WIHI - A Podcast from the Institute for Healthcare Improvement

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  Florian Daragjati, PharmD, BCPS, Director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention Lynn Deguzman, PharmD, BCGP, Regional Clinical Operations Manager, Kaiser Permanente Leslie J. Pelton, MPA, Senior Director, Institute for Healthcare Improvement Leanne Phillips, PharmD, BCPS, Clinical Pharmacy Coordinator, St. Vincent’s East, Ascension 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 adu

Date: August 9, 2018   Featuring: Barbara Balik, RN, EdD, Co-Founder, Aefina Partners, and Senior Faculty, Institute for Healthcare Improvement (IHI) Kris White, MBA, RN, Co-Founder, Aefina Partners, and Faculty, IHI Helen Macfie, PharmD, FABC, Chief Transformation Officer, MemorialCare   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

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

Corey Waller, MD, MS, FACEP, DFASAM, Addiction, Pain, Emergency Medicine Specialist; Managing Partner, Complex Care Consulting, LLC; Chair, Legislative Advocacy Committee for the American Society of Addiction Medicine (ASAM) Catherine Mather, MA, Director, Institute for Healthcare Improvement (IHI)   About 5 percent of patients in the US are individuals with complex needs. Many show up at hospital emergency departments with a combination of physical, socioeconomic, and behavioral health issues — only to return, again and again, sometimes in worse condition, because the current system isn't set up to address a multitude of problems. The burgeoning field of "complex care" is trying to break the cycle with new interventions and stronger connections to supportive services.  . But addiction, a common thread among the complex patient population, is often dealt with differently. While the recent opioid epidemic has forced health care providers to change some of their prescription practices and to become more kn

Saranya Loehrer, MD, MPH, Head of the North America Region, Institute for Healthcare Improvement (IHI) Christina Lundquist, BA, MHS, Vice President of Operations, Rainbow Babies and Children's Hospital and MacDonald Women's Hospital at University Hospitals (UH) Health System Lora Council, MD, MPH, Senior Medical Director for Primary Care, Cambridge Health Alliance ​   Health systems face numerous challenges in their efforts to improve population health. Among them, multiple entry points, such as initiating better care management for all patients with chronic asthma, widespread depression screening, or working with the community to address food insecurity. Each initiative is valuable yet, taken together, don't necessarily add up to a comprehensive population health strategy. Is there a logic to what to do first, then second, and so on? How do you know you're on the right track?   There are no simple answers, but there has been enough experience with population health in the US and elsewhere that several

Amar Shah, Consultant Forensic Psychiatrist & Chief Quality Officer, East London NHS Foundation Trust ​Lindsey Bourne, Director of Education, PFCCpartners Barbara Grey, Director SLaM Partners & Quality Improvement (QI), South London and Maudsley NHS Foundation Trust Sarah Davenport, Service User Consultant, South London and Maudsley NHS Foundation Trust ​Gabrielle Richards, Head of Inclusion, Recovery, Occupational Therapy, and Allied Health Professionals, South London and Maudsley NHS Foundation Trust​   Patients and families are playing a greater role in health care quality improvement. Over the last decade participation has grown to include serving on Patient and Family Advisory Committees, or PFACs; regularly meeting with hospital board safety and quality committees; joining co-design and co-production initiatives; and speaking or leading sessions at QI conferences.  Along the way, there's been some exposure to QI principles and methods, but now some organizations believe it's essential for

Date: May 10, 2018 Featuring: Michael Rose, MD, Anesthesiologist, Vice President of Surgical Services & Chairperson of Community Board of Trustees, McLeod Regional Medical Center ​Kate B. Hilton, JD, MTS, Faculty, Institute for Healthcare Improvement; Senior Consultant, ReThink Health​ Alex Anderson, Research Associate, Institute for Healthcare Improvement For the past 30 years, the Institute for Healthcare Improvement (IHI)​ has worked with organizations around the world to improve health and health care using an approach to quality improvement that's grounded in W. Edwards Deming's System of Profound Knowledge. Dedicated improvers know that, to achieve results, we need to consistently apply systems thinking, an understanding of variation, and theories of knowledge. So, what often stands in the way of adopting and spreading meaningful improvements? Breaking news: People are resistant to change. Deming himself stressed the importance of psychology — or the adaptive, human side of change — in his S

