WIHI - A Podcast from the Institute for Healthcare Improvement

Date: March 7, 2013 Featuring: Gene H. Burke, MD, Vice President and Executive Medical Director for Clinical Effectiveness, Sentara Healthcare Michael Howell, MD, Director of Healthcare Delivery Science, Director of Critical Care Quality, Beth Israel Deaconess Medical Center Lisa L. Maragakis, MD, MPH, FSHEA, Director of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital Scott A. Miller, MD, FACP, Vice President, Medical Affairs, Sentara Leigh Hospital Tom Talbot, MD, MPH, Chief Hospital Epidemiologist, Vanderbilt University Medical Center One of the cornerstones of infection prevention in any health care setting, including when someone is being cared for at  home, is good hand hygiene. Much of the attention in recent years has focused on hospitals and their rates of hand hygiene compliance among staff. And rightly so. Among the biggest contributors to hospital-acquired infections are, inadvertently, health professionals themselves... and others who come in contact with patients. Th

Date: February 21, 2013 Featuring: Norman E. Dascher, Jr., FACHE, CEO of Acute Care – Troy and Vice President, St. Peter’s Health Partners, Northeast Health (Troy, New York) Lucy A. Savitz, PhD, MBA, Senior Scientist, Institute for Healthcare Delivery Research, Intermountain Healthcare Katharine Luther, RN, MPM, Vice President, Hospital Portfolio Planning and Administration, Institute for Healthcare Improvement (IHI) Catherine Abbott, RN, MSN, Administrator, Performance Improvement, Hackensack University Medical Center (Hackensack, New Jersey)   Here’s the rub about reducing health care costs to improve your hospital’s bottom line: The “old” solutions of cutting back on staff and services are shortsighted at best. The best solutions require delivering better care and getting rid of wasteful practices. Even getting bigger to achieve efficiencies and economies of scale won’t help in the long run; the new world pays for value over volume. And value involves care coordination that follows patients whereve

Date: February 7, 2013 Featuring: Trissa Torres, MD, MSPH, Senior Vice President, Institute for Healthcare Improvement Xavier Sevilla, MD, MBA, FAAP, Vice President of Clinical Quality for Physician Services, Catholic Health Initiatives Lindsay A. Martin, MSPH, Executive Director and Improvement Advisor, Institute for Healthcare Improvement Randy Van Straten, Vice President Business Health, Bellin Health; Executive Director Bellin Run US employers have had a lot to say about health care costs the past several years. Large and small companies alike have openly complained about the apparently inexorable rise in health care spending, skyrocketing insurance rates, and the degree to which both trends have threatened bottom lines, restrained wages, and eroded benefits for employees. Some of the most vocal businesses have been determined to remedy the situation by exercising their purchasing clout to get better deals from insurers and by shifting more costs and co-pays onto the workforce. The most enlighten

Date: January 24, 2013​ Featuring: John D’Angelo, MD, FACEP, Chairman, Department of Emergency Medicine, Glen Cove Hospital, North Shore-Long Island Jewish Health System Martin E. Doerfler, MD, Vice President, Evidence Based Clinical Practice, North Shore-Long Island Jewish Health System Darlene Parmentier, RN, MSN, MBA, Assistant Director of Critial Care and Telemetry, Glen Cove Hospital, North Shore-Long Island Jewish Health System Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement Diane Jacobsen, MPH, CPHQ, Director, Institute for Healthcare Improvement Developing an infection can be complicated enough, but when the body's immune system reacts by going into overdrive in the form of sepsis, every second counts. The diagnosis needs to be swift and, if sepsis is confirmed, interventions in the form of fluids and antibiotics must be administered immediately. Because the global death rate from sepsis remains painfully high — tens of millions each year — stepped-up efforts t

Date: January 10, 2013 Featuring: Susan B. Hassmiller, PhD, RN, FAAN, Senior Advisor for Nursing, Robert Wood Johnson Foundation Daryl Lynch, MD, Vice Chair Ambulatory Medicine, Children’s Mercy Hospitals and Clinics (Kansas City); Director, Division of Adolescent Medicine Cathy Rick, RN, PhD, FAAN, FACHE, Chief Officer, Office of Nursing Services, US Department of Veteran Affairs (VA) Patricia Gerrity, PhD, RN, FAAN, Director, Eleventh Street Family Health Services of Drexel University; Associate Dean for Community Programs, Drexel University College of Nursing and Health Professions As we roll into 2013, the health care improvement community has a lot on its plate. Just for starters: reducing avoidable hospital readmissions, building community coalitions to improve population health, building active partnerships with patients and families, achieving meaningful use of electronic health records, and redesigning primary care. Each entails massive changes in thinking and strategy in order to achieve the

