WIHI - A Podcast from the Institute for Healthcare Improvement

March 24, 2020  All quality improvement in health and health care shares the goal of standardizing best practices, and ensuring that staff have the skills, resources, and capability to reliably implement proven and better ways of delivering care. But what does it mean to innovate, improve, and solve problems at warp speed during a time of crisis? Tune in to this WIHI to hear IHI's Chief Innovation and Education Officer, Dr. Kedar Mate, talk with host Madge Kaplan about ways health care can harness innovation to fight the COVID-19 pandemic.  Featuring Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement    

The ability of health care staff to raise concerns or report near-misses is only as strong as leadership’s willingness to listen. As Dr. Neil Baker writes, “psychological safety is quite fragile. People have a strong tendency to avoid speaking up about problems and disagreements.” Dr. Baker joined WIHI to address the  necessity of honest dialogue and psychological safety in the workplace, achieved in part by better understanding and successfully navigating the power dynamics that exist in every organization.  Featuring: Neil Baker, MD, Principal, Neil Baker Consulting and Coaching, LLC Featured Links: IHI Blog Post: Don't Let Your Staff Suffer in Silence Neil Baker Tool: Managing the Risks of Power IHI Framework for Improving Joy in Work

These days, US health systems are employing numerous efforts to address population health, but sometimes, these efforts fail to align. On this episode of WIHI, IHI’s Trissa Torres and Concord Hospital’s Vice President for Population Health, Betsey Rhynhart, discuss the Pathways to Population Health Compass to understand what it takes for a group to create a comprehensive, aligned population health strategy that unfolds over time.  Featuring: Betsey Rhynhart, MPH, Vice President for Population Health, Concord Hospital Trissa Torres, MD, MSPH, FACPM, Chief Population Health and Content Development Officer, Institute for Healthcare Improvement (IHI)  Featured Links: Pathways to Population Health Compass Pathways to Population Health Founding Partners Pathways to Population Health Framework

January 23, 2020 The relationship between workload and stress and the risk this poses for practitioners and patients alike need more attention. On this episode of WIHI, IHI's longtime senior safety expert Frank Federico, RPh, and James Won, PhD, talk about the field of human factors in health care, and the role that human factors can play in reducing today’s work-related stress. Featuring:  Frank Federico, RPh James C. Won, PhD Featured Links:   What is Human Factors in Healthcare? Cognitive Overload, Medical Errors, and a 5-point Communication Strategy to Help Clinicians Stay Focused. IHI's Patient Safety Executive Development Program

December 10, 2019  Featuring: John Toussaint, MD, Catalysis Executive Chairman Aravind Chandrasekaran, PhD, Academic Director MBOE, Fisher College of Business, The Ohio State University  WIHI is pleased to present a Special Edition Podcast: Creating a Culture of Continuous Improvement that Outlasts Your Leaders, featuring John Toussaint and Aravind Chandrasekaran.  We can all point to leaders who have championed improvement at our organizations, helping to move the dial and motivate many others. But too often organizations see their QI gains stall or, worse, reverse when a leader departs. Drs. Toussaint and Chandrasekaran have been studying this phenomenon and have identified evidence-based approaches that ensure a culture of improvement lasts beyond the tenure of any senior individual – and can be sustained during times of transition and succession.  This keynote was recorded on December 10, 2019, at IHI’s annual National Forum on Quality Improvement in Health Care in Orlando, Florida. The podcast is approximately one hour and six minutes; we recommend that you have the presentation slides handy for reference as you’re listening.  The first person speaking is John Toussaint. “AC” refers to Aravind Chandrasekaran.  We recommend that you have the presentation slides handy for reference.   

