WIHI - A Podcast from the Institute for Healthcare Improvement

Date: April 7, 2011 Featuring: James Conway, MS, FACHE, Senior Fellow, Institute for Healthcare Improvement; Adjunct Faculty, Harvard School of Public Health Anthony A. Armada, FACHE, President, Advocate Lutheran General Hospital, Advocate Lutheran General Children’s Hospital Michael A. Fisher, President and CEO, Cincinnati Children’s Hospital Medical Center (CCHMC) Uma R. Kotagal, MD, MBBS, MSc, Senior Vice President, Quality, Safety and Transformation, CCHMC; Executive Director, James M. Anderson Center for Health Systems Excellence Michelle Hoppes, RN, MS, President, American Society for Healthcare Risk Management; Senior Vice President and National Director for Healthcare Risk Management and Patient Safety, Sedgwick Claims Management Services When IHI published a white paper last year written by Jim Conway and three colleagues, there was little doubt that health care organizations were seeking guidance on the best and most transparent ways to prepare for and respond to serious medical crises. How

Date: March 17, 2011 Featuring: Karen Boudreau, MD, FAAFP, Senior Vice President, Institute for Healthcare Improvement; Medical Director, IHI Continuum Portfolio Connie Davis, MN, RN, Geriatric Nurse Practitioner, IHI Faculty; ImpactBC Senior Faculty for Patients as Partners and Adjunct Faculty, University of British Columbia School of Nursing John H. Wasson, MD, Professor of Community and Family Medicine, Dartmouth Medical School Sheila Allison, Peer Coach, Patient Advisor, Patient Voices Network (BC, Canada); Volunteer Facilitator, University of Victoria Centre on Aging – Self-Management Program Next to electronic health records (EHRs), there’s probably no other area of health care receiving as much attention these days as primary care. It’s easy to see why. Like EHRs, new and improved primary care models are considered ground zero for a system that’s better coordinated, integrated, and efficient. Hopes are high, especially in the US, that with a more robust and reliable infrastructure of primary ca

Date: March 10, 2011 Featuring: Kristine White, RN, BSN, MBA, Vice President, Innovation and Patient Affairs, Spectrum Health System Cindy Sayre, MN, ARNP, Director, Professional Practice and Patient- and Family-Centered Care, University of Washington Medical Center Dorothea Handron, EdD, APRN, Faculty Emeritus, College of Nursing, East Carolina University; Patient-Family Advisor, University Health Systems of Eastern North Carolina Brandelyn Bergstedt, Coordinator, Patient and Family Advisor Program, Evergreen Hospital Medical Center Martha Hayward, Executive Director, The Partnership for Healthcare Excellence; Founder, Women’s Health Exchange; Member, Dana Farber Cancer Institute Patient Advisory Council Here’s the first thing one discovers when planning a program about Patient and Family Advisory Councils (PFACs): there are now hundreds and hundreds of them at hospitals all across the US, and they’re a growing phenomenon internationally. In fact, there are so many outstanding examples of patients a

Date: February 24, 2011 Featuring: Rick Gilfillan, MD, Acting Director, Center for Medicare and Medicaid Innovation Most of us are familiar with the various demonstration projects the Centers for Medicare & Medicaid Services (CMS) has sponsored over the years. This year CMS is taking the notion of figuring out “what works” when it comes to better patient care to an entirely new level, with the launch of the Innovation Center at CMS. Rick Gilfillan, fresh from helping to redesign payment methods at the Geisinger Health System to align with quality outcomes — and gaining national recognition as a result — is now applying his passion for improvement to the country as a whole. As the Innovation Center ramps up, Dr. Gilfillan is eager to keep everyone up to date with what’s on the broader agenda and what’s most immediately in store. WIHI host Madge Kaplan talks with Dr. Gilfillan, who explains the strategy behind the Innovation Center and the prospects for seeding much more robust work with both new p

Date: February 10, 2011 Featuring: Pauline Chen, MD, Columnist, The New York Times;  Author, Final Exam: A Surgeon’s Reflections on Mortality Every now and again, a physician begins writing a regular column for a publication and you find yourself hooked before you know it. Part of it has to do with our being offered a way to better understand “how doctors think” and what they think about. In the case of Pauline Chen, what stands out is her frank honesty about what works and what isn’t working in medicine, not only affecting patients, but the ways physicians interact with one another, and with other practitioners. Many of Dr. Chen’s columns spring from her day-to-day experiences — from confronting assumptions about patients that physicians hold onto to confronting one’s own loss of confidence after making a mistake. Here’s an excerpt from her May 2010 New York Times column, "When Patients Share Their Stories, Health May Improve": "Devastated, I withdrew my needle and quickly took steps to confirm, the

