WIHI - A Podcast from the Institute for Healthcare Improvement

​Date: January 15, 2015 Featuring: Jean Abbott, MD, MH, The Conversation Project, Boulder County; Faculty, Center for Bioethics and Humanity and Professor Emerita, Emergency Medicine, University of Colorado Diana Silvey, MA, Program Director, Winter Park Health Foundation Kimberlie Flowers, MSW, LICSW, Senior Outreach Social Worker, Elder Services of the Merrimack Valley (Northeastern Massachusetts) Kate DeBartolo, National Field Manager, The Conversation Project, Institute for Healthcare Improvement It doesn't necessarily “take a village” to have a conversation with loved ones about wishes for end-of-life care. But it can help to have others in the community to turn to for ideas, resources, and support – especially if the “kitchen table” conversation with important people in one’s life isn’t happening so readily. Sometimes it’s easier to start this conversation with peers who get together once a week at the community center. Or with a rabbi or minister. Or, initially, with perfect strangers who’ve star

Date: December 16, 2014 Featuring: Robert Wachter, MD, Professor and Associate Chair, Department of Medicine, University of California, San Francisco WIHI is pleased to present a special edition podcast, featuring renowned hospitalist and health care safety expert, Dr. Robert Wachter. WIHI recorded Dr. Wachter’s remarks on December 10, 2014, in Orlando, Florida, at the Institute for Healthcare Improvement’s 26th Annual National Forum on Quality Improvement in Health Care.   Robert Wachter is Professor and Associate Chair of the Department of Medicine at the University of California at San Francisco, where he directs the 60-physician Division of Hospital Medicine. He’s the author of 250 articles and six books, coined the term “hospitalist” in 1996, and is generally considered the “father” of the hospitalist field, the fastest-growing specialty in the history of modern medicine. In 2004 Dr. Wachter received the John M. Eisenberg Award, the nation's top honor in patient safety. He is currently completing a b

Date: ​December 4, 2014 Featuring: Ed Wagner, MD, MPH, Director Emeritus, MacColl Center for Health Care Innovation; Senior Investigator, Group Health Research Institute Robin Henderson, PsyD, Chief Behavioral Health Officer and Vice President, Strategic Integration, St. Charles Health System (Bend, Oregon) Parinda Khatri, PhD, Chief Clinical Officer, Cherokee Health Systems (Knoxville, Tennessee) Mara Laderman, MSPH, Senior Research Associate, IHI Primary care practices across the US are facing a number of important challenges right now; prominent among them is doing a much better job at recognizing and helping patients with behavioral health issues. The operative term for this is “integration” — a notion that ranges from, at minimum, co-locating behavioral health services and counselors in primary care settings; to, at best, everyone on staff having greater training and skills to detect and address the mental health and behavioral challenges that may be impacting a patient’s health. And, together as

Date: ​November 20, 2014 Featuring: Soma Stout, MD, MS, Executive External Lead for Health Improvement, Institute for Healthcare Improvement (IHI) Erin Healy, JD, Director, Knowledge Sharing, Community Solutions Kevin Barnett, DrPH, MCP, Senior Investigator, Public Health Institute Ninon Lewis, MS, Director, Triple Aim for Populations, IHI When IHI first introduced the framework of the Triple Aim in 2008, we couldn’t have imagined how much it would resonate with health and health care improvers all over the world. Six years and much on the ground experience later, this pursuit of better experience of care, better health, and lower costs, is taking a new, exciting turn. The Guiding Coalition was launched this October by IHI and some 30 founding partners with the goal of making a demonstrable improvement in the health of communities on a global scale…starting in the US. One of the driving principles behind the effort — which over 200 individuals and organizations from across public health, community he

Date: November 6, 2014 Featuring: David Classen, MD, CMIO, Pascal Metrics; Associate Professor of Medicine and Consultant in Infectious Diseases, University of Utah School of Medicine Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement Ann Bisantz, PhD, Professor and Chair, Industrial and Systems Engineering, University at Buffalo, The State University of New York As the implementation of electronic health records (EHR) increases across healthcare, so has awareness of new patient safety risks that the technology has either introduced or exposed.  The very same EHR being counted on to improve communication, safety, and continuity of care across multiple settings and providers turns out to have features that can have the opposite effect. Getting a good handle on where the vulnerabilities lie is the first step toward coming up with solutions. Some of the most prominent concerns include EHR systems that generate so many online warnings that clinicians and staff

