WIHI - A Podcast from the Institute for Healthcare Improvement

Date: September 28, 2017 Featuring:  Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI) Jessica Perlo, MPH, Director, IHI Barbara M. Balik, EdD, MS, RN, Co-Founder, Aefina Partners, and Senior Faculty, IHI Julie Mann, CNM, MSN, Assistant Director of Midwifery, Project Manager of Quality Improvement on Labor and Delivery, Mount Auburn Hospital ​Burnout among health care professionals is quite real. At times the extent of reported stress and discontent​ seems so overwhelming, it's hard to know how to intervene in any meaningful way. Yet, many are trying.   IHI and improvement colleagues have been looking hard at the issues surrounding burnout in health care for the past three years. The result is an action-oriented framework and a new IHI White Paper, IHI Framework for Improving Joy in Work, to help leaders and managers more effectively engage with physicians, nurses, and staff in order to find out what gets in the way of joy in work — and to develop solutions together. We asse

​Date: September 15, 2017 Featuring: Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI) James B. Conway, MS, Current Board Chair of Quality of Care Committee, Lahey Health System; Trustee, Winchester Hospital; Former Senior Vice President, IHI; Former COO and EVP, Dana-Farber Cancer Institute Stephen E. Muething, MD, Co-Director, James M. Anderson Center; Professor of Pediatrics & Michael and Suzette Fisher Family Chair for Safety, Cincinnati Children's Hospital Medical Center 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, l

Date: August 24, 2017 Featuring: Michael Hanak, MD, FAAFP, Associate Chief Medical Informatics Officer, Ambulatory Care & Assistant Professor, Family Medicine, Rush University Medical Center Michelle Morse, MD, MPH, Founding Co-Director, Equal Health; Assistant Program Director, Brigham and Women's Internal Medicine Residency Program Abigail Ortiz, MSW, MPH, Director of Community Health Programs, Southern Jamaica Plain Health Center Amy Reid, MPH, Director, Institute for Healthcare Improvement (IHI) 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

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) Marsha Mauer, RN, MS, Chief Nursing Officer and Senior Vice President, BIDMC Christopher Casey, Director of Security Services, BIDMC Violence against medical staff is on the rise in the US. The circumstances, sources, and types of violent behavior vary — everything from verbal threats to deadly shootings. According to the Bureau of Labor Statistics, around 50% of all workplace assaults occur in health care settings and some studies​ put the number even higher. While most health care-related incidents occur in hospital emergency departments or on psychiatric wards, violent acts and threats can happen in any care setting and caregivers are increasingly concerned for their safety.    In response to this situation, The Joint Commission​, the American Hospital Association​, the American Nurses Association​, the American Medic

Date: July 13, 2017 Featuring: Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement (IHI) ​Kavita Bhavan, MD, MHS, Director of Infectious Diseases/OPAT Clinic, Parkland Center for High Impact Clinical Outcomes Studies, Associate Professor Internal Medicine, UT Southwestern Medical Center​ Alex Anderson, Research Associate, 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 a

Date: June 29, 2017 Featuring: Soma Stout, MD, MS, Vice President, Institute for Healthcare Improvement (IHI) Aimee Budnik, Director, Summit County Pathways HUB, Akron Summit Community Action, Inc. Kim Fairley, Care Management Supervisor, North Colorado Health Alliance Paul Howard, MPA, Director of Community Initiatives, 100 Million Healthier Lives, IHI Learning from failure is an important part of the quality improvement process in health care. Groups focused on improving the health of communities are equally discovering the value of "failing forward," as it's sometimes called — that is, leverage the learning from failure to accelerate progress — especially as many are going about the work in decidedly new ways. 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 par

Date: June 14, 2017 Featuring:  Christina Pagel, PhD, MSc, IHI Fellow and 2016-2017 Harkness Fellow in Health Care Policy and Practice (Commonwealth Fund) Jennifer Reed Beloff, RN, MSN, APN, Executive Director of Quality, Brigham and Women's Hospital Dorien Zwart, MD, PhD, 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

​​​​​​​​​​​​Date: June 1, 2017 Featuring:  Bob Wachter, MD, Chair, Department of Medicine at the University of California, San Francisco Tejal Gandhi, MD, Chief Clinical and Safety Officer, Institute for Healthcare Improvement Technology is everywhere in health care — and for many reasons, that's a good thing. It's fast, it's efficient, and it can reduce errors. And yet, technology is not a cure-all. It can make people complacent, introduce new errors, and get in the way of meaningful face-to-face interactions.   World-renowned patient safety experts Bob Wachter and Tejal Gandhi shared what they're learning about technology's impact (both positive and negative) on our industry. Wachter, the author of The Digital Doctor, discussed the computer's role in the exam room, the potential of electronic health records, the exciting world of wearables, and the patient and provider frustrations technology is causing. Gandhi, former president of the National Patient Safety Foundation and part of the expert panel tha

