WIHI - A Podcast from the Institute for Healthcare Improvement

WIHI - A Podcast from the Institute for Healthcare Improvement

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WIHI - A Podcast from the Institute for Healthcare Improvement episodes

  • WIHI: The Patient Activist

    Date: December 16, 2010

     
    Featuring:

    • Bill Thatcher, Executive Director, Cautious Patient Foundation
  • Barbara Balik, RN, EdD, Senior Faculty, Institute for Healthcare Improvement
  • Tricia Pil, MD, Pediatrician, Medical Writer, University Health Sciences Project Coordinator, Patient Activist
  • Charles Maclean, PhD, Founder, PhilanthropyNow

    •  

    The activated patient and family member – often seeking to ensure that whatever “bad” thing happened to them doesn’t happen to anyone else – is, thankfully, no longer a new phenomenon. Today in the US, hundreds of organizations of all sizes and reach are gaining a voice and the expertise to help solve some of health care’s most intractable quality and safety problems. The rapid growth of patient advisory councils is just the latest example of patients becoming an integral and integrated force in the redesign of care.
     
    On December 5, 2010, thanks to the generosity of the Cautious Patient Foundation and others, some 50 patient leaders gathered at IHI’s Annual National Forum to consider their work to date and how, by combining forces, they can be an even more effective force for change. This WIHI shares the energy and discussion from the Leadership Summit for Patient Activists and Partners in Quality and Safety, featuring four people whose work has been crucial to laying the foundation for a new era of patient activism.
     
    We’re all patients at some point, and that common experience – and sometimes unfortunate experience – is what’s bringing physicians, researchers, lawyers, parents, and every combination you can think of together to compare notes and plan for the hard work ahead.

    58 min
  • WIHI: Finding the Will to Bend the Cost Curve
    Date: December 2, 2010

    Featuring:
    • Jeffrey Selberg, MHA, Executive Vice President and COO, Institute for Healthcare Improvement
  • Robert Murray, Executive Director, Maryland Health Services Cost Review Commission
    •  
    The phrase, “bending the cost curve,” has an elegance to it that almost belies the complexity of what it’s going to take to achieve this aim. Medical home, accountable care organizations, bundled payments, global payments, value-based purchasing…they’re all in the mix. But how does it all add up, and is there a more effective overarching strategy still to come? 
     
    IHI’s Executive Vice President and COO, Jeff Selberg, has been digging into where things stand with “bending the cost curve” efforts, especially in the US, and he has some important ideas and framing that he’d like to offer to WIHI participants to move efforts forward. Robert Murray has been overseeing, at one level, one of the longest-running payment and cost control initiatives in the country – in the state of Maryland, where an all-payer hospital rate-setting system has pushed hospital costs steadily downward, below the national average. The Maryland Health Services Cost Review Commission is deeply engaged in other initiatives, too, including the country’s first bundled payment system for outpatient hospital services.
     
    There are no easy fixes, but there’s no turning away from the cost issues either. Especially if we’re also talking about quality care, improved health, and greater access to insurance coverage and primary care for everyone. What is happening in your state and your community that helps solve this cost/quality puzzle?
    58 min
  • WIHI: Nursing’s New Roadmap: Education, the Workforce, and Health Care Quality
    Date: November 18, 2010
     
    Featuring:
    • Donna Shalala, PhD, former US Secretary of Health and Human Services; President, University of Miami; Chair, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, Institute of Medicine
  • Linda Burnes Bolton, DrPH, RN, FAAN, Vice President for Nursing and Chief Nursing Officer, Cedars-Sinai Medical Center; Vice Chair, IOM Committee on the Future of Nursing
  • Patricia Benner, RN, PhD, FAAN, Senior Scholar, Carnegie Foundation for the Advancement of Teaching; Author, Educating Nurses: A Call for Radical Transformation and From Novice to Expert: Excellence and Power in Nursing
    •  
    What’s it going to take for the health care system to take full advantage of the potential of nurses – and for nurses to realize their full potential? These twin questions are not new to the nursing profession, or to policy makers. Both groups have been wrestling for years to find the right levers to increase not just the ranks of RNs, but their skills and recognition as key members of health care teams. Although this has led to some successes and improvements, the solutions haven’t kept up with demands. Health care reform has only intensified the need to sharpen strategies, especially as nurses have the potential to play a critical role in creating a more patient-centered, integrated delivery system.
     
    In October, the Institute of Medicine released a report called The Future of Nursing: Leading Change, Advancing Health. The study committee’s Chair and Vice Chair, Donna Shalala and Linda Burnes Bolton, join WIHI to review the recommendations and to talk about how to turn the substantial report into action. Everyone in health care, not just nurses, has a role to play in driving many of the ideas forward. One of health care’s and nursing’s most respected educators, Patricia Benner, will round out the panel with some special focus on the changes needed in nursing education to ensure that RNs have the necessary skills and preparation to assume greater leadership and patient care roles.
     