Date: November 15, 2012 Featuring: Patricia Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement; Co-Principal Investigator, STate Action on Avoidable Rehospitalizations (STAAR) Elizabeth H. Bradley, PhD, Professor of Public Health (Health Policy and Management), Yale School of Public Health; Faculty Director, Yale Global Health Initiative Leora Horwitz, MD, MHS, Assistant Professor, Internal Medicine, Yale University School of Medicine Of all the improvement issues facing health care, reducing avoidable hospital readmissions may well be the one that finally breaks down traditional silos — and allows promising changes to realize their full impact. Why? In order to prevent patients from bouncing back into the hospital, front-line staff must create robust care coordination strategies across multiple health care settings, as well as the home and the community — taking a fundamentally broader view of the patient journey and the reforms needed. However, doing the right thing ​— keeping

Date: November 1, 2012 Featuring: Tom Delbanco, MD, Richard and Florence Koplow–James Tullis Professor of General Medicine and Primary Care, Harvard Medical School Robert D. Harrington, MD, Professor of Medicine, University of Washington; Medical Director, Harborview Medical Center HIV clinic; Associate Section Chief of Infectious Diseases, Harborview Medical Center Richard Martin, MD, FAAFP, Department Director of Community Practice Service Lines (CPSL), Scranton and Monroe Counties; Director of Care Continuum, Geisinger Health System Michael Meltsner, AB, JD, Matthews Distinguished University Professor of Law, Northeastern University School of Law, Boston, MA Some changes in medicine are easier to contemplate than others. For a long time the notion that patients should be able to view what doctors write about them, following a visit, was unthinkable. It was a kind of “patient don’t ask, doctor don’t tell” policy. However, the growth of electronic health records, increased pressure for transparency, a

Date: October 25, 2012 Featuring: Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement (IHI) Kedar Mate, MD, Assistant Professor, Department of Medicine, Weill Cornell Medical College; Clinical Lead for Research and Development, IHI James Moses, MD, MPH, Pediatric Director of Quality and Safety, Boston Medical Center; Academic Advisor, IHI Open School for Health Professions Residency training in the US has long had the reputation of a rite of passage — a period when grueling hours on busy hospital floors are spent converting four years of medical school, and some clinical exposure, into real-time accountability for real patients who have sometimes serious and life-threatening medical conditions. However, a changing health care system now demands that residents develop the skills not just to diagnose and treat patients who are ill, but to protect them from harm and to reduce their chances of being readmitted. Residents need to know about managing chronic conditions and how

Date: October 12, 2012 Featuring: Donald M. Berwick, MD, MPP, Former President and CEO, Institute for Healthcare Improvement; Former Administrator, Centers for Medicare & Medicaid Services Chris Jennings, President, Jennings Policy Strategies (Washington, DC); Former Senior Health Care Advisor (Domestic Policy & National Economic Councils) to President Bill Clinton We’re just weeks out from the November elections in the US and, depending on the outcome, health care reforms championed by the Obama administration will either continue unabated or possibly face some serious challenges — from a new President or a differently configured Congress. In the midst of this uncertainty, numerous individuals are keeping a close eye on the national policies and initiatives that have done the most of late to accelerate new payment schemes and the redesign of health care delivery, as well as expand insurance coverage. IHI has two programs this fall to help you navigate this election cycle with a clarity of pur

Date: September 27, 2012 Featuring: Elliott Fisher, MD, MPH, Director, Center for Population Health, Dartmouth Institute for Health Policy and Clinical Practice Palmer “Pal” Evans, MD, former Senior Vice President & Chief Medical Officer, Tucson Medical Center (TMC) John Friend, Vice President Business Development & Associate General Counsel, TMC Healthcare; Executive Director, Arizona Connected Care, LLC One of the best-kept secrets about US health care this election season is the degree to which change and transformation are coming, no matter what happens in November. You won’t hear “global payment” or Medicare Shared Savings Program mentioned as often as “individual mandate” in the current political debate, but ask anyone leading a health care organization today which issue keeps them up at night, and it’s definitely payment reform. In general terms, the entire system is shifting from paying for volume – lots of procedures – to paying for value, or how well patients are cared for over time

