WIHI - A Podcast from the Institute for Healthcare Improvement

 

Have you had a CT scan lately? Chances are good that you have. In fact, you may have even had some repeat CT scans for the same problem — often because the original scans couldn’t be found. Until recently, we’ve been so enamored of this powerful diagnostic technology that most of us haven’t thought twice about repeating a scan, or considered the benefits versus the risks. Not to mention the costs. But we’re learning that a lifetime of exposure likely contributes to a greater risk of cancer. And many CT scans just aren’t needed, contributing to vast overutilization and significant health care spending. One person’s expense is of course another’s revenue, patients demand the best imaging, and physicians have a hard time saying no. What if they’ve missed something? How can we safely and wisely slow down this medical breakthrough?

 

WIHI host Madge Kaplan welcomes Drs. James Duncan and Richard Griffey. As the amount of radiation Americans are exposed to from medical imaging skyrockets, notably among children, various federal agencies, radiologists, and improvement experts are taking notice and suggesting changes.

 

Duncan and Griffey discuss the latest research on radiation imaging risks; new thinking about appropriate doses and the technology that can support greater accuracy; options for alternative imaging (e.g., ultrasound or MRI); decision supports for patients and clinicians; and more. Did you know that the International Atomic Energy Agency is spearheading the introduction of a “smart card” that could keep track of how much medical radiation an individual has been exposed to?

 

What happens when health care leaders from different regions in the country get in the same room and talk about their efforts to redesign patient care? Among other things, there’s often a sense of relief that, across state lines and political affiliations, there’s a shared concern for improving people’s health, improving their health care experiences, and lowering the costs of care. Washington may be able to bring about broad reforms for health care, but communities of all shapes and sizes are increasingly being looked to for the day-to-day solutions and innovations that will “bend the cost curve” and offer new, humane models for the future.

 

Fresh off a meeting in the Washington, DC, focused on building low-cost, high-quality health care regions in America, WIHI hosts a timely discussion about what 14 “Hospital Referral Regions” are starting to figure out about their quality data, their cost data, and the way forward. John Hogan is at the nexus of important changes taking place in Tallahassee, Florida; Tom Nolan, Carol Beasley, and Laura Landy are part of a group of national leaders (others include Don Berwick, Elliott Fisher, Atul Gawande, and Mark McClellan) who’ve been digging for the data and the ingenuity across the country that can be harnessed, shared, and turned into blueprints for change the nation so badly needs.

 

Grab your competitor from across town, or find a collaborator, or notify anyone you think is a stakeholder in your community looking for fresh thinking about costs, quality, and the health of the population. You’re sure to walk away with some new ideas from this WIHI.

 

Primary care practice in the US is undergoing a transformation. In many instances the offices still look cramped and, unlike hospitals, the changes don’t take the form of major new construction. But look closely: those sagging shelves of patient files are giving way to electronic health records; practitioners are tapping into online expertise to help with diagnoses and apply evidence-based medicine; patients have their own web portals; and people with similar chronic conditions sometimes meet as a group with a single provider for shared learning and greater efficiency. And, in case you haven’t heard, health care reformers are looking to primary care like never before to pave a better path to prevention, continuity of care, and cost containment for the country as a whole. Could the expectations be any higher?

 

Maybe so — don’t forget the medical home, which is why the newest kid on the block is something called the Primary Care Coach: someone specially trained to help office practices make sense of all these ambitions AND the successful and meaningful use of health information technology.

 

WIHI host Madge Kaplan welcomes a panel of experts, each of whom is now engaged in one way or another with leading the redesign of primary care. In addition to learning more about coaches for primary care, hear about the innovative Health Information Technology Regional Extension Centers (RECs) now popping up across the US to help office practices adopt electronic health records. One key goal of all the current efforts is to make sure technology is used in service of healthy outcomes and quality improvement, and not the other way around.

Date: May 6, 2010

Featuring: 

Steven J. Spear, Senior Lecturer, Massachusetts Institute of Technology; Senior Fellow, IHI

John Toussaint, Founder and President, ThedaCare Center for Healthcare Value; Author, On the Mend

Gary Kaplan, MD, Chairman and CEO, Virginia Mason Health System

 

When Toyota began to stumble in the late summer and fall of 2009 because of serious safety problems, the world gasped. And understandably so. Faulty gas pedals and brake systems were the last things anyone expected from the world’s number one car maker. Indeed, the high standards for quality and safety that revolutionized auto manufacturing and that inspired many other industries, health care included, to learn from Toyota, were viewed as indelible. Not any more. That’s probably a good thing in the long run, say those who’ve followed the company over the years; it’s an unfortunate turn of events, but an important wake-up call that anyone committed to sustaining gains over the long run can and must learn from.  John Toussaint, Gary Kaplan, and Steven Spear are some of this country’s top students, teachers, and implementers of Toyota methods as they apply to health care. They join WIHI host Madge Kaplan to share their analysis and wisdom about why it’s critical to “keep your eyes on the road” of improvement and not succumb to a lot of distractions and the latest shiny idea or ambition. The trio is confident that Toyota will work its way out of the current situation and restore its trust with consumers. But where in your own health care organization are there early warning signs of arrogance and loss of respect and humility towards patients and staff in hopes of workarounds and easy gains?