Date: October 23, 2014   Featuring: Robert S. Kaplan, MS, PhD, Senior Fellow and Marvin Bower Professor of Leadership Development, Emeritus, Harvard Business School Katharine Luther, RN, MPM, Vice President, Institute for Healthcare Improvement Catherine Abbott, MSN, RN, Administrator, Performance Improvement, Hackensack University Medical Center Jenny Rosengrant, RN, BSN, Orthopedic Nurse Navigator, Moses Taylor Hospital Hips and knees are replaced in record numbers these days and these frequent procedures have comparatively low rates of harm and complications, bringing new scrutiny of performance and opportunities for improvement. Public and private payers have begun targeting joint replacement for bundled payments and reimbursement tied to the quality of care, looking to include patient-reported outcomes. Health care providers who perform a lot of joint replacements have already been preparing to meet these new challenges. They’ve realized that there are multiple ways to improve the care experience

Date: ​October 9, 2014 Featuring: Kelly McCutcheon Adams, LICSW, Director, Institute for Healthcare Improvement Anna Roth, RN, MS, MPH, CEO, Contra Costa Regional Medical Center & Health Centers Teresa Pasquini, Mom/Advocate, Chair, Behavioral Healthcare Partnership, Contra Costa Regional Medical Center and Health Centers James F. O’Dea, PhD, MBA, Regional Director, Hartford Healthcare Behavioral Health Network Richard Wohl, MSW, MBA, President, Princeton House Behavioral Health; Senior Vice President, Princeton Healthcare System With all the discussion going on about the integration of behavioral health with primary care in the outpatient setting, we don’t want to ignore what’s happening in the hospital for patients with psychiatric conditions and needs. Safety has been one of the major issues identified in recent years… safety for individuals in crisis, for the staff caring for them, and for family members. Those who’ve identified effective improvements are often the patients themselves. We ven

Date: September 24, 2014 Featuring: Kevin B. Weiss, MD, MPH, Senior Vice President, Institutional Accreditation, Accreditation Council for Graduate Medical Education (ACGME) Robin Wagner, RN, MHSA, Vice President, Clinical Learning Environment Review, ACGME Maren Batalden, MD, Medical Director of Hospital Quality, Associate Director of Graduate Medical Education for Quality and Safety, Cambridge Health Alliance (CHA) James Moses, MD, MPH, Medical Director of Quality Improvement, Boston Medical Center; Academic Advisor, IHI Open School for Health Professions Whether or not you are directly involved in graduate medical education (GME), its priorities have implications for all of health care. A new Institute of Medicine (IOM) report released over the summer has reignited debate and discussion about the financing and goals of GME in the US. Given that Medicare is the primary funder, to the tune of $15 billion per year, the report’s authors call for greater accountability for all the government support, a

Date: September 11, 2014 Featuring: Kevin Little, PhD, Improvement Advisor, Institute for Healthcare Improvement (IHI); Principal, Informing Ecological Design, LLC Kristine KS White, RN, BSN, MBA, Faculty, IHI; Principal, Aerate Consulting; Co-founder, Aefina Partners, LLC Kathy Klock, Senior Vice President, Human Resources & Clinical Support Services, Gundersen Health System James Bonner, LMSW, Director of Patient Experience, Spectrum Health Have you been poring over some patient survey or patient experience data lately? Chances are good you have. How did you make sense of what you saw? What actions are you taking as a result of what you learned? Not sure? Unclear what to make of the information or what to do with it? You are not alone! In fact, as the ways to learn about how patients experience their care and their caregivers have grown, so has the confusion about how to interpret the data and how to make the best use of it. We invited Kris White and Kevin Little to lead the discussion, both of

Date: August 21, 2014 Featuring: Neel Shah, MD, MPP, Founder and Executive Director, Costs of Care September Wallingford, RN, MSN, Brigham and Women’s Hospital; Director for Nursing Advocacy, Costs of Care Christopher Moriates, MD, Assistant Clinical Professor, UCSF; Director, Center for Healthcare Value’s “Caring Wisely"; Director of Implementation Initiatives, Costs of Care​ Michele Rhee, Director of Program Initiatives, National Brain Tumor Society; Director of Strategic Initiatives, Costs of Care It's an all-too-familiar scenario: a doctor mapping out next steps at a medical appointment — perhaps prescribing new medications or ordering some tests —oblivious to the costs, including whether the patient might bear the brunt of them.  Some now consider this a form of harm that physicians, nurses, and others need to become more conscious of and do everything possible to prevent. That’s why we hope you’ll listen to this WIHI, where our guests discuss an innovative effort in the US to help caregiv