Thanks for listening to WIHI. As an organization dedicated to continuous improvement, we hope you will take a moment to give us feedback on this particular episode of WIHI. We’ll use this information to ensure we keep producing the high-value, cutting-edge conversations on health and patient care. Take the 1-minute survey here: ihi.org/PodcastSurvey.  Date: November 14, 2019  Featuring: Arpan Waghray, MD, System Director, Behavioral Medicine, System Medical Director, Telepsychiatry, Providence St. Joseph Health; Chief Medical Officer, Well Being Trust Scott Zeller, MD, Vice President of Acute Psychiatry, Vituity Scott M. Surico, BSN, RN, MICN, Education Coordinator for Emergency Services, Hoag Memorial Hospital Presbyterian ​Marie Schall, MA, Senior Director, Institute for Healthcare Improvement (IHI)​  Emergency departments (EDs) constantly handle behavioral health-related emergencies, but what if EDs were able to take a more proactive approach toward behavioral health patients, initiating treatment and better connecting individuals to optimal care?  Tune into this episode of WIHI, The Benefits of Behavioral Health in the ED, to hear about an eight-hospital system, 18-month IHI initiative, Integrating Behavioral Health in the Emergency Department and Upstream (ED and UP). With support from the Well Being Trust, the ED and UP initiative sought to improve ED culture surrounding patients with behavioral health issues, emphasizing trauma-informed care, and the need to build awareness of, and partner with, community resources. The WIHI panel highlights the importance of changing hearts and minds and practices in the ED with behavioral health patients when they’re most vulnerable, and the impact well-conceived interventions can have on patients, family members, and staff. Treating patients with the care most appropriate to their condition is of critical importance in health care, and we hope you’ll appreciate and learn from this WIHI. 

As an organization dedicated to continuous improvement, we hope you will take a moment to give us feedback on this episode of WIHI. Take the 1-minute survey here: ihi.org/PodcastSurvey. Featuring: Jamie Beach, BSN, RN, Quality Data Manager, Frankel Cardiovascular Center, Michigan Medicine Diane Lopez, RN, MSN, Clinical Nursing Director, Michigan Medicine Jessical Perlo, MPH, Network Director, Institute for Healthcare Improvement Caregiver burnout is well documented and on the rise. To address some of the underlying issues and improve patient and provider safety, the Institute for Healthcare Improvement (IHI) has developed a framework and set of recommendations known as "Joy in Work." Organizations across the country are testing how to apply the principles with encouraging results. If you want to learn how one clinical team at Michigan Medicine, spearheaded by Diane Lopez with help from Jamie Beach, has changed what was once a toxic culture in a medical unit, this episode of WIHI is for you.  IHI Joy In Work Tools and Resources:  The IHI Framework for Improving Joy in Work is the North Star for this work. Other key and helpful materials include: IHI Blog Post: In Defense of the Word “Joy” Journal of Healthcare Management: Why Focusing on Professional Burnout Is Not Enough NEJM Catalyst: Applying Community Organizing Principles to Restore Joy in Work IHI Tool: "What Matters to You?" Conversation Guide for Improving Joy in Work  Currently, IHI is gearing up for a Results-Oriented Learning Network around Joy in Work. The network will kick off in January 2020. Register here to save your spot in a free informational call with Network faculty on November 15, 2019, at 11:00 AM ET. Looking for in-person trainings? Join us at this year’s National Forum, where Joy in Work is a featured track. (You can browse all National Forum sessions here.) 

October 3, 2019 Featuring: Derek Feeley, President and CEO, Institute for Healthcare Improvement Helen Macfie, PharmD, Chief Transformation Officer, Providence St. Joseph Health Kelly Logue, MA, Senior Director of Affordability, HealthPartners The notion of waste in healthcare has expanded in recent years. Today, waste encompasses everything from diagnostic errors and hospital-acquired infections to EHR workarounds and staff burnout. Experts suggest this waste in the US health care system totals roughly one trillion dollars per year. And, as Derek Feeley writes in the foreword to the IHI Leadership Alliance’s Call to Action: “The most precious resources – the [health care] workforce’s time, spirit, and joy – are being unnecessarily drained by wasteful processes every day.”  So, what if this one trillion dollars could be cut in half by 2025? It’s no pipe dream if every health system doubles down. And, this episode of WIHI, Let’s Get to Work on Waste in Health Care, talks about how. Among our panelists, Helen Macfie will trace how the IHI Leadership Alliance waste workgroup arrived at its key interventions and savings calculations in the Call to Action; IHI’s Derek Feeley will share why he’s championing waste reduction in health care; and Joanna Roberts, and Kelly Logue will discuss the encouraging trajectory of current strategies in their organizations. We hope you’ll tune in.  

