WIHI - A Podcast from the Institute for Healthcare Improvement

Date: November 17, 2016 Featuring: Joanne Zee, BScPT,  MSc, MCPA, Senior Clinical Director, Brain and Spinal Cord Rehab Program, Toronto Rehab, University Health Network (Toronto, Canada) Brenda Kenefick, Director, Lean Process Improvement, University Health Network Gregg Meyer, MD, MSc, Chief Clinical Officer, Partners Healthcare System (Boston, MA) We’d like to think that robust safety cultures are so common in health care organizations today, everyone is comfortable pointing out missteps and discrepancies to their colleagues and even getting better at bringing them to the attention of their supervisors. Not so fast.   Consider this scenario: A patient is being discharged from the hospital and you, a staff person, notice that the discharge nurse has been called away from the bedside and left the patient’s chart on a table where anyone can view it. Here’s another one: You observe a doctor not washing her hands before entering a patient’s room. And, there’s this: You spot the same equipment, a monitor,

Date: November 3, 2016 Featuring: Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement Allan Frankel, MD, Principal, Safe and Reliable Healthcare Hundreds of hospitals in the US, Canada, Europe, and elsewhere have made significant progress reducing incidents of harm related to hospital-acquired infections, pressure ulcers, surgical errors, and more. At the end of September, when the Centers for Medicare & Medicaid Services (CMS) announced a new initiative to improve patient safety, it reported that the US hospitals that took part in its prior program saved some 87,000 lives. CMS now wants to build on those results. That’s all good news, but there's more work to be done.   Carol Haraden and Allan Frankel, who between them have worked with hundreds of hospitals on improving safety, point to a few factors as sources of concern: research in the US using Trigger Tool methodology, which suggests that overall rates of harm remain stubbornly high despite all the hard work; ongoing challe

Date: October 20, 2016   Featuring: Jennifer Wolff, PhD, Associate Professor of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health and Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine Meg Kabat, LCSW-C, CCM, National Director, Caregiver Support Program, US Department of Veterans Affairs Rebecca A. Stametz, DEd, MPH, Senior Director, Clinical Innovation, Geisinger Institute for Advanced Application Carol Levine, MA, Director, Families and Health Care Project, United Hospital Fund Christina Gunther-Murphy, MBA, Executive Director, IHI A lot has been said and written over the years about the important role family caregivers play on behalf of loved ones with various health conditions and disabilities. But acknowledgment of the estimated 42 million family caregivers in the US alone hasn’t always translated into needed support. All sorts of groups and agencies have done their best to help family caregivers navigate health care, locate resou

Date: October 6, 2016 Featuring: Martha Hayward, IHI Faculty and Patient Advisor Cody Mullen, Doctoral Candidate/Associate Instructor, Indiana University– Purdue University at Indianapolis Robert Doherty, Senior Vice President, Governmental Affairs and Public Policy, American College of Physicians ​Cheri C. Wilson, MA, MHC, CPHQ, Public Speaker and Trainer — Diversity and Inclusion, Cultural and Linguistic Competence, Health Equity Are patients and family members feeling more positive about the experiences they’re having in the US health care system? Are they feeling more connected to their care teams? With so much attention being paid to improving patient satisfaction scores, and with patient-centered care so central to just about every health care organization’s strategic goals and mission, you’d think the answer would be a resounding yes. But the picture is decidedly mixed, according to recent surveys and many champions of person- and family-centered care (PFCC). Research and anecdotal evidence sug

Date: September 22, 2016 Featuring: John D. Halamka, MD, MS, International Healthcare Innovation Professor at Harvard Medical School, Chief Information Officer, Beth Israel Deaconess Medical Center (BIDMC) Laurance Stuntz, Director, Massachusetts eHealth Institute ​Jill Duncan, RN, MS, MPH, Executive Director, Institute for Healthcare Improvement (IHI)  What do we want from electronic health records? Well, it all depends on who you ask. If you ask health care providers — doctors, nurses, and other practitioners — be prepared: they often have long lists of frustrations with the very tools that promised to make taking care of patients a lot more reliable, safe, and efficient. Patients often have a difficult time navigating new online portals, too. That's not to say EHRs haven't made many things better, and there's certainly no going back. But what about fixing those daily headaches and workarounds with EHRs we're now hearing so much about, and designing or redesigning the software so it better matches wha

