WIHI - A Podcast from the Institute for Healthcare Improvement

Date: December 1, 2015 Featuring: Mark Graber, MD, FACP, President, Society to Improve Diagnosis In Medicine; Senior Fellow, RTI International Thomas Gallagher, MD, FACP, Professor and Associate Chair, Department of Medicine; Director, Hospital Medicine and Center for Scholarship in Patient Care Quality and Safety, University of Washington Kedar Mate, MD, Senior Vice President, Institute for Healthcare Improvement (IHI) Jennifer Lenoci-Edwards, RN, MPH, CPPS, Director, Patient Safety, IHI In September 2015, the Institute of Medicine issued a landmark report on diagnostic errors in the US, and the news wasn’t good: one in 20 adults suffers a diagnostic error every year. The report offers a two-part definition of diagnostic error: “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” And it shines a light on the multiple factors that cause diagnostic errors – ranging from cognitive failures on the part of d

Date: November 19, 2015 Featuring: Kate Lally, MD, FACP, Director of Palliative Care, Care New England; Hospice Medical Director, VNA of Care New England; Clinical Assistant Professor of Medicine, Alpert Medical School of Brown University Harriet Warshaw, Executive Director, The Conversation Project Holly Oh, MD, Chief Medical Officer, The Dimock Center Jocelyn Moore, Managing Director, The Glover Park Group On October 30, the US Centers for Medicare & Medicaid Services (CMS) announced that, starting January 1, CMS will reimburse physicians and other practitioners for talking with any Medicare recipient about their health care preferences at the end of life – also known as advance care planning. Caught up in a political maelstrom several years ago, CMS has now caught up with a growing desire of patients and loved ones to express, and have health care respect, their wishes. Talking with a trusted provider, before one is faced with a terminal illness, can be an important part of the process. The goo

Date: November 12, 2015 Featuring: Bruce Spurlock, MD, President and CEO, Cynosure Health Solutions Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement (IHI) Kedar Mate, MD, Senior Vice President, IHI Jane Brock, MD, MSPH, Medical Director, Telligen; Clinical Director, Quality Innovation Network - Quality Improvement Organizations National Coordinating Center One of the hallmarks of the health care improvement movement has been the way in which diverse organizations and teams come together to gain the knowledge, skills, and confidence needed to implement change. The most celebrated of these models over the past few decades has been the “collaborative” – as simple a concept as it is radical. Simple because it’s essentially a gathering of health care practitioners and leaders willing to move beyond their own walls in order to learn with and from others facing similar patient care challenges, in pursuit of the shared goal of accelerating improvement. Radical because to take thi

Date: October 29, 2015 Featuring: Kimberlydawn Wisdom, MD, MS, Senior Vice President of Community Health & Equity and Chief Wellness and Diversity Officer, Henry Ford Health System John Whittington, MD, Lead Faculty, IHI Triple Aim; Senior Fellow, Institute for Healthcare Improvement Sandra Bailey, Vice President for Care Transitions, Methodist Le Bonheur Healthcare Joy Sharp, Manager, Community Navigators, Methodist Le Bonheur Healthcare Mara Laderman, MSPH, Senior Research Associate, IHI Health and health care improvement communities in the US are focusing on equity and racial disparities in some important new ways. Frustrated by the slow progress of closing gaps (despite decades of research and documentation of the problems), many are forging ahead to create more equitable access to care and better outcomes wherever and whenever they can. The new learning is coming from the “doing,” often making use of existing data that already tell a powerful story of persistent inequities (e.g., in cancer di

Date: October 15, 2015 Featuring: Durrell J. Fox, BS, Community Health Worker & Health Equity, Public Health Consultant Kevin Barnett, DrPH, MCP, Senior Investigator, Public Health Institute Shreya Kangovi, MD, MS, Founding Executive Director, Penn Center for Community Health Workers; Assistant Professor of Medicine, University of Pennsylvania Heidi Behforouz, MD, Founding Executive Director, AnansiHealth; Associate Professor of Medicine, Harvard Medical School Of all the people who can make a difference in the lives of patients these days, one group that’s rising in importance is community health workers, or CHWs. CHWs are increasingly being utilized by community health centers, office practices, and hospitals to bridge gaps for patients between health care, home, and the community. Since many CHWs come from the same neighborhoods as the patients themselves, there’s a lot of mutual trust right off the bat. This is true whether a CHW is helping a patient manage a chronic illness, develop healthier