    Any discussion about the goals and ambitions for any health profession must take into consideration how these align with the needs of health care reform – including better quality, better health, at reduced costs.
    57 min
  • WIHI: The Leaders Needed for the Changes Health Care Needs

    Date: November 4, 2010

    Featuring:

    • Marshall Ganz, MPA, PhD, Lecturer in Public Policy, Harvard University
  • Kate B. Hilton, MTS, JD, Principal in Practice, Leading Change; Leadership Coach, NHS England; Director, Organizing for Health


    • If you don’t work in the health care system, it’s sometimes hard to understand why, when so much is known about better ways to take care of patients and better ways to deliver quality at lower cost, people don’t just “do it!” What’s so complicated? If one hospital or hospital system has dramatically lowered infection rates, trained its practitioners to work as teams, AND coordinates with outpatient clinics to help people with serious, chronic conditions avoid the emergency department, then why can’t all hospitals do this? What’s the excuse?

    Well, there is no “excuse” per se, but the reasons for the uneven and unreliable pace of change are many and complex. So much so that many health care improvement experts believe that the massive challenges facing health care systems in the US and in other countries, such as the UK, now require a new type of focus and mobilization. Where else in society have broad based, necessary changes come about before? How does this happen? Who makes it happen? Enter Marshall Ganz whose organizing in the civil rights movement and with everyone from farm workers to political candidates is legendary. This is the same Marshall Ganz, whose 2009 IHI National Forum keynote had several thousand attendees taking copious notes.

    Marshall and Kate Hilton are in the midst of a timely initiative dubbed Organizing for Health. In a nutshell, the two are harnessing some of the best known and proven practices from community organizing and successful social and political movements, to help spawn a new type of health care leader—one who can then mobilize colleagues and staff to create fundamental, organizational change. And we’re not just talking about a better run chart. It’s about new goals, new skills, new ways of working across all health care settings, new partnerships with patients and families, and new teamwork; it’s about meeting new cost and payment expectations, and the needs of an expanding number of patients coming into the US health care system with insurance for the first time.

    WIHI host Madge Kaplan welcomes Marshall Ganz and Kate Hilton to share a fresh vision for health care reform that could change business as usual in your organization.

    58 min
  • WIHI: The Power to Detect and Reduce Harm: IHI’s Global Trigger Tool and Adverse Events in the US
    Date: October 21, 2010
     
    Featuring:
    • Lee Adler, DO, Vice President for Quality, Safety, Innovation, and Research, Florida Hospital
  • Ruth Ann Dorrill, MPA, Team Leader, Office of Inspector General, US Department of Health and Human Services
  • Amy Ashcraft, Senior Analyst, Office of Inspector General, US Department of Health and Human Services
  • Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement
  • Fran Griffin, Senior Manager of Clinical Programs for BD Medical/Medical Surgical Systems; Faculty, Institute for Healthcare Improvement
    •  
    How often are patients harmed in US hospitals, and what is the best way to determine this? Ever since the Institute of Medicine (IOM) estimated that up to 98,000 patients die in hospitals each year due to medical errors, and some subsequent studies that claim the number is much higher, getting a more precise “national” handle on where and when and how frequently harm occurs has bedeviled most researchers. Without a baseline, it’s been impossible to state with any certainty whether patients are any safer today in US hospitals than they were ten years ago, when the IOM issued its seminal report.

    This is the backdrop for a groundbreaking series of studies that the Office of Inspector General (OIG) at the Department of Health and Human Services has been undertaking. In the past two years, the OIG has issued a series of reports focused on harm that reaches hospitalized Medicare recipients, including analysis of the sensitivity and accuracy of methods for detecting harm. Its most recent report, slated for publication in October, provides a first-of-its-kind national incidence rate for adverse events.

    IHI’s Global Trigger Tool, designed to facilitate a retrospective review of medical records to identify adverse events, combined with a physician review, has been singled out by the OIG as a powerful means of determining when an adverse event has occurred.

    This WIHI offers a window into all the research findings — straight from the experts — and their significance for patient safety, harm detection, improvement work, and policy reform going forward.
    59 min
  • WIHI: Reducing Readmissions, Restoring Revenues: Making Good Care Count
    Date: October 7, 2010
     
    Featuring:
    • Amy Boutwell, MD, MPP, Director of Health Policy Strategy, Institute for Healthcare Improvement
  • Jeffrey Burke, Director, Financial Decision Support, Spectrum Health
  • Rosemary Rotty, Director, Financial Planning, UMass Memorial Health Care

    • You’d be hard pressed to find anyone working in a hospital who’d say, “Yes, we really want Mrs. Jones to be back here a few days after she’s been discharged, running a fever, suffering complications from surgery, and now needing to be readmitted so we can run more tests.” And yet, scratch the surface of even the most dedicated hospital these days, working hard on sending people home with appropriate information, support, and planning… and you’ll find someone working late who’s been asked to come up with the business model that’s going to replace all the lost revenues when those “unwanted” readmissions are reduced!