Date: April 22, 2010

Featuring: 

Anthony M. DiGioia, MD, Founder, The Orthopaedic Program and Innovation Center, Magee-Womens Hospital of UPMC

Dale Shaller, Principal, Shaller Consulting Group

 

There’s no particular reason why a patient- and family-centered care program would start off in a hospital’s orthopaedic surgery department, but if you’ve had the pleasure of speaking with Dr. Tony DiGioia you’d know immediately why that’s the way things went. Passionate about improving care for patients, Dr. DiGioia first saw all sorts of opportunities right in front of his nose at Magee-Womens Hospital, part of the University of Pittsburgh Medical Center (UPMC). The rest, as they say, is history. There are now some 16 working groups in the UPMC system innovating and implementing communication and navigation processes that smooth the way for patients having elective surgery, dealing with urgent care, or facing a transition home. There’s an online Innovation Center to capture learning AND to share tools and resources and strategies with anyone interested. And, perhaps most importantly, Dr. DiGioia and his colleagues have developed a methodology for implementing patient- and family-centered care programs, taking a lot of the guess work and starting from scratch out of the picture. WIHI host Madge Kaplan welcomes Dr. Tony DiGioia and Dale Shaller, one of the country’s foremost experts on improving quality and safety in health care and increasing patient satisfaction. If your head is spinning with so many definitions of patient- and family-centered care that you’re not sure whose interpretation to believe, OR you fear the concept is in danger of becoming more a matter of good intentions than actual results, this is a WIHI discussion you don’t want to miss.

Date: April 8, 2010

Featuring:

Sue Gullo, RN, MS, Managing Director, Institute for Healthcare Improvement

Maureen P. Corry, MPH, Executive Director, Childbirth Connection

Rima Jolivet, CNM, MSN, MPH, Associate Director of Programs, Childbirth Connection

Peter H. Cherouny, MD, The University of Vermont College of Medicine

 

Here’s how most of us are exposed to the state of health care for pregnant women, new mothers, and newborns: we hear about it in the news. And the issues are usually presented in an alarming and fragmented fashion: high rates of infant mortality and disparities across race and ethnicity; high-tech interventions for premature infants; a dramatic rise in caesarean or c-sections; induced delivery prior to 39 weeks. At the same time, Ob/Gyn complications remain unacceptably high, as do maternal deaths. Here’s another picture to consider: an emerging coalition of maternity care leaders in the US armed with a Blueprint for Action and a “2020 Vision” that aims to transform maternal and newborn experience from one fraught with danger and risks to what it should be: a safe, healthy, celebratory start to childhood and parenting. WIHI host Madge Kaplan welcomes Maureen Corry and Rima Jolivet from Childbirth Connection to explain the new energy they’ve ignited to ensure that good quality maternal health is reliably understood and practiced on a wide scale. High-quality, safe, cost-effective maternity care is a growing part of IHI’s work globally – in Malawi and Ghana – and central to IHI’s work in the US. Sue Gullo and Peter Cherouny work with some 50 hospital teams in IHI’s Improving Perinatal Care Community to reduce harm and variation, and to improve patient-centered care and teamwork among all concerned. Sue Gullo talks about a new way of thinking, a “mind shift” that brings the needs of pregnant women, new moms, and infants into the foreground like never before. Learn more about accelerating change and implementing processes to reduce misuse, overuse, and underuse of maternity care. Good things happen when experts unite around good care and good policies.

Date: March 31, 2010

Featuring: 

Donald M. Berwick, MD, Former President and CEO, Institute for Healthcare Improvement

Lucian L. Leape, MD, Chair, Lucian Leape Institute at NPSF, and Adjunct Professor of Health Policy, Harvard School of Public Health

Dennis S. O’Leary, MD, President Emeritus, The Joint Commission

Diane C. Pinakiewicz, President, Lucian Leape Institute at NPSF

What do today’s medical students need to know to safely and effectively take care of patients? This question isn’t really a new one. But in recent years, the focus on making sure students are prepared to practice in an environment dominated by advancements in medical treatment has been coupled with something equally urgent: the need for newly minted MDs to listen effectively, to engage in difficult conversations, to work as members of teams, and to practice with sharpened awareness and skills drawn from the very latest in improvement science and patient safety.​None of these changes can come about overnight. IHI’s “virtual” Open School is starting to make a difference in the lives and skills of students across the health professions, and now the Lucian Leape Institute at the National Patient Safety Foundation has issued a groundbreaking report that lays out an important blueprint for change. Unmet Needs: Teaching Physicians to Provide Safe Patient Care may be the most important call for medical education reform since the Flexner Report in 1910. The principal authors of the report join Don Berwick and WIHI host, Madge Kaplan, for an important discussion of the key findings and recommendations in the report and a look at where reform of the sort called for can already be noted and applied more broadly.Dennis O’Leary labels the current state of medical education as one of “producing square pegs for the delivery system’s round holes.” This is clearly not the future we want to embrace. This WIHI focuses on a timely conversation on one of the most important gateways to a better and safer health care system: medical education.