Date: January 27, 2011   Featuring: Christopher P. Landrigan, MD, MPH, Director, Sleep and Patient Safety Program, Brigham and Women’s Hospital David B. Sweet, MD, FACP, Program Director, Internal Medicine Residency, Summa Health System James F. Whiting, MD, Surgical Director, Maine Transplant Program and Surgical Residency Program Director, Maine Medical Center Don Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement     Rules are rules, but efforts to limit the number of hours medical residents can work before getting rest and sleep have not gone down easily in the US. The latest set of regulations from the Accreditation Council for Graduate Medical Education (ACGME), focused especially on first-year residents, is scheduled to go into effect in July 2011.   Amid ongoing debate about research tying long hours spent taking care of hospital patients to impaired judgment and an increased likelihood of making errors (or harming oneself), and what are fair and appropriate remedies, a gro

Date: January 13, 2011   Featuring: Neil Baker, MD, IHI Faculty and Improvement Advisor; Improvement Consultant, Neil Baker Consulting Lawrence Shapiro, MD, Managed Care Medical Director, Palo Alto Medical Foundation Here’s something most clinical and quality leaders agree with: a lot of specialty care isn’t always necessary or beneficial. What’s more, there’s tremendous variation across the US in the use of specialist services — variation that tends to be driven by the volume of what’s available, not the health needs of a community’s residents. Meanwhile, in the trenches of decision making and with state-of-the-art interventions available to diagnose and treat diseases of all sorts, doctors and patients want what’s best, and potentially lifesaving. We applaud the oncologist who’s carefully helping a patient with cancer weigh treatment options; we respect the cardiologist who’s prescribing someone who’s had a heart attack the best medications to prevent a recurrence; we want the C-section for the pregn

Date: December 16, 2010   Featuring: Bill Thatcher, Executive Director, Cautious Patient Foundation Barbara Balik, RN, EdD, Senior Faculty, Institute for Healthcare Improvement Tricia Pil, MD, Pediatrician, Medical Writer, University Health Sciences Project Coordinator, Patient Activist Charles Maclean, PhD, Founder, PhilanthropyNow   The activated patient and family member – often seeking to ensure that whatever “bad” thing happened to them doesn’t happen to anyone else – is, thankfully, no longer a new phenomenon. Today in the US, hundreds of organizations of all sizes and reach are gaining a voice and the expertise to help solve some of health care’s most intractable quality and safety problems. The rapid growth of patient advisory councils is just the latest example of patients becoming an integral and integrated force in the redesign of care.   On December 5, 2010, thanks to the generosity of the Cautious Patient Foundation and others, some 50 patient leaders gathered at IHI’s Annual National Forum

Date: December 2, 2010 Featuring: Jeffrey Selberg, MHA, Executive Vice President and COO, Institute for Healthcare Improvement Robert Murray, Executive Director, Maryland Health Services Cost Review Commission   The phrase, “bending the cost curve,” has an elegance to it that almost belies the complexity of what it’s going to take to achieve this aim. Medical home, accountable care organizations, bundled payments, global payments, value-based purchasing…they’re all in the mix. But how does it all add up, and is there a more effective overarching strategy still to come?    IHI’s Executive Vice President and COO, Jeff Selberg, has been digging into where things stand with “bending the cost curve” efforts, especially in the US, and he has some important ideas and framing that he’d like to offer to WIHI participants to move efforts forward. Robert Murray has been overseeing, at one level, one of the longest-running payment and cost control initiatives in the country – in the state of Maryland, where an all-pa

Date: November 18, 2010   Featuring: Donna Shalala, PhD, former US Secretary of Health and Human Services; President, University of Miami; Chair, Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, Institute of Medicine Linda Burnes Bolton, DrPH, RN, FAAN, Vice President for Nursing and Chief Nursing Officer, Cedars-Sinai Medical Center; Vice Chair, IOM Committee on the Future of Nursing Patricia Benner, RN, PhD, FAAN, Senior Scholar, Carnegie Foundation for the Advancement of Teaching; Author, Educating Nurses: A Call for Radical Transformation and From Novice to Expert: Excellence and Power in Nursing   What’s it going to take for the health care system to take full advantage of the potential of nurses – and for nurses to realize their full potential? These twin questions are not new to the nursing profession, or to policy makers. Both groups have been wrestling for years to find the right levers to increase not just the ranks of RNs, but their skills and recognition as

