WIHI - A Podcast from the Institute for Healthcare Improvement

Date: March 8, 2012 Featuring: Maureen Bisognano, President and CEO, Institute for Healthcare Improvement Mark R. Chassin, MD, FACP, MPP, MPH, President, The Joint Commission and the Joint Commission for Transforming Healthcare How many patient safety goals does it take to get the US health care system to function as safely and as reliably as it should? And, looked at through the lens of the Joint Commission’s program for hospitals, can 15 broad goals covering patient identification, medication safety, infection prevention, surgical error prevention, communication, and prevention of patient suicide add up to the safe and effective care that must become a hallmark of health care delivery and that patients deserve? The answer is, “Of course not.” Everyone, including the Joint Commission, knows that health care organizations today can’t possibly meet the Joint Commission’s goals, or any other benchmarks, unless they’re embedded in huge culture changes that comprise strong leadership, good communication skil

Date: February 23, 2012 Featuring: John Moore, MD, PhD Candidate, MIT Media Lab – New Media Medicine David Judge, MD, Project Leader, CIMIT Ambulatory Practice of the Future; Instructor in Medicine, Harvard Medical School New technologies by themselves cannot create more robust patient-provider partnerships. But, with a lot of ingenuity and thoughtful design, and a commitment to creating tools that help put patients more in charge of their health, technology can be a game changer. That’s the guiding principle behind some fascinating work under development at the MIT Media Lab, and that’s where this WIHI takes place for its first ever “live on location” broadcast. If you’ve never heard of NewMediaMedicine, you’re in for a treat. Using a conceptual and software platform called CollaboRhythm, researchers are designing and testing tools that offer patients real-time data about their own chronic health conditions that can then be easily conveyed to a health care provider, enabling coaching and communicatio

Date: February 9, 2012 Featuring: Donald Berwick, MD, MPP, Former Administrator, Centers for Medicare & Medicaid Services; Former President and CEO, Institute for Healthcare Improvement (IHI) Gerard M. Shea, Assistant to the President for External Affairs, American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) Imagine this. You’re driving or walking or maybe even bicycling by your local hospital and you notice a big sign over the entrance that you’ve never seen before. Here’s what it says: “This hospital saved 5 Million Dollars in 2011 by improving patient care and reducing unnecessary procedures. We have returned the money to local employers, local unions, and the state.” Sound preposterous? Hopefully not, because this is the kind of bold commitment and public declaration that Don Berwick and Gerry Shea would like everyone in health care to start thinking about, seriously. It’s just that urgent, they say, and they’ll explain why. WIHI host Madge Kaplan welcomes Berwick

Date: January 26, 2012 Featuring: Ellen Goodman, Columnist, Author, founding member of The Conversation Project Ira Byock, MD, Professor, Dartmouth Medical School; Director of Palliative Medicine, Dartmouth-Hitchcock Medical Center Bernard “Bud” Hammes, PhD, Director, Medical Humanities and Respecting Choices®, Gundersen Health System Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement Most of us, if asked, say we care a great deal about will happen to us when we’re at the end of our lives. And yet, because we’d also rather focus on just about anything but death and dying, especially if we’re young and healthy or aging well, we’re all vulnerable to what can transpire by default: spending our last few days in an ICU, even if that’s at odds with our needs and preferences. The reasons for this disconnect are complex but often stem from the fact that individual and family decisions come late, are hashed out during a crisis, and in the very setting — a hospital — th

Date: January 12, 2012 Featuring: Barry Zuckerman, MD, Chair, Department of Pediatrics, Boston University School of Medicine; Founder, National Center for Medical-Legal Partnership Robert Kahn, MD, MPH, Associate Professor of Pediatrics and Director, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center Carol Beasley, MPPM, Director of Strategic Projects, Institute for Healthcare Improvement Let’s face it. If someone mentions the words “medical” and “legal” in the same sentence, the next thing we imagine we’ll hear about is a lawsuit. Picture this instead: empowered, proactive social workers, collaborating with health care providers, lawyers, and legal experts, to ensure that the health of indigent patients isn’t undermined by unsafe housing, lack of food, or lack of access to benefits and entitlements. Some people refer to this type of outreach as “preventive law” because it’s directly related to preventive health measures we now recognize are crucial to help pe