Date: October 1, 2015 ​ Featuring:  ​Shannon Brownlee, MS, Senior Vice President, Lown Institute; Visiting Scientist, Harvard T.H. Chan School of Public Health Jim Conway, MS, Adjunct Faculty, Harvard T.H. Chan School of Public Health; Member, IOM Committee on Optimizing Scheduling in Health Care Kedar Mate, MD, Senior Vice President, IHI Aaron Stupple, MD, Hospitalist, Department of Medicine, Beth Israel Deaconess Medical Center   There’s growing awareness of the need to curb health care’s overuse of interventions that lack a strong evidence base, unnecessarily subject patients to potential harm, and are more expensive than equally effective, cheaper alternatives. Initiatives like Choosing Wisely and Costs of Care have done a great job sounding the proverbial alarm about particular treatments and procedures doctors have grown too accustomed to prescribing automatically; antibiotics, certain screenings, and imaging tests often top the list. Costs of Care has put the spotlight on the financial harm of

​Date: ​September 17, 2015 Featuring: James Moses, MD, MPH, Medical Director of Quality Improvement (QI), Boston Medical Center; Academic Advisor, IHI Open School Justin Slade, Fourth Year Medical Student, Boston University School of Medicine; Senior Student Advisor, Former President, IHI Open School Chapter Jessica Perlo, MPH, Senior Community Manager, IHI Open School Rebekah Bally, MPH, CPH, Former Learning Coordinator, PSU and OHSU IHI Open School Chapter When you imagine the legions of quality improvers around the globe working hard to transform health and health care, does your picture include students? If it doesn’t, it definitely should.   Right now, thanks to the IHI Open School and other initiatives, there are thousands of students in the health professions – and health professionals themselves – actively engaged in gaining the knowledge and skills to improve health and health care delivery and to build bridges between the classroom and the community. And, what’s important to underscore is th

Date: July 23, 2015   Featuring:  L. Nneka Mobisson-Etuk, MD, MBA, MPH, Executive Director of African Operations, Institute for Healthcare Improvement Sodzi Sodzi-Tettey, MD, MPH, Director, Project Fives Alive!, Senior Technical Director, Africa Region, IHI Pierre Barker, MD, Senior Vice President, Institute for Healthcare Improvement Nana A.Y. Twum-Danso, MD, MPH, Founder & CEO, MAZA; Former Senior Program Manager, Gates Foundation; Former Director, Project Fives Alive! Kavita Singh Ongechi, PhD, Research Assistant Professor, Gillings School of Public Health, University of North Carolina at Chapel Hill   One of the biggest ongoing challenges facing health and health care quality improvers is moving from small-scale successes to large-scale ones. This turns out to be far more complicated than originally thought, no matter what aspect of improvement you’re working on. That’s why it’s incredibly inspiring to learn from initiatives that are cracking the code — moving beyond barriers one deliberate st

Date: July 9, 2015   Featuring:  Sanjeev Arora, MD, FACP, FACG, Director, Project ECHO (Extension for Community Healthcare Outcomes), Department of Internal Medicine, UNM School of Medicine Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement There’s telemedicine, and then there’s Project ECHO. Founder and director, Dr. Sanjeev Arora, makes the distinction so we don’t miss what’s groundbreaking about Project ECHO’s approach. While telemedicine focuses on bridging geographic divides that can separate patients from needed specialists, Project ECHO is on a mission to bridge divides within the provider community itself that prevent medical expertise from being shared and distributed more widely.   With Project ECHO, primary care doctors and others working in underserved, isolated, or small community settings use videoconferencing to advance their skills and ability to handle complex cases because of what they learn from specialists some distance away. T

Date: June 25, 2015 Featuring: John Whittington, MD, Lead Faculty, IHI Triple Aim; Senior Fellow, IHI Trissa Torres, MD, MSPH, FACPM, Senior Vice President, IHI Kevin Nolan, MA, Associates in Process Improvement; Senior Fellow, IHI Ninon Lewis, MS, Executive Director, Triple Aim for Populations, IHI It’s never been easy to define an overall strategy for the transformation of US health care. And that may explain why the Triple Aim has been so resonant with so many. In part it’s the simplicity of a three-part framework to achieve better care, better health, at lower per capita costs. It’s also the goals themselves. The idea of simultaneously improving the care of individual patients, improving the health of larger populations, and bringing health care costs down, first conceived by the Institute for Healthcare Improvement (IHI) in 2008, now defines the pursuits of health care systems and communities in many parts of the world, but especially here in the US.   Fast forward to June 2015 and Milbank Quarter

