WIHI - A Podcast from the Institute for Healthcare Improvement

November 8, 2018

 Featuring:

• ​Brent C. James, MD, MStat, Clinical Professor (Affiliated), Department of Medicine, Stanford University School of Medicine; Senior Fellow, IHI; Former Chief Quality Officer, Intermountain Healthcare

 Clinical and administrative leaders in health care know how difficult it is to shape one, unifying workplace culture. And while interdisciplinary team-based care is becoming more common in health systems, the range of people taking care of patients perform their jobs based on very different professional backgrounds and training.

 Can quality improvement (QI) break down these silos? Can it nurture a new kind of culture, where QI is the knowledge that unites clinicians in the common pursuit of better clinical decision making and encourages more clinicians to take the lead with improving care delivery? There’s evidence to suggest yes.

 Whether the issue is curbing overdiagnosis and overtreatment; reducing waste, costs, and patient suffering; or factoring in “what matters” to a patient when considering treatment options, clinicians who are improvers can lead the way. We explored this topic and more on the November 8 WIHI: Building the Will and Skill to Be a Clinical Improver.

Date: October 25, 2018

 Featuring:

 Andrea Tull, PhD, Director of Reporting and Analytics, Edward P. Lawrence Center for Quality & Safety, Massachusetts General Hospital (MGH)  

Aswita Tan-McGrory, MBA, MSPH, Deputy Director, The Disparities Solutions Center

Initiatives to reduce avoidable readmissions are the norm in US health systems today, particularly because Medicare fines hospitals with higher-than-expected rates. Health care leaders also recognize that when patients are readmitted to the hospital within 30 days of discharge, it usually indicates that processes are not what they should be.

In addition, health care organizations have come to appreciate that non-clinical issues, often referred to as social determinants of health, have a great bearing on rehospitalizations — everything from poor housing to unstable income to food insecurity. Collecting data to better assess the impact and better address these determinants to prevent readmissions is ongoing. We gained gain some valuable insights into the efforts of a major health care system in Massachuestts and their learning curve on the October 25 WIHI: Lowering Readmissions, Reducing Disparities. 

Date: September 13, 2018

Featuring:

• Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP, Executive Director, Peter Lamy Center on Drug Therapy and Aging; Professor, University of Maryland School of Pharmacy 

The ground is shifting for prescription medication in the US and Canada, and in other countries, too. There’s much talk and publicity about weaning people off drugs, or what is referred to as “deprescribing”: a process that entails taking patients off some of their medications or tapering down the dosages.

The underlying reasons for deprescribing include concerns about polypharmacy, especially the impact on older and frail adults; antibiotic resistance caused by inappropriate and excessive use; and the ongoing opioid epidemic connected to years of overprescribing highly addictive medicines for pain.

A growing number of health care organizations are working with IHI on how to safely implement deprescribing. Learn about their experiences and the future of this work on the September 13 episode of WIHI, The How and Why of Deprescribing,

Date: August 9, 2018

Featuring:

• Barbara Balik, RN, EdD, Co-Founder, Aefina Partners, and Senior Faculty, Institute for Healthcare Improvement (IHI)

Most hospitals are understandably preoccupied with patient experience scores. High-performing organizations worry when their scores plateau, and those with mediocre scores wonder why their attention to better "customer service" hasn't improved the numbers. Up and down the rankings, there's discussion about patients as unreliable informants, flawed survey instruments, low survey response rates, and institutions being judged unfairly by these scores.

A decade into publicly reported patient experience data for US hospitals (most notably with HCAHPS​), experts say that health systems are working on patient experience too much in isolation, separate from other organizational strategic aims. If you're tired of the same old discussion about patient experience scores, we hope you'll listen the new ideas and best practices presented on the August 9 WIHI: Connecting Patient Experience to Culture and Strategic Aims.

Scott Zeller, MD, Vice President of Acute Psychiatry, Vituity

Robin Henderson, PsyD, Chief Executive, Behavioral Health, Providence Medical Group Oregon and Clinical Liaison, Well Being Trust

Vera Feuer, MD, Director of Pediatric Emergency Psychiatry, Northwell Health

Mara Laderman, MPH, Director for Innovation, Institute for Healthcare Improvement (IHI)​

​For all that emergency departments (EDs) do to stabilize individuals and save lives, they’ve never been the ideal place for patients whose crises are related to behavioral health. EDs are designed to address the most urgent, sometimes life-threatening problems, and then discharge or transfer patients to the appropriate next level of care. If a psychiatric or addiction-related admission is needed, however, there may not be any beds. This often leads to boarding patients in the ED or adjacent hallways for hours, sometimes days. ​

In the US, many blame an underfunded mental health system for the shortage of inpatient beds and an inadequate supply of outpatient services that might help patients avoid going to the hospital altogether. Emergency department staff aren't any happier with the status quo. They have begun to look at how EDs might improve the overall care experience for behavioral health patients and contribute to continuity of care.

Promising new practices are being tested in nine hospitals participating in Integrating Behavioral Health in the Emergency Department and Upstream​, an initiative led by IHI in partnership with Well Being Trust​. Improvements these hospital EDs are testing include creating new lines of communication and care coordination, including post-discharge follow-up, with community-based services; standardizing and streamlining processes from intake to discharge for a range of mental health and substance abuse issues; working with both patients and their family members on self-management skills; and educating ED staff on behaviors consistent with a trauma-informed and empathetic culture.

We dicsussed these tests and innovations on the July 12 episode of WIHI: How to Build a Better Behavioral Health in the Emergency Department