Date: July 24, 2014 Featuring: Kedar Mate, MD, Vice President, Institute for Healthcare Improvement David Williams, PhD, Improvement Advisor and Founder, TrueSimple Jonathan R. Studnek, PhD, NRP, Quality Improvement Manager, Mecklenburg EMS Agency (North Carolina) Kevin Rooney, MBChB, FRCA, FFICM, Consultant in Anaesthesia and Intensive Care Medicine; Professor of Care Improvement, University of the West of Scotland When it comes to reliability, it’s hard to beat the track record of paramedics and EMTs. Whether it’s speed, knowing just what to do in the event of an accident, serious injury, gun violence, or heart attack, or the amazingly calm and reassuring way  emergency responders go about their work, there are plenty of reasons to heap praise on this group of individuals. This also includes how patients are cared for during that ambulance ride to the hospital emergency department.   Could our opinion of EMTs get even higher? Maybe so, now that emergency medical services (EMS) are becoming part of

Date: June 19, 2014 Featuring: Trissa Torres, MD, MSPH, FACPM, Senior Vice President, Institute for Healthcare Improvement D. Clay Ackerly II, MD, MSc, Associate Medical Director, Population Health and Continuing Care, Partners Healthcare; Assistant Chief Medical Officer, Non-Acute Services, Massachusetts General Hospital L. Gordon Moore, MD, Chief Medical Officer, Treo Solutions (a wholly owned subsidiary of 3M) Jennie Chin Hansen, CEO, American Geriatrics Society If you’re wondering why health care quality and clinical leaders have been talking a lot more with their counterparts in finance or IT, look no further than the latest value-based contract they’ve likely just entered into with a payer. Within a hospital, these leaders may be putting their heads together to figure out how to deliver better care and better value for whole populations of patients. How might their data systems, for instance, help them better understand the utilization patterns and needs of everyone they see with Type 2 Diabetes

Date: June 5, 2014 Featuring: Chris Hayes, MD, MSc, Med, FRCPC, Harkness Fellow in Health Care Policy and Practice (IHI); Medical Officer, Canadian Patient Safety Institute Uma R. Kotagal, MBBS, MSc, Senior Vice President for Quality, Safety, and Transformation, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center Julie A. Holt, RN, MSN, CENP, Vice President, Patient Services, Cincinnati Children’s Hospital Medical Center If a systems approach is our best shot at improving the safety and quality of health care, a systems approach might also help address the added time and complexity that’s often a feature of improvement work itself. There are growing signs that even the most dedicated improvement champions and clinicians are overwhelmed by what’s required to meet new standards, regulations, and reporting requirements; and, even more troubling, frontline staff are starting to resent and question the value of new quality initiatives and expectations. Add to

Produced in collaboration with the Journal of the American Medical Association (JAMA) Date: May 22, 2014 Featuring: Mark Friedberg, MD, MPP, Natural Scientist, Professor, Pardee RAND Graduate School Christine A. Sinsky, MD, Medical Associates Clinic and Health Plans (Dubuque, Iowa); Director, American Board of Internal Medicine Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement Richard Baron, MD, President and CEO, American Board of Internal Medicine, ABIM Foundation The patient-centered medical home (PCMH) is getting a hard look this year. In a study published in JAMA in February 2014, the largest of its kind, researchers followed 32 primary care practices certified as PCMHs over a three-year period, and were unable to find any impact on overall health care costs or patients’ utilization of health care services, including emergency departments. To put it mildly, this was not welcomed news by the health care improvement community — especially those w

Date: May 8, 2014 Featuring: Tejal K. Gandhi, MD, MPH, CPPS, President, National Patient Safety Foundation and Lucian Leape Institute Susan Edgman-Levitan, PA, Executive Director, John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital Maureen Bisognano, President and CEO, Institute for Healthcare Improvement Linda K. Kenney, Executive Director and President of MITSS (Medically Induced Trauma Support Services, Inc.) Health care is at a tipping point with respect to patient engagement – from something that’s “nice to do” (or even “the right thing to do”) to something that’s absolutely necessary. Research and experience are making it clear that no health care organization can operate in a reliably safe way without the involvement of patients and families. And without their involvement, any organization’s safety agenda is bound to encounter diminishing returns. Patients and family members offer extra eyes and ears to events unfolding around them, and have crucial knowledge a