Date: December 15, 2011 Featuring: Jeffrey D. Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement (IHI)   2011-2012 IHI Fellows     Every December, nearly half the people who attend IHI’s National Forum in Orlando, Florida, do so for the very first time. They join with the “regulars” and the “veteran” conference-goers and immerse themselves in intense learning and networking over four packed days. By the time it all winds up, everyone is eager to return to colleagues back home to share new ideas and initiate new improvement strategies. Some of IHI’s best informants wind up being our fellows, most of whom have never attended the Forum before. At the Forum, they fan out to cover as much ground as possible so that they can spread the learning among themselves and beyond. That’s the spirit behind WIHI’s December 15 program, “Heard at the Forum.” The 2011-2012 IHI Fellows and IHI’s Executive Vice President and COO Jeff Selberg join WIHI host Madge Kap

Date: December 1, 2011  Featuring: David Gozzard, FRCP, FRCPath, MBA, Consultant in Quality Improvement, North Wales, UK; Former Consultant Haematologist Christine White, MD, MAT, Assistant Professor, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center Win Whitcomb, MD, MHM, Medical Director of Healthcare Quality, Baystate Health   Although most hospitals are open for business 24/7, patients are well aware that days, nights, weekends, and holidays are not created equally in hospitals. There’s a history of assigning fewer medical and nursing staff during these times, creating a host of challenges for improvement leaders seeking to ensure safe and reliable care regardless of what the clock says. And there are real consequences: a study published in JAMA in 2008 found that patients who had heart attacks in the hospital at night and on weekends were less likely to survive than if they’d arrested during “normal business hours.” Innovative solutions to close this gap i

Date: November 17, 2011 Featuring: Helen Osborne, MEd, OTR/L, President, Health Literacy Consulting; Author, Health Literacy from A to Z Gail A. Nielsen, BSHCA, Director, Learning and Innovation, Center for Clinical Transformation, Iowa Health System; Faculty, Institute for Healthcare Improvement Lisa M. Stevens, MSHSA, Director of Clinical Quality, Crusader Community Health   In its 2004 report, "Health Literacy: A Prescription to End Confusion," the Institute of Medicine defined health literacy as “the degree to which individuals have the capacity to obtain, process, communicate, and understand basic health information and services needed to make appropriate health decisions.” Seven years later, the field of health literacy has exploded into something far beyond this most basic description. There are legions of health literacy advocates and initiatives; innovative, creative, and culturally attuned resources; a much greater emphasis on empowerment and engagement rather than mere compliance; and a far g

Date: November 3, 2011 Featuring: Rick Foster, MD, Senior Vice President of Quality and Patient Safety, South Carolina Hospital Association Kate B. Hilton, Director, Organizing for Health; Principal in Practice for Leading Change at the Hauser Center for Nonprofit Organizations at Harvard University Landis Landon, President, Immaculate Merchant Services; Resident, Columbia, South Carolina In August 2011, a very different sort of town hall meeting was held in Columbia, South Carolina. About 90 people who shared the zip code 29203 sat down to talk about the health issues they faced. The list was long: lack of dental care, colon cancer, breast cancer, diabetes, heart disease, stroke, mental illness, low birth weight babies, and more. Any one of these issues is worthy of attention; indeed, in most parts of the US, you can find initiatives trying to either prevent or reduce the burden of specific diseases that affect specific individuals. But what if the approach was more comprehensive and more widespread

Date: October 20, 2011 Featuring: Bruce Siegel, MD, MPH, President and Chief Executive Officer, National Association of Public Hospitals and Health Systems (NAPH) Linda Cumming, PhD, Vice President for Research at the National Association of Public Hospitals and Health Systems (NAPH) and Director of the National Public Health and Hospital Institute (NPHHI), NAPH’s research affiliate Steven R. Counsell, MD, Chief of Geriatrics and Medical Director for Senior Care, Wishard Health Services, Indianapolis; Professor, Indiana University School of Medicine; Director, Indiana University Geriatrics Caroline M. Jacobs, MPH, MSEd, Chief Patient Safety Officer/Senior Vice President, Patient Safety, Accreditation and Regulatory Services, New York City Health and Hospitals Corporation   The usual way safety net hospitals wind up in the news in the US is when — faced with insufficient reimbursements and other reductions in funding — survival is questionable. The story angle becomes one of fiscal woes exacerbating and

