WIHI - A Podcast from the Institute for Healthcare Improvement

Date: February 4, 2010

Featuring:

Albert Wu, MD, MPH, Professor, Johns Hopkins Bloomberg School of Public Health

Linda Kenney, President and Executive Director, MITSS

Susan D. Scott, RN, MS(N), CLNC, Coordinator, Patient Safety, University of Missouri Health Care

Whenever there's an adverse event or medical error in health care, clinicians are affected, too. As organizations develop more accountable and transparent ways to interact with families and patients who've been harmed, the emotional and professional needs of doctors, nurses, and staff — whether directly or indirectly involved in an incident — also need to be addressed. In a 2000 essay in the BMJ, Dr. Albert Wu coined the phrase “the second victim” to put a face to the health care personnel facing loss of confidence and isolation in the aftermath of a tragic event. Now, a decade later, Dr. Wu's courage in naming a problem and his willingness to openly discuss the “private hell” that can beset even the most talented caregivers have helped many hospitals and health care organizations acknowledge the needs of their staff and create systems to support them.​​There's not nearly enough in place...yet...but Dr. Albert Wu, along with Linda Kenney of MITSS (Medically Induced Trauma Support Services, Inc.) and Susan Scott from University of Missouri Health Care, are among those leading the way with experience and solid recommendations that can benefit all health care organizations. WIHI host Madge Kaplan welcomes the trio to the program to discuss building reliable “aftermath safety nets” for clinicians and staff when adverse events occur.

Date:  January 21, 2010

Featuring: 

Rosanne Haggerty, Founder and President, Common Ground

Becky Kanis, Director of Innovations, Common Ground

Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine, NYU School of Medicine

Joe McCannon, Faculty, Institute for Healthcare Improvement

 

Every winter in the US, volunteers fan out across most major cities to count the number of people residing in shelters and living on the streets. This annual census of the homeless serves many functions, but always reminds us of the complex web of economic, behavioral, and social factors that underlie life without any permanent housing for at least three million Americans at any given time.

 

Many of the people living on the streets and in shelters are well known to nearby hospital emergency departments (EDs). The health problems are typically chronic, sometimes life threatening, and usually part of a repeating pattern of addiction, mental illness, or disease that those who work in EDs can only begin to address. Underlying needs often go unmet.

 

Common Ground has a proven track record of creating housing for people on the streets. Now, as part of its effort to end homelessness, Common Ground wants to forge innovative relationships with hospitals to better target outreach and resources to some of the most vulnerable. WIHI host Madge Kaplan talks with two of the organization’s leaders, Rosanne Haggerty and Becky Kanis, who are actively laying the foundation for permanent, affordable housing for the homeless, as well as new, effective coalitions with the health care system to stop the revolving door in and out of the ED. Dr. Maria Raven is an expert on care coordination for complex patients, and Joe McCannon is helping Common Ground map out a new, national strategy.

Date: January 7, 2010Featuring: 

Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement

Doug Salvador, MD, Associate Chief Medical Officer/ Patient Safety Officer, Maine Medical Center

 

It’s hard to point to a position more central today for making good on the goals of hospital patient safety than that of the Patient Safety Officer (PSO). And yet, perhaps no job is more challenging due to the overarching responsibility for multiple players, layers, and departments in an organization. It’s one thing for The Joint Commission to require that every US hospital have a PSO; it’s quite another to build the systems and teams to make the prevention of errors and injury a living mantra, and everyone’s priority, each and every day. When the national discussion puts more of the spotlight on coordinating care, reducing costs, and reducing readmissions, it’s easy to get distracted. But, that would be a mistake.

Date: December 17, 2009

Featuring: 

Tom Delbanco, MD, Beth Israel Deaconess Medical Center, Harvard Medical School

Mary Merkel, DO, Merrimack Family Practice, Dartmouth-Hitchcock Nashua

If you had the chance to look at what your physician wrote in your medical record about your last visit, would you take advantage of it? Would this make your relationship with your doctor or primary care provider more collaborative? More effective? These are just some of the important questions and issues bearing down on our health care system as an online universe and electronic medical records make shared viewing of what are often referred to as the “doctor’s notes” feasible. What’s contained in the notes and does transparency interfere in any way with their value?