Date: November 4, 2010 Featuring: Marshall Ganz, MPA, PhD, Lecturer in Public Policy, Harvard University Kate B. Hilton, MTS, JD, Principal in Practice, Leading Change; Leadership Coach, NHS England; Director, Organizing for Health If you don’t work in the health care system, it’s sometimes hard to understand why, when so much is known about better ways to take care of patients and better ways to deliver quality at lower cost, people don’t just “do it!” What’s so complicated? If one hospital or hospital system has dramatically lowered infection rates, trained its practitioners to work as teams, AND coordinates with outpatient clinics to help people with serious, chronic conditions avoid the emergency department, then why can’t all hospitals do this? What’s the excuse? Well, there is no “excuse” per se, but the reasons for the uneven and unreliable pace of change are many and complex. So much so that many health care improvement experts believe that the massive challenges facing health care systems in

Date: October 21, 2010   Featuring: Lee Adler, DO, Vice President for Quality, Safety, Innovation, and Research, Florida Hospital Ruth Ann Dorrill, MPA, Team Leader, Office of Inspector General, US Department of Health and Human Services Amy Ashcraft, Senior Analyst, Office of Inspector General, US Department of Health and Human Services Donald Goldmann, MD, Senior Vice President, Institute for Healthcare Improvement Fran Griffin, Senior Manager of Clinical Programs for BD Medical/Medical Surgical Systems; Faculty, Institute for Healthcare Improvement   How often are patients harmed in US hospitals, and what is the best way to determine this? Ever since the Institute of Medicine (IOM) estimated that up to 98,000 patients die in hospitals each year due to medical errors, and some subsequent studies that claim the number is much higher, getting a more precise “national” handle on where and when and how frequently harm occurs has bedeviled most researchers. Without a baseline, it’s been impossible to state

Date: October 7, 2010   Featuring: Amy Boutwell, MD, MPP, Director of Health Policy Strategy, Institute for Healthcare Improvement Jeffrey Burke, Director, Financial Decision Support, Spectrum Health Rosemary Rotty, Director, Financial Planning, UMass Memorial Health Care You’d be hard pressed to find anyone working in a hospital who’d say, “Yes, we really want Mrs. Jones to be back here a few days after she’s been discharged, running a fever, suffering complications from surgery, and now needing to be readmitted so we can run more tests.” And yet, scratch the surface of even the most dedicated hospital these days, working hard on sending people home with appropriate information, support, and planning… and you’ll find someone working late who’s been asked to come up with the business model that’s going to replace all the lost revenues when those “unwanted” readmissions are reduced! Even as payers, including Medicare, are poised to make hospitals that don’t reduce their readmissions feel added financial

Date: September 23, 2010 Featuring: Lawrence Smith, MD, Dean, Hofstra/North Shore-Long Island Jewish School of Medicine; Chief Medical Officer, North Shore-LIJ Health System John Rock, MD, Founding Dean, Herbert Wertheim College of Medicine at Florida International University M. Brownell Anderson, Senior Director, Educational Affairs, Association of American Medical Colleges (AAMC) It’s not easy to turn medical training upside down to better fit the needs of today’s patients and health care system. Consider that the last major reform occurred some 100 years ago and many, many institutions and individuals would say they’ve done just fine with the basics and, besides, some of the new content areas like “humanism” would be nice to know, but they’re hardly essential. I’m going to be a surgeon, after all! Well, don’t try that out on the Deans of some 20 new medical schools. The attitude also might not wash with a new breed of curriculum architects who pair students with patients in low-income neighborhoods

Date: September 9, 2010 Featuring: Maureen Bisognano, President and CEO, Institute for Healthcare Improvement   Here's the thing about IHI's new President and CEO, Maureen Bisognano: she has unshakable optimism. And it's not because she wears rose-colored glasses or is looking at a different health care world than the rest of us. No, Maureen’s optimism is fed by her regular contact with some of health care's most reliable sources: patients and families, front-line providers, leaders — all of whom know firsthand where the problems lie and where the opportunities reside. They also share Maureen’s belief, honed by over 25 years’ worth of experience working to improve patient care, that the next barrier is only as formidable as you make it. The questions always need to be, “What new processes can you test?”  “What new skills are needed?” “Who haven’t you included in the discussion?” Talk to anyone who has met Maureen, and they’ll tell you she is a leader for our times; she’s keenly aware of every vexing an

