, and experiences on the ground, in order to make the right kinds of changes.
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