Date: August 30, 2012​ Featuring: Ellen Goodman, co-founder, The Conversation Project; Pulitzer-Prize winning columnist and author Larry Weber, Chairman, W2 Group; Author, Everywhere: Comprehensive Digital Business Strategy for the Social Media Era Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement We have lots of meaningful conversations in the course of our lives, but topping the list has to be talking with family members and loved ones about our own — or their — wishes for care at the end of life. Despite the inevitability of death, for many of us this is the last conversation we either want to have or know how to have; it can be especially difficult to initiate. And yet, without these discussions, we or our loved ones run the risk of running headlong into a medical crisis and getting care we don’t want, and not getting the care we do.   Back in January, WIHI offered listeners a preview of a ground-breaking, grass-roots initiative aimed at changing this sta

Date: August 9, 2012 Featuring: Victor Montori, MD, MSc, Director, Mayo Clinic Healthcare Delivery Research Program; Professor of Medicine, Mayo Clinic. Nilay Shah, PhD, Assistant Professor of Health Services Research, Mayo Clinic Please note: Dr. Montori will be offering a Special Interest Keynote on Minimally Disruptive Medicine on December 11, 2012, at IHI’s National Forum. One of the most common phrases used to describe patients who are not taking their prescribed medications or following up on the recommendations of their health care providers is “non-compliant.” What if we viewed the behavior as an act of civil disobedience instead? This provocative notion definitely got the attention of health professionals in the audience at IHI’s 13th Annual Summit on Improving Patient Care in the Office Practice and the Community (March 18-20, 2012). It’s the thinking of Dr. Victor Montori, a diabetologist and researcher at Mayo Clinic whose keynote remarks at the gathering were, in part, intended to shake

Date: July 26, 2012 Featuring: Craig Brammer, Director, Beacon Communities, Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services Shelley B. Hirshberg, MHSA, Executive Director, P2 Collaboration of Western New York; Project Director, Western New York Aligning Forces for Quality(AF4Q), Robert Wood Johnson Foundation Carol Beasley, MPPM, Executive Director of Strategic Projects, Institute for Healthcare Improvement Katherine Browne, MBA, MHA, Chief Operating Officer, National Program Director, Aligning Forces for Quality, Robert Wood Johnson Foundation There’s a lot of interest in the Triple Aim in the US, Canada, and several European countries. And it’s no wonder. Ever since IHI conceived of the framework of the simultaneous pursuit of better health, better health care, and lower per capita costs, a whole array of strategies have opened up for health care improvers. Some of the most interesting and groundbreaking strategies have built as much

Date: June 20, 2012 Featuring: Parker J. Palmer, Founder and Senior Partner, Center for Courage and Renewal; Author, Healing the Heart of Democracy Jeffrey D. Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement The health care improvement community has often benefited from the work and perspective of other industries. Taking a systems approach to improving quality and safety in health care owes much to the concepts and work that turned the tide on risks and defects and waste in aviation and manufacturing. The quality improvement movement has also benefited from the wisdom of “outsiders” — individuals asked to look in at what health care improvement is trying to achieve and to tell us what we may be missing or what they see that we don't, because we’re just too close to the problems and the day-to-day solutions. Parker Palmer is just such a person, and he’s visited with the improvement community before; in 1997 he delivered a moving keynote at IHI’s N

Date: June 7, 2012 Featuring: Stephen Muething, MD, Vice President for Safety, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center Anne Lyren, MD, Co-Leader, OCHSPS National Children’s Network; Strategic Advisor for Quality and Safety, Rainbow Babies & Children’s Hospital Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement It may seem obvious that anticipating problems makes a whole lot more sense than dealing with things after the fact. Especially if the problems could have been prevented. When it comes to patient care, this can of course mean the difference between life and death but, more often, the lack of attention to complexities that could arise leads to a lot of unnecessary complications and suffering and costs. But what exactly do the systems look like that focus ahead of time on risky situations and high-risk patients with the same degree of science and scrutiny as we’ve come to associate with studying failures, after