Date: April 19, 2018   Featuring: Julie Kennedy Oehlert, DNP, RN, Chief Experience Officer, Vidant Health Jermaine McNair, Executive Director, NC CIVIL Jafet Arrieta, MD, MMS, Director, Institute for Healthcare Improvement (IHI) Meghan Hassinger Welch, MBA, Senior Project Manager, IHI   Eight health systems are working with IHI to broaden their impact on health equity as part of the two-year Pursuing Equity initiative​. These systems are working to elevate health equity to a strategic priority, confront institutional racism, and improve the livelihood and health of their patients, employees, and surrounding communities. Vidant Health​, based in Greenville, North Carolina, is a 1,447-bed health system serving more than one million patients each year from 29 eastern North Carolina counties. This part of the state is largely rural, poor, and home to a racially diverse population. Vidant's health equity priorities are centered on improving the health and wellbeing of their patients and — as the largest e

Date: April 5, 2018 Featuring: James L. Reinertsen, MD, The Reinertsen Group Ronette Wiley, RN, BS, MHSA, CPPS, Executive Vice President, COO, Bassett Medical Center Helen Mackie, MB, ChB, FRCP, Consultant Gastroenterologist, University Hairmyres Hospital, NHS Lanarkshire; National Clinical Advisor for "Realistic Medicine," Scottish Government The safety huddle​ has become an important way for hospitals to surface safety concerns affecting patients and the workforce. The best huddles are multidisciplinary, highly structured, brief (15 minutes or less), take place early in the morning and focus on incidents from the day before and risks to safety in the day ahead. Is the safety huddle effective? Have organizations grown lax with the process over time? Some participants have observed that, over time, safety huddles tend to become "just another meeting" or "another box to check off." Dr. James Reinertsen, who has spent decades coaching clinical leaders and staff about safety, says too many huddles allow d

Date: March 22, 2018 Featuring: ​Mary Tinetti, MD, Gladys Phillips Crofoot Professor of Medicine (Geriatrics) and Professor, Institution for Social and Policy Studies; Section Chief, Geriatrics (co-chair) Marie Cleary-Fishman, BSN, MS, MBA, CPHQ, CPPS, CHCQM, Vice President, Clinical Quality, Health Research & Educational Trust (AHA) J. Michelle Moccia, DNP, ANP-BC, CCRN, Program Director, Senior Emergency Center, St. Mary Mercy Hospital (Trinity Health) Belinda Dokic, CPht, BA, MBA, Quality Performance Improvement Leader, St. Mary Mercy Hospital (Trinity Health)  Preventing injuries from falls, especially among the elderly, has been a flagship issue for health care quality improvement and patient safety for nearly two decades. The complications that can follow broken bones at an advanced age, most notably a broken hip, can literally be deadly. This reality, numerous programs, and reporting requirements have kept falls prevention front and center across the health care continuum. Now a new initiat

Date: March 8, 2018 Featuring: Kate FitzPatrick, DNP, RN, ACNP, NEA-BC, FAAN, Chief Nursing Officer, University of Vermont Medical Center Teri Pipe, PhD, RN, Dean, College of Nursing & Health Innovation and Chief Wellbeing Officer, Arizona State University​ Part of the appeal of mindfulness​ is the simplicity of its central tenet: bringing awareness and focused attention to the present moment. Mindfulness also offers a measure of control when everything else feels out of control. As stress-reduction and other health benefits of mindfulness become better known, clinicians are discovering that they, too, need new ways to deal with stress…often on the fly. Practicing mindfulness can be restorative in the middle of a hectic day, create mental space to be more tuned into patients, and reduce the likelihood of medical errors. So, what does practicing mindfulness look like, in practice? On the March 8 episode of WIHI, Mindfulness and Patient Safety, we learned from two leading experts on how mindfulness c