    Even as payers, including Medicare, are poised to make hospitals that don’t reduce their readmissions feel added financial pain, the fiscal impact on hospitals doing the right thing, right now, is already real. At times, it feels like it comes down to “choose your poison.” That’s why, experts say, hospitals have often made the unbelievable decision of throwing successful readmission reduction programs overboard, quite simply because they can’t afford the negative effect on the bottom line.

    IHI’s STAAR (STate Action on Avoidable Rehospitalizations) initiative is taking a hard look at finances, working with a courageous group of hospitals that are learning how to open their books and analyze their admissions (and readmissions) patterns with some new eyes and new thinking. As with any serious commitment to improvement, knowing the facts is the essential first step. It turns out that asking one set of hard, financial questions, leads to others about utilization patterns and overall hospital operations… helping hospitals get ever closer to truly understanding how to care for patients in the right place, at the right time.

    WIHI host Madge Kaplan talks with Amy Boutwell from the STAAR initiative and two hospital leaders who crunch numbers, Jeffrey Burke and Rosemary Rotty, share why it’s critically important to make the financial impact of reducing readmissions a living, breathing, part of your quality agenda.
    1 hr
  • WIHI: The Buzz about Medical Training: It’s (Slowly) Changing

    Date: September 23, 2010

    Featuring:

    • Lawrence Smith, MD, Dean, Hofstra/North Shore-Long Island Jewish School of Medicine; Chief Medical Officer, North Shore-LIJ Health System
  • John Rock, MD, Founding Dean, Herbert Wertheim College of Medicine at Florida International University
  • M. Brownell Anderson, Senior Director, Educational Affairs, Association of American Medical Colleges (AAMC)


    • It’s not easy to turn medical training upside down to better fit the needs of today’s patients and health care system. Consider that the last major reform occurred some 100 years ago and many, many institutions and individuals would say they’ve done just fine with the basics and, besides, some of the new content areas like “humanism” would be nice to know, but they’re hardly essential. I’m going to be a surgeon, after all!

    Well, don’t try that out on the Deans of some 20 new medical schools. The attitude also might not wash with a new breed of curriculum architects who pair students with patients in low-income neighborhoods from day one, who insist on the mastery of good communication skills, and who have begun to weave the science and the tools of quality improvement and patient safety in and out of all science and clinical coursework. This is the new reality for future doctors and a lot of the changes are occurring at the grassroots, school by school, with educational leaders and governing bodies just now harnessing the best that’s out there to create a new blueprint for medical training, overall.

    Dr. Lawrence Smith is serious about change. At his brand new medical school, Hofstra/North Shore–LIJ, first-year students will, among other things, get certified as EMTs and learn firsthand about teamwork and what patients and families need in crisis situations. At the Wertheim College of Medicine–Florida International University, Dean John Rock is sending medical students into diverse and complex communities so they’ll immediately appreciate medical realities within the context of social and economic realities. The AAMC’s Brownie Anderson, who’s in regular contact with all the new Dean innovators, joins WIHI fresh off a conference highlighting a vast amount of change occurring at all the nation’s medical schools. Whether it’s the IHI Open School or the virtual MyCaseSpace pioneered by the University of Central Florida, change is in the air and on the ground.

    59 min
  • WIHI: Leaders Never Stop Learning

    Date: September 9, 2010

    Featuring:

    • Maureen Bisognano, President and CEO, Institute for Healthcare Improvement  


    Here's the thing about IHI's new President and CEO, Maureen Bisognano: she has unshakable optimism. And it's not because she wears rose-colored glasses or is looking at a different health care world than the rest of us. No, Maureen’s optimism is fed by her regular contact with some of health care's most reliable sources: patients and families, front-line providers, leaders — all of whom know firsthand where the problems lie and where the opportunities reside. They also share Maureen’s belief, honed by over 25 years’ worth of experience working to improve patient care, that the next barrier is only as formidable as you make it. The questions always need to be, “What new processes can you test?”  “What new skills are needed?” “Who haven’t you included in the discussion?”

    Talk to anyone who has met Maureen, and they’ll tell you she is a leader for our times; she’s keenly aware of every vexing and hard-nosed cost and policy issue the US health care system especially is facing, and clearer than ever how IHI and the quality improvement movement can and must provide a path forward.