Date: May 17, 2012 Featuring: Daniel B. Wolfson, Executive Vice President and COO, ABIM Foundation Steven Pearson, MD, MSc, FRCP, President, Institute for Clinical and Economic Review – Institute for Technology Assessment Amanda Kost, MD, Acting Assistant Professor, University of Washington Department of Family Medicine Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement Karen Boudreau, MD, FAAFP, Chief Medical Officer, Boston Medical Center, HealthNet Plan; Former Senior Vice President, Institute for Healthcare Improvement and Medical Director for IHI Continuum Portfolio Of all the sources of excessive health care spending, none may be higher on the list than the habit of ordering lots of expensive tests and procedures. This appetite for the best of what high-tech medicine can offer – whether warranted or not – is a big factor behind estimates that up to a third of health care spending in the US is wasteful and unnecessary. But everyone also has a story of someone, maybe

Date: May 3, 2012 Featuring: Maureen Bisognano, President and CEO, Institute for Healthcare Improvement, Co-author, Pursuing the Triple Aim Charles Kenney, Writer and Journalist, Co-author, Pursuing the Triple Aim Alide Chase, Senior Vice President, Medicare Clinical Operations and Population Care, Kaiser Foundation Health Plan, Inc., and Kaiser Foundation Hospitals Anthony M. DiGioia, MD, Renaissance Orthopaedics; Medical Director, Bone and Joint Center, Magee-Womens Hospital and PFCC Partners – Innovation Center of UPMC George E. Kerwin, FACHE, President and Chief Executive Officer, Bellin Health Patricia A. McDonald, Vice President, Technology and Manufacturing Group and Director of Product Health Enhancement Organization, Intel Corporation Diane K. Miller, MBA, Vice President, Virginia Mason Medical Center, Executive Director, Virginia Mason Institute Rebecca Ramsay, RN, MPH, Director, Care Support Manager, CareOregon Brian H. Rank, MD, Medical Director, HealthPartners Medical Group, HealthPartn

Date: April 19, 2012 Featuring: Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement Dale Webb, PhD, Director of Evaluation and Strategy, The Health Foundation, UK Mary Dixon-Woods, BA, DipStat, MSc, DPhil, Professor of Medical Sociology, University of Leicester, UK Gareth Parry, PhD, Senior Scientist, Institute for Healthcare Improvement WIHI doesn’t need to travel all the way to Paris, France, to focus on challenges with the design and evaluation of improvement initiatives. But, four leading experts in this area are going to be sharing some of the latest thinking on this topic at the 17th annual International Forum on Quality and Safety in Healthcare in Paris. WIHI host Madge Kaplan talks with these four presenters after their panel to share their observations with the WIHI audience. Here’s just a sample of what Don Goldmann, Dale Webb, Mary Dixon-Woods, and Gareth Parry want to cover:  Despite best intentions and commitment, improvement initiatives don’t always yield h

Date: April 5, 2012 Featuring: Gary Cohen, President and Co-Founder, Health Care Without Harm John Messervy, AIA, Director of Capital and Facility Planning, Partners HealthCare, Inc. Amy Collins, MD, Emergency Physician, MetroWest Medical Center; Chair, Go Green Committee, MetroWest How green is your hospital? Green, as you know, has become shorthand for everything from recycling to the use of safer products to shrinking one's carbon footprint to preventing pollutants from spewing into the air. There are any number of urgent reasons for the health care sector to be examining its green practices. One of them is just the sheer amount of resources hospitals consume: in the US, that’s tons and tons of water and 836 trillion BTU of energy annually. These same hospitals dispose of 6,600 tons of waste per day. Fortunately, we can all now point to visible efforts at most hospitals to “think and act” a lot greener. But even these well-intentioned efforts have a tendency to stall or lose steam, too often depende

​Date: March 22, 2012 Featuring: Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement Lindsay Martin, MPH, Executive Director for Innovation, Research & Development, Institute for Healthcare Improvement Bela Patel, MD, Assistant Dean of Healthcare Quality and Division Director for Critical Care Medicine, The University of Texas Health Science Center Where do new ideas for how to improve health care come from? Sometimes they start with a hunch or an expressed need from health care providers; sometimes they’re unearthed by deciding to make a dramatic reduction in mortality in a resource-poor setting or by drawing a line in the sand on the wasteful practices of fee-for-service medicine. Whatever the motivation or source — whether a hunch or a need or a challenge — even the best-sounding new improvement ideas need careful vetting and scrutiny and, if appropriate, a well-designed test to determine if an innovative approach to better patient care can make a difference in an a