Date: ​March 18, 2010

Featuring: 

Chip Heath, Co-author, Switch: How to Change Things When Change Is Hard

Joe McCannon, Faculty and former Vice President, Institute for Healthcare Improvement

There are probably as many books out there on “change” as there are problems in need of solutions. But, just when you think you’ve read and heard it all, comes one of the most inventive approaches yet to getting things moving. Switch offers just the excuse we need right now to set down the almost unbearable burden of trying to do everything at once to fix health care. While we wonder what happens next with health care reform or any big system’s attempts at transformation, why not also focus on “bright spots” and the power of turning standard strategic plans on their heads and unleashing a very different kind of innovation?​WIHI host Madge Kaplan welcomes Chip Heath and Joe McCannon to remind health care improvers everywhere of the resources and possibilities to improve patient care that are, in some instances, staring us in the face. There’s a lot in the behavioral psychology that Chip and co-author (and brother) Dan Heath are drawing from that will sound familiar to anyone who’s been bowled over by unexpected learning that results from small tests of change and PDSA cycles. Find out how those emotions matter more than you might think, especially if your aim is making a lot of small successes roll up into larger and more lasting change. That’s where Joe McCannon comes in. He successfully ran two of the biggest improvement initiatives yet in the US, involving thousands of hospitals. Turns out the Rider, the Elephant, and the Path were all engaged. Curious? Listen to this WIHI!

Date: March 4, 2010

Featuring: 

Jim Conway MS, FACHE, Senior Fellow, former Senior Vice President, Institute for Healthcare Improvement

Timothy McDonald, MD, Professor of Anesthesiology and Pediatrics, Associate Chief Medical Officer for Safety and Risk Management, University of Illinois-Chicago

Richard Boothman, Chief Risk Officer, University of Michigan Health System

What should happen in the first hour or first day after an adverse or sentinel event in your health care organization? Wait for all the facts to come in? Sequester yourselves until all the talking points have been agreed upon and legal counsel gives the go ahead to say something? Not too long ago, guidelines like these would not have seemed outrageous or outside the norm. Indeed, a large percentage of organizations are still tempted to react defensively and protectively when anything unexpected happens on their turf. It’s understandable but the evidence is mounting that nothing good comes from this approach – not for patients, not for staff, and definitely not for the future health and vitality of the organization.Who better to help us understand the brave new world of “effective crisis management” than Jim Conway, Timothy McDonald, and Richard Boothman: three national improvers, well versed in risk management, who are actively reframing the priorities to be patient-centered most of all. In the process, they’re pioneering and demonstrating models of transparency and accountability any institution would be proud to emulate. WIHI host Madge Kaplan welcomes the trio to the program to tell us what they’ve been learning and to find out from you, our participants, what’s working in your own organizations. One key to effective crisis management is being prepared with a response system that everyone is familiar with and knows how to activate – before bad things occur.

Date: February 18, 2010

Featuring:

David Kessler, MD, FDA Commissioner (1990-1997), Professor, UCSF School of Medicine

Charles J. Homer, MD, MPH, President and CEO, National Initiative for Children’s Healthcare Quality

Rachelle Mirkin, Executive Program Director, National Initiative for Children’s Healthcare Quality

Hardly a day goes by anymore, it seems, that doesn’t include new research findings about obesity and its health consequences. At the same time, headlines heralding the latest tactics to help Americans, especially, shed the excess pounds often compete for space with some of the most sophisticated advertising ever to lead us to precisely the foods wreaking havoc with our bodies and brains. The former head of the US Food and Drug Administration, David Kessler, identifies with those of us gaining and losing weight, like the seasons, and our seemingly insatiable desires for foods high in sugar, salt, and fat. That’s why he wrote the book, The End of Overeating, and he’s hoping his investigation adds to the understanding of the levers needed to turn the obesity epidemic around.​​WIHI host Madge Kaplan welcomes Dr. Kessler to the program, along with two national leaders, Charles Homer and Rachelle Mirkin, who are helping to provide communities and health care providers with known best practices to combat obesity in children. If ever there was a frontline for effective strategies, it is with kids who are otherwise on track for a lifetime of chronic and serious illness. Forty billion dollars in increased medical spending in the US because of obesity, according to one recent analysis, gets our attention. But, if you’re wondering what’s working, where, to reverse this spiral, this WIHI features an urgent discussion about obesity and what experts are learning about best ways to focus interventions and efforts.