Date: June 11, 2015 Featuring:  Gilbert Salinas, MPA, Chief Clinical Officer, Rancho Los Amigos National Rehabilitation Center Christopher Duff, MDiv, Executive Director, Disability Practice and Policy Consultant Regina Estela, MPA, Chief Operating Officer, Independence Care System Rachael Stacom, MS, AnP-BC, MSCN, Senior Vice President, Care Management, Independence Care System Rebecca Bills, MSW, LICSW, Clinical Manager, Medica Health Plan A lot of progress has been made the past several decades for people with disabilities. But, there are still barriers and biases that prevent disabled individuals from leading full lives and fully accessing health care. For those with physical disabilities, once you get beyond basic accommodations such as parking spots, ramps, and wide corridors, myriad processes at hospitals and office practices don’t always factor in how someone, say confined to a wheelchair, may need to navigate much of it differently — with more time allotted to see a provider, access to multi

Date: May 21, 2015 Featuring: Leonard L. Berry, PhD, University Distinguished Professor of Marketing, Mays Business School, Texas A&M; IHI Senior Fellow Pat Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement Jeffrey Landercasper, MD, FACS, Gundersen Health System Robert Anthony Chapman, MD, Senior Staff Physician, Medical Oncology, Henry Ford Hospital When someone is first diagnosed with cancer, those first few days and weeks can be terribly disorienting. Even when health care professionals and staff try to provide clear information about next steps, the person who’s supposed to be taking everything in may be severely distracted. This can be true no matter what type of cancer; but when the news is especially frightening, we can all appreciate why, for some patients, nothing computes. Are there particular ways the health care system can behave, best practices that can be deployed, to ease this initial, hard part of the cancer journey? Yes, say a growing number of cancer treatment p

Date: May 7, 2015 Featuring: Chris DeMars, MPH, Director, Systems Innovation, Oregon Health Authority- Transformation Center Ronald Stock, MD, MA, Director of Clinical Innovation, Oregon Health Authority-Transformation Center Trissa Torres, MD, MSPH, FACPM, Senior Vice President, IHI Far from the epicenter of Washington, DC, and the federal government’s efforts to expand health insurance coverage and usher in health care delivery and payment reform, states are moving ahead with amazing innovations of their own these days. Medicaid waivers, which offer states running room to experiment with public dollars, are one big reason. And one big example of what’s possible is unfolding in Oregon. No stranger to trail-blazing with transformative ideas and initiatives, Oregon’s latest efforts to provide better care and value to nearly one million Medicaid recipients the focus of this WIHI. The groundwork and the enabling policies and legislation for Coordinated Care Organizations (CCOs) have been several years in

Date: April 23, 2015 Featuring: Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement Steven J. Spear, PhD, MS, Senior Lecturer, MIT Sloan School of Management; Senior Fellow, IHI Alexia Green, PhD, RN, FAAN, Professor and Dean Emerita, Texas Tech University Health Sciences Center Roger Resar, MD, The Mayo Clinic Health System; Senior Fellow, IHI As health care quality improvement has matured, it’s common to hear the phrase, “Quality is everyone’s responsibility.” But what does that mean more precisely, and how does the concept apply day-to-day? How feasible is it for those on the front lines of delivering care to not just detect defects in systems and processes, but also solve many of them, right then and there? It turns out this is quite doable, especially if frontline staff and providers are empowered to do far more than patch up problems AND if they can count on operational guidance and leadership from others, including middle managers. The goal is first and foremost to r

Date: April 9, 2015 Featuring: Dale Gerding, MD, Professor of Medicine, Loyola University Chicago Stritch School of Medicine; Research Physician, Edward Hines Jr. VA Hospital Jason Leitch, PhD, MPH, National Clinical Director, Healthcare Quality, Scottish Government Alan Whippy, MD, Medical Director of Quality and Patient Safety, Permanente Medical Group, Northern California Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement What was your reaction when you heard the news that Clostridium difficile (C. diff) infected far more people in 2011 than first reported by the US Centers for Disease Control and Prevention (CDC)? Writing in the New England Journal of Medicine at the end of February, the CDC updated its own prior calculations to report that the burden of infection in 2011 was 80% higher than previously stated. In total an estimated 453,000 people were afflicted with C. diff in 2011; C. diff was a factor in some 29,000 deaths.   Our reaction here was,