Date: September 15, 2016 Featuring: Ronald Wyatt, MD, MHA, Patient Safety Officer and Medical Director, Office of Quality and Patient Safety, The Joint Commission Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement Anurag Gupta, MPhil, JD, Founder and CEO, Be More America Abigail Ortiz, MSW, MPH, Director of Community Health Programs, Southern Jamaica Plain Health Center Alex Anderson, Research Associate; Co-Chair, Diversity and Inclusion Council, IHI What might be possible if health care organizations across the US made a commitment to work to achieve health equity in their communities in dramatically new ways? This is something IHI, in collaboration with partners who've been wrestling with health inequities for years, have been looking into in search of fresh solutions. The results of this exploration are captured in a new IHI White Paper and make up the discussion featured on the September 15 WIHI: How Health Care Can Accelerate Health Equity.   So, how might

Date: July 28, 2016 Featuring: Marianne McPherson, PhD, MSPH, Director, 100 Million Healthier Lives Implementation Soma Stout, MD, MS, Executive Lead, 100 Million Healthier Lives Laura Brennan, MSW, Co-Chair, 100 Million Healthier Lives Leadership Team Drew Martin, MS, Leadership Team, 100 Million Healthier Lives Shanika L. Blanton, Ph.D., Director of Curriculum Development and Assessment, Ra-messut Academy of Higher Learning, Chicago Chapter The goal, when you first hear it, is daunting: We will help 100 million people live healthier lives by 2020. One hundred million. Not 1 million. Not 10 million. Not even 50 million. But 100 million. In a way, it sounds abstract, something someone hangs on a wall and then looks at for inspiration every once in a while.   But the goal (and the work to get there) is very concrete.   For nearly two years, the “unprecedented collaboration of change agents across sectors” convened by the Institute for Healthcare Improvement has been changing the world in meaningful way

Date: June 30, 2016 Featuring: Karen Baldoza, MSW, Executive Director, Institute for Healthcare Improvement (IHI) ​Christina Gunther-Murphy, MBA, Executive Director, IHI Julianna Spranger, University of Wisconsin Health Improvement Coach You have a great idea for an improvement project to reduce infection rates at your organization. You and your team have created a meaningful aim, crafted a useful set of measures, and brainstormed several creative change ideas to test in the coming months. There’s support from leadership, energy from staff, and excitement around every corner. You’re ready to go!   Except for one thing — now you need to successfully manage the project.   Managing a quality improvement project is a critical skill for anyone interested in making care — and systems — better where they work. But for many in health care, project management is not a full-time job. In fact, there’s a sizable gap between coming up with a great idea for a project and guiding a team to successful, meaningful impro

​Date: June 2, 2016   Featuring: Helen Bellanca, MD, MPH, Associate Medical Director, Health Share of Oregon Nancy Goler, MD, Regional Director for Early Start, Kaiser Permanente Northern California Daisy Goodman, CNM, DNP, MPH, Perinatal Addiction Treatment Program, Dartmouth Hitchcock Medical Center Marian Bihrle Johnson, MPH, Director of Innovation, Institute for Healthcare Improvement (IHI) Jeffrey Rakover, MPP, Research Associate for Innovation, IHI Addiction is always a complex challenge, but when a woman using substances is pregnant, suddenly two lives are at stake. Despite the difficulty of the situation, people in a position to help can increase the odds of a healthy pregnancy and good birth outcome. That’s the underlying principle behind numerous efforts in the US to reach out to pregnant women with drug dependency and to integrate treatment for addiction with perinatal care. Such models are getting more attention because of the current opioid crisis and an alarming rise in neonatal abstinen

​Date: May 26, 2016 Featuring:   Don A. Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement David M. Williams, PhD, Executive Director, Institute for Healthcare Improvement Last month, researchers at Johns Hopkins called upon the US Centers for Disease Control and Prevention (the CDC) to rethink how it classifies the country’s “leading causes of death.” The authors argue that deadly medical errors, conservatively estimated at over 250,000 annually, should be included in the rankings — which would make medical errors the third leading cause of death in the US, just after heart disease and cancer. It’s a provocative idea AND it raises the question: What difference would this make? Would it accelerate efforts to reduce preventable patient deaths? Would it make the problem more prominent and more intolerable, adding urgency to research and public policy? IHI's Chief Scientific and Medical Officer Don Goldmann joined us on this WIHI to take a look at the current state of