​Date: May 18, 2017 Featuring:  ​David M. Williams, PhD, Executive Director & Improvement Advisor, Institute for Healthcare Improvement Susan Hannah, Head of Improvement Programmes, Early Years Collaborative & Raising Attainment for All, Scottish Government At IHI, we do our best to keep our fingers on the pulse of the health care improvement world — what trends are emerging, what projects are happening, and what improvers need to do their work. And improvement tools clearly make a difference. In fact, in March of this year, in just one month, you downloaded IHI’s tools about 16,500 times. So, for this WIHI, we want to make sure you’re getting the most out of them, and when to use these tools in your improvement work. With guidance from improvement experts David Williams and Susan Hannah, we tackled those questions and more on the May 18 WIHI, Seven Popular Improvement Tools: How (and When) to Use Them. Wondering what improvement tools we focused on? ​PDSA Time Series Charts: Run Chart and Co

Date: May 3, 2017 Featuring: John E. McDonough, DrPH, MPA, Professor of Practice, Harvard TH Chan School of Public Health John B. Chessare, MD, MPH, President and CEO, GBMC Healthcare (Baltimore, Maryland) A lot of the quality and safety improvements that have taken place in recent years in the US — think reducing hospital-acquired infections, creating safety cultures, implementing team-based primary care — have occurred regardless of what was or wasn't happening in Washington, DC. While political debates raged on, somehow the health care quality improvement movem​​ent continued to move ahead. However, with the enactment of the Affordable Care Act in 2010, government became more of a force for change, expanding access to care and insurance, and steering health care toward better value and performance. To understand what continues to keep some health care leaders up at night, we turned to GBMC Healthcare President and CEO, John Chessare. A member of the IHI Leadership Alliance and a strong proponent of p

Date: April 20, 2017 Featuring:  ​Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement Lillian Banchero, MSN, RN, Senior Director, Patient Flow/Nursing Operations/Geriatrics, Anne Arundel Medical Center ​This spring, five health systems in the US are embarking on an initiative​ to discover how they can reliably deliver the best care to older adults. It’s not that they’re failing to provide high-quality care now — far from it. But even at exemplar institutions, best practices for older or elderly patients aren’t always top of mind, nor do practitioners always know how they might do things differently. Now, a small group of health systems is about to test some new, evidenced-based interventions that promise to model for the rest of the industry the types of changes needed. IHI has the fortunate role of guiding this initiative for the next few years, thanks to support from The John A. Hartford

Date: April 6, 2017 Featuring:  Kate DeBartolo, National Field Director, Institute for Healthcare Improvement (IHI) and The Conversation Project (TCP) Suzanne Salamon, MD, Associate Chief, Gerontology Division, Beth Israel Deaconess Medical Center Ravi B. Parikh, MD, MPP, Resident in Internal Medicine, Brigham and Women’s Hospital (Boston) Fiona McCaughan, RN, MS, Cambridge Health Alliance None of us likes to imagine being unable able to speak for ourselves when it comes to our health care. But situations arise throughout our lives when we need a trusted person to communicate with doctors and nurses on our behalf. And, if we are facing care decisions near the end of life, a trusted proxy can play a crucial role ensuring our wishes are respected. So, does everyone have a documented health care proxy? In all likelihood, no, or not yet, which is why there are numerous efforts underway to close this gap.   The Conversation Project, a five-year-old grassroots initiative based at IHI, has just published a

Date: March 23, 2017 Featuring: Jose Figueroa, MD, MPH, Instructor of Medicine, Harvard Medical School; Associate Physician, Brigham and Women’s Hospital David Labby, MD, PhD, Health Strategy Adviser, Health Share of Oregon Marian Bihrle Johnson, MPH, Director of Innovation, IHI There’s a lot of attention being paid to developing new models to care for and support patients with multiple, complex health problems. And, for good reason. It’s long been known that individuals with chronic, intertwined health and social issues make frequent use of expensive emergency departments or stay away from health care altogether until things get really bad. The motivation of providers to change this situation is strong. So is their desire to find out how others are addressing the problem, to avoid starting from scratch. That’s where a newly available online resource comes in called The Playbook: Better Care for People with Complex Needs. Spearheaded by five foundations and developed by IHI, this episode of WIHI orient

Date: March 9, 2017 Featuring: Frederick C. Ryckman, MD, Professor of Surgery, Senior Vice President, Medical Operations, Cincinnati Children’s Hospital Medical Center (CCHMC) Uma R. Kotagal, MBBS, MSc, Executive Lead, Community and Population Health, CCHMC Pat Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement Making sure patients get the right care, in the right place, at the right time couldn’t be a clearer set of aims. And yet achieving them isn’t so simple, especially at large health systems. It requires a number of underlyi​ng system improvements, including well-designed hospital flow. This has been a focus for health care for the past few decades, often prompted by bottlenecks and overcrowding in emergency departments (EDs). Things are getting better in some places, but there’s definitely a ways to go. IHI’s work on hospital flow dates back to the early 2000s. That’s when we and hospital teams started learning about the ways most hospitals scheduled their operating rooms,