Date: December 2, 2009

Featuring: 

Eugene Litvak, PhD, President and CEO, Institute for Healthcare Optimization

James M. Anderson, President and CEO, Cincinnati Children’s Hospital Medical Center

Scott Hamlin, Senior Vice President of Finance and CFO, Cincinnati Children's Medical Center

 

Imagine this scenario: a hospital CEO, a chief surgeon, and an operations management expert decide there has to be something better than daily overcrowding in the emergency department, no vacant operating rooms, a lackluster occupancy rate, stressed staff, and patients waiting around to be seen. The trio, along with others in the hospital, decide they’re going to dig into the problem and apply the best improvement science available to turn things around. And they do.

 

Read the case study that explains how Cincinnati Children's redesigned perioperative flow.

Date: November 19, 2009

Featuring:

Helen Darling, President, National Business Group on Health

Raymond J. Zastrow, MD, FAAFP, President, QuadMed, LLC

 

If you’re a US employer providing health care benefits to your employees, there’s no sitting still anymore or sitting on the sidelines and accepting whatever comes next. Even in the midst of possibly historic health care reform, insurance premiums continue to rise and take a far greater chunk out of a company’s bottom line; employees are being asked to pay more out of pocket, too.

 

In this environment, employers have become a lot smarter about what they’re purchasing. They’re paying more attention than ever to issues of quality and patient safety, and the degree to which health plans focus on wellness and primary care. In some instances, such as at QuadMed, employers are seizing the reins and building the type of integrated health care delivery system they believe should serve as a model for society as a whole. That’s what Dr. Raymond Zastrow describes on this WIHI, joined by Helen Darling in a timely discussion of the more sophisticated role they believe companies must play in reforming health care. What sorts of incentives can employers offer employees to improve their health without being punitive?

Date: November 5, 2009

Featuring:

Gordon Schiff, MD, Associate Director, Center for Patient Safety Research and Practice, Brigham and Women’s Hospital

Pat Croskerry, MD, PhD, Professor in Emergency Medicine at Dalhousie University, Halifax, Nova Scotia

 

It’s an all too familiar story: The initial diagnosis of a patient’s condition turns out to be wrong; or there’s an incorrect interpretation of a test result; or a patient never learns of a test result; or a physician relies too much on memory to form a diagnostic opinion, forgetting about other important clues. Each of these diagnosis errors can be traced back to a system failure or an overreliance on cognitive skills (ignoring decision supports), and often, both. Thankfully, many years’ worth of robust research on diagnosis errors is finally receiving greater attention, and is starting to lay the groundwork for improvement across the US and internationally.

Date: October 22, 2009 

Featuring:

Donna Shalala, PhD, former US Secretary of Health and Human Services, President, University of Miami

Sue Hassmiller, PhD, RN, FAAN, Director of the RWJF Initiative on the Future of Nursing, Institute of Medicine

Pat Rutherford, RN, MS, Vice President, IHI

 

There may be a shortage of nurses in many parts of the US, but there’s no shortage of rethinking and redesign underway to strengthen the profession and to help nurses be more effective providers of quality patient care. Health care reform, along with a greater emphasis on primary care and prevention, are just some of the forces that point to a more prominent, satisfying, and critical role for nurses in the near future.

Date: October 8, 2009

Featuring: 

Diane Meier, Director, Center to Advance Palliative Care

Jim Conway, Senior Vice President, Institute for Healthcare Improvement

 

Between the care that patients and families want when faced with advanced illness, and what is often made available, “lies not just a gap but a chasm.” Those words, associated with the IOM’s groundbreaking blueprint, Crossing the Quality Chasm, are as apt a rallying cry as ever for transforming US health care, including what patients need at the end of their lives. Yet, patients and families often find themselves at odds with or abandoned by their medical providers at this stage of their care, forced to seek others who will respect their wishes.

Learning from failure is an important part of quality improvement in health care. But what can we learn from improvement efforts that languish or stall due to the inglorious nature of the work itself?