Date: May 5, 2016 Featuring: Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI) Stephen Swensen, MD, MMM, FACR, Medical Director for Leadership and Organization Development, Mayo Clinic Kathy Kerscher, Team Leader of Operations Primary Care, Bellin Health Joanna D’Aflitti, MD, MPH, Associate Medical Director for Primary Care Quality and Innovation, Boston Medical Center When we hear about physician and staff burnout these days, a lot of attention focuses on the pressures health care is under to deliver much, much better care, much more cost effectively. These pressures and expectations are impacting hospital systems, already busy office practices, and, very importantly, individual practitioners themselves who often feel they’re being asked to do more without the necessary resources. What can make the difference between having the tools and the support to manage new realities vs. being overwhelmed and drained? Plenty —​ and that’s why we hope you’ll listen to this WIHI.   Our pa

Date: April 21, 2016 Featuring: Joseph Foster, JD, New Hampshire Attorney General, New Hampshire Department of Justice Joel Hyatt, MD, FAAFP, Emeritus Assistant Regional Medical Director, Kaiser Permanente, Southern California Lindsay Martin, MSPH, Executive Director and Improvement Advisor, Institute for Healthcare Improvement (IHI) Mara Laderman, MSPH, Senior Research Associate, IHI The US is in the midst of a serious opioid addiction epidemic. Driven largely by an explosion of prescribed pain medications, the dramatic rise in addiction and deaths from overdoses (quadruple what they were in 1999, according to the Centers for Disease Control and Prevention) now has the attention of just about every sector of society that can play a role in addressing the problem. This includes innovative approaches coming from law enforcement, local, state, and federal health departments, drug treatment programs, community groups, and health care delivery.   While providers who write prescriptions for painkillers such

Date: April 7, 2016 Featuring: Saranya Loehrer, MD, MPH, Executive Director, North America Strategy and Operations, Institute for Healthcare Improvement (IHI) Helen Macfie, PharmD, FABC, Chief Transformation Officer, Certified Lean Leader, MemorialCare Health System Carolyn Candiello, Vice President, Quality and Patient Safety, GBMC HealthCare, Inc. Cate O’Connor-Devlin, RN, BSN, Administrative Director of Patient Throughput/Nurse Safety, GBMC Healthcare, Inc. Rhonda Holden, MSN, CENP, Chief Nursing Officer/Administrator Patient Care Services, Kittitas Valley Healthcare, Ellensburg, WA Cheryl Woodman, ND, MHSc, CHE Chief Strategy Officer, Women’s College Hospital (Toronto, Canada) It started from a very human place. Hospital staff found a way for a new mom recovering in the ICU, and her infant in the NICU, to visit with one another in the aftermath of a difficult birth. When the mom and dad were asked later on about their hospital experience, they singled out this breaking (or bending) of the rules t

Date: March 24, 2016 Featuring: Maren Batalden, MD, MPH, Associate Chief Quality Officer and Associate Director of Graduate Medical Education for Quality and Safety, Cambridge Health Alliance Kathy Sabadosa, MPH, Senior Research Director, Dartmouth Institute for Health Policy and Clinical Practice Sarah Myers, MPH, RN, Executive Improvement Director, ImproveCareNow, Cincinnati Children’s Hospital Medical Center Julie Bass, DO, Medical Director, Pediatric Inflammatory Bowel Disease Program, Children’s Mercy Hospital (Kansas City, MO) Jamie Hicks, RN, Lead Parent of Patient & Family Advisory Council, Children’s Mercy Hospital IBD Program Christina Gunther-Murphy, Executive Director, Institute for Healthcare Improvement (IHI) When we say patients and clinicians should be “co-producing health and health care,” do we really mean it? Dr. Maren Batalden from the Cambridge Health Alliance certainly hopes so. In fact, in her recent article on the subject, she and her co-authors assert that a form of co-pr

Date: March 10, 2016 Featuring: Mark Jarrett, MD, MBA, MS, Chief Quality Offer and Senior Vice President, Northwell Health Fran Ganz-Lord, MD, FACP, Director of Ambulatory Quality & Medical Director, Northwell Health Premium IPA Network and Northwell ACO Ann Lewis, CEO, CareSouth Carolina Tejal Gandhi, MD, MPH, CPPS, President and CEO, National Patient Safety Foundation, Lucian Leape Institute, Certification Board for Professionals in Patient Safety Jennifer Lenoci-Edwards, RN, MPH, CPPS, Director, Patient Safety, IHI What comes to mind when you think about patient safety in the ambulatory setting? Infection rates? Probably not. The issues are of course quite different in outpatient care, and that's one reason it's not always obvious to practitioners and staff which of their many daily activities might inadvertently contribute to patient harm. Activities such as failing to follow up on patient referrals, or to communicate test results. Or getting frustrated with the EHR and creating workarounds.  