Date: February 23, 2017 Featuring: Ninon Lewis, MS, Executive Director, Institute for Healthcare Improvement (IHI) Soma Stout, MD, MS, Executive External Lead for Health Improvement, IHI Greg Vandenberg, Director of Giving and Community Engagement, USVenture, Inc. Susan Hannah, Head of Improvement Programmes – Early Years Collaborative & Raising Attainment for All, Scottish Government Renee Boynton Jarrett, MD, ScD, Founding Director, Vital Village Community Engagement Network What do communities in Northeast Wisconsin, Scotland, and Boston have in common? More than you might think. Increasingly, they share a view of what it takes to build coalitions and collaborations that can change the trajectory of people’s lives and health… for the better. And in all three locations, the methods and tools of quality improvement (QI) to tackle socioeconomic issues ― not just health status ― are proving to be a game changer. Increasingly, we’re recognizing that health care needs to look beyond its walls to bet

Date: February 9, 2017 Featuring: Patricia E. Folcarelli, RN, MA, PhD, Interim Vice President, Health Care Quality, Beth Israel Deaconess Medical Center (BIDMC) Lauge Sokol-Hessner, MD, Attending Physician; Associate Director, Inpatient Quality, Silverman Institute, BIDMC Erica Dente, Patient Family Advisor, BIDMC Frank Federico, RPh, Vice President, Institute for Healthcare Improvement (IHI) Most of us know what it feels like to have an interaction with someone that can feel rushed, incomplete…maybe even abrupt or downright rude. When that’s the type of encounter patients have with health care providers and staff, it cannot only be upsetting but have other consequences: patients may lose confidence in those overseeing their care, withhold information, and generally withdraw from the treatment process. One major health system has decided it’s high time we track and label these situations for what they are: emotional harm. They shared with the WIHI audience what led them to become far more proactive ab

Date: January 26, 2017 Featuring: Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI) Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, IHI What are your plans to improve patient safety in 2017? Are they hospital-specific or do they extend across the continuum of care? Are they proactive or reactive? Is the work part of an overall system of safety, knitted together by an engaged staff, a thriving safety culture, and continuous learning? However you answer these questions, IHI is heading into the new year more determined than ever to help hospitals and health systems make greater gains in reducing harm to patients, anchored by a renewed focus and new framing.  ​ Who better to explain all this than IHI President and CEO, Derek Feeley, and IHI President Emeritus, Don Berwick. Derek was eager to talk about six principles that organizations can use to guide their safety work going forward. Among them: Shifting from a mindset of preventing things from going wrong to m

Date: January 12, 2017   Featuring: Donald Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement Elizabeth A. McGlynn, PhD, Vice President, Kaiser Permanente Research A little over 13 years ago, a team of researchers reported in the New England Journal of Medicine that adults in the US receive only about half the care that’s recommended to prevent, treat, and manage some 30 leading causes of illness and death. The study, by then RAND Corporation health care analyst and lead author Beth McGlynn, acted as a call to action, challenging providers to do much, much better at incorporating evidence-based practices.   Has the situation improved? Not nearly enough, according to a study first published online in 2016 in the Journal of the American Medical Association’s JAMA Internal Medicine. Why that's the case is the focus of the January 12 WIHI: Improving the Rate of Recommended Care. In the spirit of January, we looked back and looked ahead with Beth McGlynn and Don B

Date: December 15, 2016 Featuring: Rishi Manchanda, MD, MPH, Chief Medical Officer, The Wonderful Company; President & Founder, HealthBegins  WIHI is pleased to present a Special Edition Podcast, featuring Rishi Manchanda of HealthBegins, discussing why it’s important for health care to “move upstream” to address the social determinants contributing to many patients’ poor health today. Dr. Manchanda also argues that if frontline providers are asked to address upstream factors like poor housing or job insecurity, they need to have the resources and the knowledge and the active partnerships to draw from. Otherwise, they’re at risk for burnout and anything but joy in work. This is why Dr. Manchanda and some others suggest we consider expanding the IHI Triple Aim to the “Quadruple Aim” to include critically important job satisfaction. WIHI recorded Dr. Manchanda’s remarks on December 5, 2016, in Orlando, Florida, at the Scientific Symposium, held in conjunction with the Institute for Healthcare Improvem

Date: December 1, 2016 Featuring: Lindsay A. Martin, MSPH, Executive Director and Improvement Advisor, Institute for Healthcare Improvement (IHI) Alide Chase, MS, Senior Fellow, IHI Jeff Rakover, MPP, Research Associate, IHI The health care quality improvement movement in the US is in the midst of an important discussion and debate about reducing measurement burden and homing in on measures that really matter. Against a backdrop of hundreds of improvements that are being tracked and reported on by thousands of health systems in the US alone, guidance on which measures are most important to the pursuit of better care, better health, and lower cost couldn’t be more timely.   The Institute for Healthcare Improvement (IHI) has a longstanding interest in measures that health and health care leaders, including hospital trustees, can make sense of and track. Strong examples of this focus are two IHI White Papers: Whole System Measures(published in 2007) and A Guide to Measuring the Triple Aim (published in 201