Date: July 15, 2010 Featuring: Nana Twum-Danso, MD, MPH, FACPM, Director, Project Fives Alive! Jo Ivey Boufford, MD, President, New York Academy of Medicine Sue Gullo, RN, MS, Managing Director, Institute for Healthcare Improvement   It’s difficult to assess just how much progress is being made in the decades-long battle to prevent women from dying during pregnancy and childbirth. In April, The Lancet reported that worldwide maternal death rates dropped significantly from 1980 to 2008. The good news wasn’t uniformly shared across the 181 countries studied, but some global health experts felt there was reason for optimism. In May, the Kaiser Family Foundation presented a more sobering picture, suggesting that efforts to fulfill the United Nations Millennium Development Goal (MDG) of reducing maternal mortality by 75 percent by 2015 were not on track.   At the same time, new initiatives in some of the poorest parts of the globe are successfully targeting maternal health and delivering healthy prognoses fo

Date: July 1, 2010 Featuring: Barry Silbaugh, MD, MS, FACPE, CEO, American College of Physician Executives Kevin Stewart, FRCP, Medical Director Winchester and Eastleigh NHS Trust; Health Foundation Fellow, IHI Charlotte Guglielmi, RN, CNOR, Perioperative Nurse Specialist, BIDMC; President, Association of periOperative Registered Nurses Gerald B. Healy, MD, Emeritus Healy Chair in Otolaryngology, Children’s Hospital (Boston); Senior Fellow, IHI Ron Wyatt, MD, MHA, General Internist, Huntsville Hospital (Alabama); Merck Fellow, IHI   Over the years, the positions held by doctors in health care organizations have unfortunately empowered some to behave unprofessionally towards other staff and practitioners, especially nurses. Giving a pass to belligerent or temperamental clinicians, even while many of those affected quietly seethe, has been tolerated in part because of the pecking order in medicine, and in part as a nod to the organization’s sources of revenue.   Well, the times are a changing…and not ju

Date: June 17, 2010 Featuring: James R. Duncan, MD, PhD, Associate Professor of Radiology and Surgery, Washington University School of Medicine Richard T. Griffey, MD, MPH, Associate Chief for Quality and Safety, Emergency Medicine, Washington University School of Medicine   Have you had a CT scan lately? Chances are good that you have. In fact, you may have even had some repeat CT scans for the same problem — often because the original scans couldn’t be found. Until recently, we’ve been so enamored of this powerful diagnostic technology that most of us haven’t thought twice about repeating a scan, or considered the benefits versus the risks. Not to mention the costs. But we’re learning that a lifetime of exposure likely contributes to a greater risk of cancer. And many CT scans just aren’t needed, contributing to vast overutilization and significant health care spending. One person’s expense is of course another’s revenue, patients demand the best imaging, and physicians have a hard time saying no. What

Date: June 3, 2010 Featuring: Carol Beasley, Director, Institute for Healthcare Improvement Tom Nolan, PhD, Statistician and Co-Founder, Associates in Process Improvement; Senior Fellow, IHI Laura K. Landy, President and CEO, Fannie E. Rippel Foundation   What happens when health care leaders from different regions in the country get in the same room and talk about their efforts to redesign patient care? Among other things, there’s often a sense of relief that, across state lines and political affiliations, there’s a shared concern for improving people’s health, improving their health care experiences, and lowering the costs of care. Washington may be able to bring about broad reforms for health care, but communities of all shapes and sizes are increasingly being looked to for the day-to-day solutions and innovations that will “bend the cost curve” and offer new, humane models for the future.   Fresh off a meeting in the Washington, DC, focused on building low-cost, high-quality health care regions in A

​Date: May 20, 2010 Featuring: Ann Lefebvre, MSW, CPHQ, Associate Director, North Carolina Area Health Education Centers Program Neil Baker, MD, IHI Faculty and Improvement Advisor, and Improvement Consultant Cory B. Sevin, RN, MSN, NP, Director, Institute for Healthcare Improvement Roger Chaufournier, CEO, CSI Solutions   Primary care practice in the US is undergoing a transformation. In many instances the offices still look cramped and, unlike hospitals, the changes don’t take the form of major new construction. But look closely: those sagging shelves of patient files are giving way to electronic health records; practitioners are tapping into online expertise to help with diagnoses and apply evidence-based medicine; patients have their own web portals; and people with similar chronic conditions sometimes meet as a group with a single provider for shared learning and greater efficiency. And, in case you haven’t heard, health care reformers are looking to primary care like never before to pave a better