Date: February 25, 2016   Feauturing: Leonard D’Avolio, PhD, Assistant Professor, Brigham and Women’s Division of General Internal Medicine and Primary Care; CEO and Co-founder, Cyft Kedar Mate, MD, Senior Vice President, Institute for Healthcare Improvement If you’re going to measure, as we know health care improvers must do, you’re going to generate data. But in a world where there increasingly seems no end to what can be tracked and quantified and analyzed, there’s a real danger of creating a lot more data than you truly need. It’s great to have the data, and electronic health records are making it easier to obtain and store tons of information, but now what? How can it be put to good use? Will it make patients safer and healthier? Will it help determine where the gaps are? Reduce visits to the ED? Increase visits to primary care? If you’re starting to wonder what you’re doing with all your data, you might want to listen to this WIHI.    Our guide for this discussion is someone who’s been doing a lot o

Date: February 18, 2016 Featuring:  Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement Jessica Berwick, MD, MPH, Internist, Beth Israel Deaconess Medical  Center (Boston) What is the “true north” for the health care quality improvement movement? What are the questions leaders and champions of quality and safety initiatives must periodically ask themselves as a natural part of the process of seeking dramatic change? If you’re IHI’s founder and President Emeritus and Senior Fellow, Don Berwick, the questions, and the answers, are often moral ones. Don is known for reminding improvers at critical moments that whatever they’re working hard on must, finally, come back to the patients themselves and principles of service and healing relationships. When the vision starts to go blurry in a miasma of metrics and measures and monitoring, Don argues, we lose our way. In December, Don took to the podium at IHI’s National Forum in Orlando and delivered a keyn

Date: January 28, 2016 Featuring:   Victor Montori, MD, Professor of Medicine, Mayo Clinic; Director, Late Stage Translational Research, Mayo Center for Clinical and Translational Science Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement (IHI) Kasey Boehmer, MPH, Health Services Researcher, Knowledge and Evaluation Research (KER) Unit, Mayo Clinic Dave Paul, Secretary, KER Unit Patient Research Advisory Group, Mayo Clinic   If you work in primary care today, odds are good that you’re seeing patients with multiple chronic conditions. Individuals with combinations of diabetes, high blood pressure, arthritis, and depression are rapidly becoming the norm in outpatient offices and clinics. And even if a provider and patient work together to choose the right medications and agree on making some lifestyle changes that will improve health, the best-laid plans often fall apart. Labeling patients “noncompliant” has been a tempting response but, many argue, is pejorative and tends to

Date: January 14, 2016 Featuring: Beth Hennessey, RN, MSN, Executive Director of Integrated Care Management, Sutter Center for Integrated Care Paula Suter, RN, MA, Director of Clinical Care, Sutter Center for Integrated Care Geraldine Marsh, Improvement Advisor for Older People’s Care, NHS Greater Glasgow and Clyde Healthcare Improvement Scotland Jennifer Rodgers, Chief Nurse, Pediatrics and Neonates, NHS Greater Glasgow and Clyde Healthcare Improvement Scotland Christina Gunther-Murphy, Executive Director, Institute for Healthcare Improvement (IHI) A few years ago, IHI and others began suggesting to providers that instead of routinely asking patients “What’s the matter with you?” they should begin asking “What matters to you?” Ever since, many have been struck by the richness and the value of what they learn when they ask this apparently simple question. So much so, champions of this concept in the improvement community are now working hard to spread the practice. And they’re demonstrating how to rel

Date: December 17, 2015 Featuring: Neil Baker, MD, Neil Baker Consulting and Coaching LLC; Faculty, Institute for Healthcare Improvement (IHI) WIHI is pleased to present a Special Edition Podcast, featuring Neil Baker. WIHI recorded Dr. Baker’s remarks on December 8, 2015, in Orlando, Florida, at the Institute for Healthcare Improvement’s 27th Annual National Forum on Quality Improvement in Health Care.   The broadcast is 1:12 long; we recommend that you have the presentation slides, along with the other materials listed below, handy for reference as you’re listening. During his Forum session, Dr. Baker orchestrated four one-minute table conversations among attendees; you might consider engaging co-workers in similar table conversations while listening, using the handouts for guidance. All the elements, including the audio, are posted below.    Neil Baker works with health care organizations to enhance leadership and team impact. His signature contribution to this field is his adept way of using any work