    Opportunity has knocked for health care reform in tandem with quality and patient safety like never before. WIHI host Madge Kaplan has a candid discussion with Maureen about these issues and more.

    56 min
  • WIHI: Against All Odds: Maternal Survival in Ghana and the US

    Date: July 15, 2010

    Featuring:

    • Nana Twum-Danso, MD, MPH, FACPM, Director, Project Fives Alive!
  • Jo Ivey Boufford, MD, President, New York Academy of Medicine
  • Sue Gullo, RN, MS, Managing Director, Institute for Healthcare Improvement
    •  
    It’s difficult to assess just how much progress is being made in the decades-long battle to prevent women from dying during pregnancy and childbirth. In April, The Lancet reported that worldwide maternal death rates dropped significantly from 1980 to 2008. The good news wasn’t uniformly shared across the 181 countries studied, but some global health experts felt there was reason for optimism. In May, the Kaiser Family Foundation presented a more sobering picture, suggesting that efforts to fulfill the United Nations Millennium Development Goal (MDG) of reducing maternal mortality by 75 percent by 2015 were not on track.
     
    At the same time, new initiatives in some of the poorest parts of the globe are successfully targeting maternal health and delivering healthy prognoses for women and newborns alike. The work draws upon existing resources, takes into account geography and available transportation, respects local traditions, and utilizes the tools of quality improvement. In mostly rural northern Ghana, for instance, greater numbers of pregnant women are for the first time gaining access to skilled deliveries in clinics and hospitals – especially crucial when mother and baby may be in distress and most at risk.
     
    WIHI host Madge Kaplan welcomes Dr. Nana Twum-Danso (Director of Project Fives Alive! in Ghana), Dr. Jo Ivey Boufford, and Sue Gullo to the program to share their frontline experiences on behalf of improved maternal health in Africa, New York City, and across the US. The trio will help connect the global dots about best practices in challenging settings. They’ll also discuss striking similarities between efforts to reduce maternal mortality in Africa and new approaches springing up in underserved and poor communities in the US.
     
    And what of the differences? How can a country such as the US, with skyrocketing numbers of C-sections, frequent use of powerful medications to induce labor, and technology to address just about every imaginable situation work its way back to something closer to community and support, helping more women feel empowered before, during, and after childbirth? How can we prevent highly medicalized, high-tech births from becoming the “gold standard” for countries that have suffered from resource disadvantages for so long? One key is understanding the alternative approaches and making sure these become more widely known.
    55 min
  • WIHI: Unprofessional Behavior Not Permitted Here

    Date: July 1, 2010

    Featuring:

    • Barry Silbaugh, MD, MS, FACPE, CEO, American College of Physician Executives
  • Kevin Stewart, FRCP, Medical Director Winchester and Eastleigh NHS Trust; Health Foundation Fellow, IHI
  • Charlotte Guglielmi, RN, CNOR, Perioperative Nurse Specialist, BIDMC; President, Association of periOperative Registered Nurses
  • Gerald B. Healy, MD, Emeritus Healy Chair in Otolaryngology, Children’s Hospital (Boston); Senior Fellow, IHI
  • Ron Wyatt, MD, MHA, General Internist, Huntsville Hospital (Alabama); Merck Fellow, IHI
    •  
    Over the years, the positions held by doctors in health care organizations have unfortunately empowered some to behave unprofessionally towards other staff and practitioners, especially nurses. Giving a pass to belligerent or temperamental clinicians, even while many of those affected quietly seethe, has been tolerated in part because of the pecking order in medicine, and in part as a nod to the organization’s sources of revenue.
     
    Well, the times are a changing…and not just because hospitals are worried about their reputation or retaining staff. Those in a position to confront a culture that’s permitted outbursts and intimidation now consider such behavior a contributor to medical errors, and a major disruption to the teamwork and robust communication that’s so critical to patient safety and quality improvement today. It’s a start. And nurses with a penchant for coming down hard on other, less senior RNs, or giving new interns and residents a hard time, are also being called out.
     
    WIHI host Madge Kaplan gathers an expert panel to parse out these complicated and controversial issues, get a handle on what regulators have to say about unprofessional conduct, and learn about a new determination among professional societies and hospitals to face up to behavior that truly has no place in a safe, high performing organization. The guests have stories to share and, most importantly, are tracking the solutions and policies that show the most promise. There’s word that that newer generations of health professionals are more willing to stand up to inappropriate behavior of colleagues and superiors alike. That’s the right spirit… now we need the systems to back this up.
    1 hr 26 min

About WIHI - A Podcast from the Institute for Healthcare Improvement

From the publisher's feed

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…