Date: February 22, 2018 Featuring: Sarah L. Szanton, PhD, ANP, FAAN, Associate Director for Policy, Center on Innovative Care in Aging, Department of Health Policy and Management, & Johns Hopkins Bloomberg School of Public Health Judith Kell, MPA, Manager, Pathways to Better Health, Mercy Health Gary Felser, ME, Construction Supervisor, Elder Services at Civic Works One of the biggest challenges facing older patients with disabilities is that the care and support services needed to function optimally at home are often fragmented — and not always obtainable. Thi​s is especially true for low-income disabled adults whose home circumstances may not fit the bill, literally and figuratively, for what public insurers such as Medicaid and Med​icare will cover. In a handful of communities in the US, a program called CAP​ABLE​ is demonstrating low-cost, practical ways to fill the void. The research into the health benefits and cost savings associated with CAPABLE are yielding impressive results. Learn how th

Date: February 8, 2018 Featuring: Gordon Schiff, MD, Associate Director, Brigham and Women's Center for Patient Safety Research and Practice; Quality and Safety Director, Harvard Medical School (HMS) Center for Primary Care Christine K. Cassel, MD, Executive Advisor to Founding Dean, Kaiser Permanente School of Medicine Bruce Lambert, PhD, Director, Center for Communication and Health, Northwestern University We don’t like to think of the diagnosis process as causing as many problems as it’s trying to solve. But when the complaints are more chronic than acute, there’s growing concern that a plethora of diagnostic tests and procedures have raised expectations of always finding a precise answer or explanation. When that's not possible, or tests aren't recommended as the first line of attack, a provider's clinical observations and reasoning can seem less than satisfactory. It’s this complexity of diagnosis and the difficulty of sometimes having to admit "there's no way to know for sure" that we explored o

Date: January 25, 2018 Featuring: ​ David M. Williams, PhD, Executive Director for Improvement Capability, Institute for Healthcare Improvement (IHI) Petrina McGrath, RN, MN, PhD, Executive Transition Lead: People, Practice and Quality, Saskatchewan Health Authority James Moses, MD, Chief Quality Officer and Vice President of Quality and Safety, Boston Medical Center  Health care systems are under tremendous pressure to create and sustain transformative changes on multiple fronts: patient and worker safety, overall quality of care, moving from volume to value, and population health, just to name a few! The job of overseeing these efforts, and nurturing the culture and vigilance required to stay on track, is increasingly the province of the Chief Quality Officer or CQO.  In many ways, the CQO functions as symbol, sense maker, and keeper of the flame for constant, unwavering, system-level change. The CQO also often marries quality aims with an organization's financial and strategic goals. He or she canno

Date: January 11, 2018   Featuring:  ​​Glenn Crotty, Jr., MD, FACP, Clinical Associate Professor of Medicine, West Virginia University; Executive Vice President and COO, Charleston Area Medical Center (CAMC) Robert B. Saper, MD, MPH, Associate Professor Family Medicine, Boston University; Chair, Academic Consortium for Integrative Medicine & Health Shane Coleman, MD, MPH, Division Medical Director, Behavior Services Division, Southcentral Foundation​ Mara Laderman, MSPH, Director, Innovation, Institute for Healthcare Improvement (IHI)​​ As efforts continue to curb the opioid addiction epidemic in the US and reduce deaths from overdoses​, the underlying problem of overprescribing remains very much in the spotlight. There's growing evidence that clinicians writing prescriptions for Vicodin, Percocet, OxyContin, and the like are adhering to new, stricter guidelines, and doing a better job keeping track of their patients taking opioids.    But with these changes in prescribing, experts and providers