Date: October 5, 2011​ Featuring: Arthur Kleinman, MD, Esther and Sidney Rabb Professor of Anthropology, Professor of Medical Anthropology, Professor of Psychiatry, William Fung Director: Harvard University, Harvard Medical School, Harvard University Asia Center Jeremy Boal, MD, Chief Medical Officer, North Shore–LIJ Health System; Professor of Medicine, Hofstra North Shore–LIJ School of Medicine Dana R. Lustbader MD, FCCM, FCCP, FAAHPM, Section Head, Palliative Medicine, North Shore–Long Island Jewish Medical Center; Program Director, Palliative Medicine Fellowship, North Shore–LIJ; founding Director, Palliative Care Unit, North Shore University Hospital; Assistant Medical Director, New York Organ Donor Network   Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement When we talk about caring for loved ones with serious illness, we usually focus on the problems and challenges most of all. And that makes sense. There is nothing easy or simple about family caregiving, and when

Date: September 22, 2011 Featuring: Frank Federico, RPh, Executive Director, Strategic Partners, Institute for Healthcare Improvement​ Michael R. Cohen, RPh, MS, ScD, FASHP, President, Institute for Safe Medication Practices Lynn Eschenbacher, PharmD, MBA, Assistant Director of Clinical Services and Director PGY-1 Pharmacy Residency Program, WakeMed Health and Hospitals   Medication safety has gotten a lot more challenging in the past year or so, due to circumstances health care providers can’t typically predict or control: a growing, critical shortage of prescription drugs, hundreds of them, including mainstay generics hospitals use to treat several forms of cancer.  News organizations have begun to pay attention to the trend because of the tough decisions providers and patients now face when preferred treatments for certain types of aggressive leukemia or testicular cancer aren’t available. A recent story on The PBS NewsHour offers one of the more comprehensive looks at the underlying industry prac

Date: September 8, 2011 Featuring: Lucile O. Hanscom, Executive Director, Picker Institute Dale Shaller, MPA, Principal, Shaller Consulting Group Martha Hayward, Lead for Public-Patient Engagement, Institute for Healthcare Improvement Gaye Smith, Chief Patient Experience and Service Officer, Vanderbilt University Medical Center Anthony M. DiGioia, MD, Founder, The Orthopaedic Program and Innovation Center, Magee-Womens Hospital of UPMC Most of us are familiar with the National Quality Forum’s list of Serious Reportable Events in health care — often referred to as “Never Events.” There’s a wide consensus that everything from performing surgery on the wrong patient or wrong site, to a medication error-induced death, to a physical assault aren’t only tragic and harmful, they are not supposed to happen. Period. It’s a strong statement about patient safety and what the system as a whole should not be willing to tolerate. And, by extension, it’s a call to action to do better and to take care of patients di

Date: July 21, 2011 Featuring: Stuart H. Altman, PhD, Sol C. Chaikin Professor of National Health Policy and former Dean of The Heller School for Social Policy and Management, Brandeis University Jeffrey Selberg, MHA, Executive Vice President and Chief Operating Office, Institute for Healthcare Improvement ​ What's the value of value-based purchasing? This is the term used for a new initiative of the Centers for Medicare and Medicaid Services (CMS) that is perhaps the government’s boldest move yet to tie hospital reimbursement to quality, focused initially on 13 measures, including patient satisfaction. The intent is pretty clear, but how likely is it that the new “carrot,” in the form of bonus payments starting in October 2012, will accelerate better patient care and usher in a new day of financial expectations? IHI’s Jeff Selberg says the answer isn’t clear BUT, as a former hospital executive, he can’t imagine sitting on his hands waiting to see how things will play out. In other words, to Jeff, the h

Date: July 7, 2011 Featuring: Lord Nigel Crisp, Strategic Advisor on Global Health and Senior Fellow, Institute for Healthcare Improvement; Author, Turning the World Upside Down: The Search for Global Health in the 21st Century Pierre Barker, MD, Senior Vice President for IHI improvement initiatives in South Africa, Ghana, Malawi, and India Pedro Delgado, MSc, Executive Director for IHI large-scale health system improvement efforts in Europe and Latin America Health care improvers in the US have so much on their plates these days, it can seem like a luxury to focus on what’s happening in other countries. That’s unfortunate because health care improvement has become a global endeavor, and nations of all sizes and stages of development are confronting strikingly similar issues. These include how to care for aging populations, how to give individuals the tools to be shared decision makers and managers of their chronic conditions, and how to design systems that optimize communication and coordination acr

