WIHI - A Podcast from the Institute for Healthcare Improvement

​Date: September 15, 2017

Featuring:

• Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI)

What do we need and expect from trustees of health systems when it comes to their oversight of quality and safety? It's a question that's getting increased attention because board members aren't typically sought out or sufficiently trained for this type of expertise. Greater granularity and constant exposure aren't always the answer. Indeed, board meetings are often filled with lots of quality and safety data and other metrics that many members can't easily navigate, let alone discuss and act upon.

With a growing consensus that quality and safety must become a more prominent part of board education and continuous shared learning among all leaders, this doesn't have to be the case. The latest thinking on effectively engaging boards in quality and safety was our topic of discussion on the September 15 WIHI: Tuning Up Health System Boards for Patient Safety.

Date: August 24, 2017

Featuring:

• Michael Hanak, MD, FAAFP, Associate Chief Medical Informatics Officer, Ambulatory Care & Assistant Professor, Family Medicine, Rush University Medical Center

While there are many ways to improve health equity, few recognize the importance of curiosity as part of this work. For instance, you may have a lot of solid data pointing to outcomes disparities in your health system by race, ethnicity, and other factors. But what's behind the numbers that may be contributing to health inequities in your specific patient population and community? Are there dynamics in play that no one's considered before?

Our guests are from health system teams participating in IHI's two-year initiative known as Pursuing Equity​, which is focused on deepening and broadening work to improve health equity at the clinical, institutional, and community level. At Rush University Medical Center in Chicago, this means taking steps to uncover what's behind pronounced racial and ethnic disparities in cardiovascular outcomes and care. In Boston, Brigham and Women's Hospital has teamed up with the Southern Jamaica Plain Health Center, a nearby community clinic, to tackle health equity and the complex relationship that exists between big teaching hospitals and surrounding low-income neighborhoods, including the local health center.

It's no small feat when leaders from big institutions decide that in order to more effectively work together on health equity for patients, they need to first look at themselves to reduce power imbalances and institutional racism. Why is this a groundbreaking step? And What does health equity look like in your community and where you work? In what ways is your organization making health equity a strategic priority? We addressed these questions and more on the August 24 WIHI: Pursuing Health Equity with Curiosity — Notes from New Initiatives.

Date: August 10, 2017

Featuring: 

• Pat Folcarelli, RN, PhD, Interim Vice President, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center (BIDMC)

Date: July 13, 2017

Featuring:

• Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement (IHI)

Patients undergoing dialysis typically do so in a hospital or health care facility. Most people don't question the need to have experienced health care staff on hand or what's considered a safe environment for the treatments. But that might be changing.

A growing number of patients in Sweden have 24/7 access to special units at health systems where they schedule and conduct their hemodialysis themselves. And, inspired by Sweden, a small number of US nephrology centers are trying something similar. Even more ambitious: One of the largest safety net hospitals in the US has been teaching a few thousand patients how to administer their own IV antibiotics at home.

A team at Parkland Health and Hosptial System in Dallas, led by WIHI guest Dr. Kavita Bhavan, wanted to see if a population of patients without health insurance, whose multiple hospital days on an antibiotic drip weren't being reimbursed by anyone, might do as well and maybe even better than patients with insurance, receiving nurse-assisted IV antibiotic therapy at home, at an infusion center, or skilled nursing facility. The answer seems to be, "Yes."

This is patient engagement at a whole new level. Listen to this episode of WIHI to hear more about this groundbreaking quality improvement work.

Date: June 29, 2017

Featuring:

• Soma Stout, MD, MS, Vice President, Institute for Healthcare Improvement (IHI)

On the June 29 WIHI, How to Fail Forward (Quickly) On the Road to Population Health, we looked in on two communities who emerged from a boot camp of sorts known as Spreading Community Accelerators through Learning and Evaluation, or SCALE. Funded by the Robert Wood Johnson Foundation and part of the larger 100 Million Healthier Lives initiative, SCALE comprises 24 communities who have spent the past 24 months learning new leadership skills and, for the first time, improvement methods to deepen their work on a range of community health issues. SCALE communities are engaged with everything from reducing chronic disease among homeless women and decreasing teen pregnancy, to replacing food deserts with affordable, healthy options, to building greater resiliency among children traumatized by violence.  

• Christina Pagel, PhD, MSc, IHI Fellow and 2016-2017 Harkness Fellow in Health Care Policy and Practice (Commonwealth Fund)

​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? 

This issue has caught the attention of a researcher and a physician who argue in arecent article in NEJM Catalyst that not all QI initiatives are created equal; some are inherently more interesting and enjoy a higher profile in an organization (e.g., reducing sepsis), while other projects, no matter how necessary (e.g., decreasing patient no-shows), occur out of the spotlight, are tedious and, sometimes, just plain boring. Is that a fair characterization of what goes on in your organization? Would you put it another way? 

Of course, what's boring is often in the eye of the beholder. Developing the technological and administrative processes needed to get information from primary to acute care — and the other way around — in a timely, accurate fashion may cause the eyes of some members of your clinic staff to glaze over, while others are completely energized. We discussed navigating that dynamic with our guests on the June 14 episode of WIHI.