Date: April 24, 2014 Featuring: Neil Baker, MD, Principal, Neil Baker Consulting and Coaching Nan Cochran, MD, President, American Academy on Communication in Health Care (AACH); Associate Professor of Medicine, Geisel School of Medicine and Dartmouth Institute for Health Policy and Clinical Practice Calvin Chou, MD, PhD, FAACH, Professor of Clinical Medicine, UCSF; Vice President for External Education, AAC The last thing a patient needs to experience at a hospital or a clinic is tensions between staff members. Yet, we've all been there and seen and heard things that make us wonder “who isn’t getting along with whom” or, worse, are we getting the best care when we can tell providers are just barely disguising their frustrations with one another? It's a fair question, especially since health care is being redesigned at all levels to be more of a team effort. Doesn't that mean that the team has to be cohesive and everyone needs to get along?   For this WIHI, we brought together the expert group that spok

Date: April 10, 2014 Featuring: Helen Riess, MD, Director, Empathy and Relational Science Program, Department of Psychiatry, Massachusetts General Hospital Stacie Pallotta, MPH, Senior Director, Office of Patient Experience, Cleveland Clinic Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement Empathy is not the same thing as sympathy. In the first instance, we feel seen and truly heard; sympathy tends to maintain a distance between two people, often deliberately so. One of the best explanations of the distinction, and why empathy can be so much more powerful, is an online video narrated by human vulnerability expert Dr. Brené Brown. And then there’s the Cleveland Clinic’s video about empathy, directed at health professionals. This moving reminder of the stories behind the faces of patients that pass through health care every day has been viewed on YouTube over a million times. Why the seemingly sudden need to draw the attention of doctors and nurses to the hum

Date: March 27, 2014 Featuring: John W. Whittington, MD, Lead Faculty, Triple Aim Initiative, Institute for Healthcare Improvement Crispin Kontz, Manager, Support and Clinical Systems, Alberta Health Services (Edmonton, Canada) Catherine Craig, MPA, MSW, Independent Consultant, Community Health Transformation, Care Coordination Ann Lindsay, MD, Co-Director, Stanford Coordinated Care, Stanford Hospitals and Clinics When Atul Gawande wrote in The New Yorker about high utilizers of the health care system in Camden, New Jersey – “hot spotters,” he called them – he attached faces and stories to the very real human drama and challenge of meeting the needs of some of the most complex patients among us. Since that article was published in 2011, interventions and initiatives to better support, care for, and partner with populations with costly and life-draining multiple illnesses and problems have grown in number and effectiveness. We touch base with some of the people spearheading this work on this WIHI.   Dr.

Produced in collaboration with the Journal of the American Medical Association (JAMA) Date: March 13, 2014 Featuring: Craig W. Robbins, MD, MPH, Medical Director, Center for Clinical Information Services, Kaiser Permanente Care Management Institute Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement Peter Basch, MD, FACP, Medical Director, Ambulatory EHR and Health IT Policy, Medstar Health Eric Peterson, MD, MPH, Director, Duke Clinical Research Institute; Professor of Medicine, Division of Cardiology, Duke University Medical Center   Hypertension is a hot issue, especially in the US, where an expert committee recently recommended that the available evidence does not support initiating treatment (largely medication) for people 60 years or older until their blood pressure climbs to 150 over 90. The decades-long consensus had been to initiate treatment at 140 over 90, which is still the recommendation for adults younger than 60. The reasons for this change are p

Date: February 27, 2014 Featuring:   Laurie Herndon, MSN, GNP-BC, Director of Clinical Quality, Massachusetts Senior Care Foundation David Gifford, MD, MPH, Senior Vice President, Quality and Regulatory Affairs, American Health Care Association Annette Crawford, Administrator, Stafford Healthcare at Ridgemont Marie Schall, Director, Institute for Healthcare Improvement In the world of health care improvement, and in society at large, talking about skilled nursing facilities (SNFs) and long-term can be a tough subject. When a loved one moves in to a nursing home, they’re usually quite elderly, and it's often the last move they'll make of this kind before dying. So, whether because of this association or because other sectors of health care tend to get more attention, the hard work that’s going on to ensure that all types of SNFs, and nursing homes, deliver high-quality and patient-centered care, has been somewhat obscured. We’d like to help change this by zeroing in on one aspect of the work.   This WIH