Date: June 23, 2011 Featuring: Catherine Craig, LMSW, MPA, Director of Health Integration – National Programs, Common Ground Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine, New York University School of Medicine Geraint Lewis, MA, MSc, FRCP, FFPH, Public Health Physician and Senior Fellow, The Nuffield Trust, UK There isn’t a health care provider anywhere in the US who hasn’t witnessed the disconnect between a patient with multiple health and social needs and the systems available to help that individual. The gap between what’s needed and what’s available (and what’s paid for) is often staggering. Stories abound of doctors and nurses and social workers painstakingly trying to patch together services that might function as an alternative to the hospital’s emergency department, get a prescription filled, get someone a hot meal… and on it goes. There are communities in the US and other countries that have worked for years to do things better but, wherever you go, patients with multip

Date: June 9, 2011 Featuring: Catherine D. DeAngelis, MD, MPH, Editor-in-Chief, Journal of the American Medical Association   It's hard to imagine the Journal of the American Medical Association (JAMA) without its editor-in-chief, Cathy DeAngelis, who will be stepping down this July. Since 2000 Dr. DeAngelis, JAMA’s first woman editor, has steered the peer-reviewed publication in important new directions and successfully brought about greater scientific integrity across the medical research and publishing industry. Because of her efforts, as a condition of publication virtually all clinical trials in the US are now listed in a public registry. JAMA won’t consider industry-funded research unless it’s been independently vetted.   Dr. DeAngelis’ principled stands, along with her interest in the narrative side of practicing medicine, as well as health policy and reforming the status quo, have all made JAMA more accessible and “required reading” for a broader audience. And her own story — which began in a coal

Date: May 5, 2011 Featuring: Maureen Bisognano, President and CEO, Institute for Healthcare Improvement The last time WIHI sat down with Maureen Bisognano (September 9, 2010: "Leaders Never Stop Learning") she was newly ensconced as the head of IHI and everyone was getting a big dose of her undying optimism and passion for new designs to improve care that include input from patients and families every step of the way. Seven months later, Maureen is as committed to these principles as ever, in part because everywhere she travels she witnesses the benefits that true patient-centered care and true collaboration have on people’s lives — including the clinicians on the front lines. And yet, it’s easy to understand why leaders of health care organizations today aren’t always so sure how to connect their own home-grown innovations to the high-stakes challenges cropping up on the larger stage. Will cultivating a robust system of patient advisors lead to better HCAHPS (satisfaction) scores? Greater fiscal stabi

Date: April 21, 2011 Featuring: Jennifer Temel, MD, Director, Fellowship Program at Massachusetts General Hospital (MGH); Clinical Director, Thoracic Oncology, MGH; Assistant Professor in Medicine, Harvard Medical School Daniel Ray, MD, Medical Director, Medical Critical Care Program and Fellowship Director, Hospice and Palliative Medicine, Lehigh Valley Health Network Allan Ramsay, MD, Medical Director, Palliative Care Service, Fletcher Allen Health Care; Professor and Associate Chair, Department of Family Medicine, University of Vermont College of Medicine   Sometimes when a researcher’s work gets published in an academic journal, intense media attention isn’t the full story. Since August 2010, when Dr. Jennifer Temel’s New England Journal of Medicine article was published, the findings have had a major impact on clinical leaders on the frontlines of palliative care. Just ask Dr. Allan Ramsay from Fletcher Allen in Vermont. He and his colleagues couldn’t pass around the NEJM article fast enough! For t

Date: April 14, 2011 Featuring: David C. Classen, MD, MS, Associate Professor of Medicine, University of Utah; Active Consultant in Infectious Diseases, University of Utah School of Medicine; Senior Partner, CSC Roger K. Resar, MD, Senior Fellow, Institute for Healthcare Improvement Andrea Kabcenell, RN, MPH, Vice President, Institute for Healthcare Improvement Kathleen M. Haig, RN, Corporate Patient Safety Officer, OSF Health Care System It’s safe to say that reducing harm is a priority at virtually every health care delivery organization today in the US. Few health care leaders waste time anymore defending high rates of hospital-acquired infections or medication errors. Progress is also notable in this country and other nations similarly focused on improvement, when it comes to significant reductions in infections associated with use of central lines, ventilators, resistant bacteria, or with events such as preventable patient falls. That’s the good news. The mixed news is that when independent res