Date: December 21, 2017 Featuring: Steve Spear, DBA, MS, MS, Principal, The High Velocity Edge, LLC; Author; IHI Senior Fellow WIHI is pleased to present a Special Edition Podcast, Discovering Your Way to Greatness, featuring author and operations expert, Steve Spear. Steve Spear, DBA, MS, MS, is principal of The High Velocity Edge, LLC, which provides advisory services and has developed software that enables accelerated problem solving, particularly with distributed workforces. His book, The High Velocity Edge, has won numerous awards. Dr. Spear is a Senior Lecturer in MIT’s Management and Engineering schools, a faculty affiliate at Harvard Medical School and a Senior Fellow at the Institute for Healthcare Improvement. He is an internationally recognized expert on leadership, innovation, and operational excellence, and an authority on how select companies in various industries generate unmatchable performance by converting improvement and innovation from inspiration to repeatable, broad-based, skill-bas

Date: December 7, 2017 Featuring:  ​​Victor Montori, MD, Professor of Medicine, Mayo Clinic Maggie Breslin, MDes, Director, The Patient Revolution Kerri Sparling, Diabetes Advocate; Creator and Author, Six Until Me When Dr. Victor Montori first started talking about Minimally Disruptive Medicine ​more than a decade ago, he shook the establishment. Dr. Montori, who works with patients with diabetes, had come to believe that shared decision making – an effort to help patients make informed decisions about managing their health problems – wasn't proving all that effective. Dr. Montori felt doctors and nurses weren't factoring in the burden of being a patient with a chronic condition, and the real life challenges – social, economic, or personal – of following prescribed treatment plans. It was time, he argued, for providers to look up from strict protocols and guidelines long enough to get curious about their patients' lives in order to minimize barriers to better health, not add to them.    Fast forward

Date: November 9, 2017 Featuring: Lindsay A Martin, Founder, I-Squared Consulting Group; Instructor, T.H. Chan School of Public Health, Harvard University Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement (IHI) John Whittington, MD, Senior Fellow, IHI; Lead Faculty, IHI Triple Aim ​ The health care quality improvement movement has rallied around some significant innovations over the years, many of which have had a lasting impact. The failure of most hospitals to make real progress on reducing hospital-acquired infections led IHI to launch the 100,000 Lives Campaign​ in 2004. The IHI Open School​ was launched in 2008 to fill in for what too many medical educators were failing to do: incorporate quality and safety into their health professions educational curricula. Frustration with the slow pace of change is often grist for innovation. Ten years ago IHI chartered an R&D team to engage in a regular, rigorous process of examining and testing new ideas and mod

Date: October 26, 2017 Featuring: Fred E. Shapiro, DO, Chair, ASA Committee on Patient Safety and Education; Founder, Institute for Safety in Office-Based Surgery ​Alexander Hannenberg, MD, Faculty, Safe Surgery Program, Ariadne Labs; Chief Quality Officer, American Society of Anesthesiologists Jennifer Lenoci-Edwards, RN, MPH, Executive Director, Patient Safety, Institute for Healthcare Improvement These days, no one thinks twice about getting a mole removed or undergoing cataract surgery outside of a hospital. Heading to an office practice or an ambulatory care center for what's considered "minor surgery" tends to be more convenient for the patient and often more cost effective. According to recent figures, upwards of 20 million outpatient procedures are performed in the US each year — everything from cosmetic to knee to eye surgeries. As the numbers rise, so do concerns about safety. While serious harm, including deaths, remains uncommon in outpatient settings, adverse events can and do occur. When

Date: October 12, 2017 Featuring: Jake Maguire, MA, Principal, Community Solutions, Built for Zero Beth Sandor, Principal, Community Solutions, Built for Zero Nate French, Senior Improvement Advisor, Community Solutions Ninon Lewis, MS, Executive Director, Institute for Healthcare Improvement On any given night of the year, the nation's homeless veterans number around 40,000; another estimated 84,000 fit the definition of chronically having no place to live. Frustrated by the seemingly entrenched situation, a group called Community Solutions​has been using tools and methods and campaign-style momentum adopted from IHI and the health care quality improvement movement to decrease homelessness in the US. Their improvement science approach coupled with a strategy called Built for Zero​ is leading to impressive results. Community Solutions has taken a rigorous, relentless, real-time, data-driven approach — including careful tracking of individuals by name, and the engagement of a wide range of social serv