Date: March 26, 2015 Featuring:   David Munch, MD, Senior Vice President and Chief Clinical Officer, Healthcare Performance Partners Stephanie Calcasola, MSN, RN-BC, Director of Quality and Medical Management, Baystate Medical Center Kedar Mate, MD, Senior Vice President, Institute for Healthcare Improvement (IHI) No one’s capabilities and talent should be wasted when it comes to improving health and health care for those we serve. We know you agree. Health care leaders have an incredibly important role to play in driving improvement initiatives in their organizations. So do people on the frontlines of care. What we aren’t as articulate about is the role that middle managers play. You know, the people with the job titles of House Supervisor or Shift Supervisor or Team Lead or Manager of the PACU (Post Anesthesia Care Unit). A growing number of experts say we can’t afford to ignore how people in these jobs are essential to improvement, too.    WIHI host Madge Kaplan is joined by one of those experts, Dr.

Date: March 12, 2015 Featuring: Mark P. Jarrett, MD, MBA, Chief Quality Officer, Sr. Vice President & Associate Chief Medical Officer, North Shore-LIJ Health System Susan Browning, MPH, FACHE, Vice President, Neurosciences, Head & Neck Surgery/ENT and Ophthalmology, North Shore-LIJ Health System Katharine Luther, RN, MPM, Vice President, Institute for Healthcare Improvement Mark Hiller, MBA, Vice President for Innovative Solutions & Leader, Premier Bundled Payment Collaborative, Premier Alice Ehresman, RN, Healthcare Quality Specialist, Baystate Health   Are your care teams ready for value-based payments? Does everyone understand the relationship between better patient care and potential savings? Are there some new skill sets and mindsets required of doctors and nurses and support staff that need to be called out and called for, rather than just taking everyone’s buy-in and readiness for granted?   There is more than a few questions to answer, and there’s no question that public and private

​Date: February 26, 2015 Featuring: Adebisi Alli, DO, MS, Chief Resident in Quality & Patient Safety, Department of Internal Medicine, Banner-University Medical Center, Phoenix VA Healthcare System Gareth Parry, MSc, PhD, Senior Scientist, Institute for Healthcare Improvement (IHI) Lori Rutman, MD, MPH, Attending Physician, Division of Pediatric Emergency Medicine, Seattle Children’s Hospital Angela Statile, MD, MEd, Attending Physician, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center Thirty-two abstracts and 56 posterboards were shared at IHI’s 20th Annual Scientific Symposium this past December. At the end of the day, the audience voted three of these as the best for clarity of presentation and strength of research. We gathered the leaders of the teams behind the winning presentations to talk about their work on this WIHI. IHI’s Senior Scientist Gareth Parry, who runs the Scientific Symposium, kicked off our discussion with some framing about the state of health and

Date: February 12, 2015 Featuring: Donald M. Berwick, MD, MPP, FRCP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement David Cutler, PhD, Otto Eckstein Professor of Applied Economics, Harvard University, Harvard Kennedy School of Government, Harvard School of Public Health There are lots of health care issues to speculate about in the coming year. Here in the US, the ongoing expansion of health insurance coverage is an ambitious work in progress that continues to face plenty of political and legal headwinds. And then there’s the still glaring and still growing $3 trillion national price tag of US health care. Some are encouraged that health spending is slowing, but do we have any strong evidence that improvements in the quality of care, safety, and IT, coupled with payment reforms that increasingly tie reimbursements to quality and value, are key factors? Fortunately, our guests on this WIHI, Don Berwick and David Cutler, bring important improvement, policy, and economic per

Date: January 29, 2015 Featuring: Catherine Craig, MPA, MSW, Independent Consultant; Faculty, Better Health and Lower Costs for Patients with Complex Needs, IHI Matt Stiefel, MPA, MS, Senior Director, Center for Population Health Care Management Institute, Kaiser Permanente Eleni Carr, MBA, MSW, Senior Director of Care Integration, Cambridge Health Alliance Kathy Weiner, MHSA, Regional Executive Director, Medicare, Kaiser Permanente  A relatively small percentage of the US population accounts for the largest share of health care costs. Everyone knows who we're talking about, right? Well, not exactly. Broad assumptions (e.g., high utilizers of the emergency department) and sweeping generalizations often substitute for more robust inquiries and analysis designed to better pinpoint a hospital or clinic's patients with unmanaged, complex health problems. And, without this specificity, it's hard to know who will benefit most from additional supports and interventions. This is among the reasons why an IHI C