September 19, 2019 Featuring: Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI)​ Rear Admiral Jeffrey Brady, MD, MPH, United States Public Health Service, Director, Agency for Healthcare Research and Quality's Center for Quality Improvement and Patient Safety  Helen Haskell, President, Mothers Against Medical Error and Consumers Advancing Patient Safety Jay Bhatt, DO, MPH, MPA, FACP, Senior Vice President & Chief Medical Officer, American Hospital Association; President, Health Research and Educational Trust It’s been 20 years since the renamed National Academy of Medicine (former Institute of Medicine) first shined light on the unintended consequences of medical errors in American health care. Their report, To Err is Human: Building a Safer Health System, has served as a catalyst for safety initiatives at health systems, and progress has been made on multiple fronts — from significant reductions in health care - associated infections, to an embrace of quality improvement and patient safety solutions that now encompass the entire continuum of care. Even with this progress, obstacles to safe and reliable care persist. Systems are confronting a new payment environment, it remains difficult to sustain improvement gains, there are EHR headaches, and ongoing concerns about physician and staff burnout. These are just some of the reasons IHI convened national safety leaders and stakeholders to form the National Steering Committee for Patient Safety (NSC). Co-chaired by IHI and the Agency for Healthcare Research and Quality (AHRQ), the NSC is hard at work on a new National Action Plan it expects to release in early 2020. In light of these developments, and in support of World Patient Safety Day on 9/17, we’re focusing this edition of WIHI: No Let Up on Safety, on the work of the NSC and their bold intention to re-energize the safety movement in the US with foundational safety principles and priorities.  If you’re looking to continue the conversation, join industry leaders at this year’s IHI National Forum on Quality Improvement in Health Care and attend a special interest breakfast with members of the NSC.

Date: August 8, 2019 Featuring: Joia Crear-Perry, MD, FACOG, Founder and President, National Birth Equity Collaborative  Ebony Marcelle, CNM, MS, FACNM, Director of Midwifery, Community of Hope  Shannon Welch, MPH, Project Director, Institute for Healthcare Improvement (IHI) A significant rise in maternal deaths in the United States, especially among black women, has recently gotten a lot of public attention. According to the US Centers for Disease Control and Prevention (CDC), acute events tied to childbirth are contributing to the upward trend. Experts also highlight other factors putting black women, in particular, at risk: racism and implicit bias within health care, the daily struggles of poverty, and disregard for pregnant women’s knowledge about their own bodies and potentially dangerous symptoms.  With lives at stake, we invite you to listen to this WIHI: Black Women and Maternal Care: Redesigning for Safety, Dignity, and Respect to learn more about the issues that have led to an alarming rise in maternal mortality disproportionately impacting Black women and what can be done to reverse this trend. Dr. Joia Crear-Perry, Ebony Marcelle, and Kiddada Green are among national and local leaders of organizations that are co-creating solutions and interventions with Black women all across the US to improve the quality of support and health care surrounding pregnancy and childbirth. Shannon Welch will describe how the current partnerships and learning with IHI promise to offer new and better practices to improve outcomes and save lives.

Date: July 18, 2019 Featuring: Stephen Mette, MD, Chief Clinical Officer, interim Chief Executive Officer, Senior Vice Chancellor Clinical Programs, University of Arkansas for Medical Sciences (UAMS) Medical Center Andrea Werner, MSW, Senior Vice President, Bellin Health Systems Kalyn Witak, Talent Acquisition Specialist, Bellin Health Systems Saranya Loehrer, MD, MPH, Head of Innovation, Institute for Healthcare Improvement If you’re looking to learn more about the role health care systems can play in the efforts to improve workforce equity, then this episode of WIHI, Aim High for Equity in the Health Care Workforce, is for you. We’ll hear from two members of IHI’s Leadership Alliance: Bellin Health Systems and the University of Arkansas for Medical Sciences Medical Center (UAMS) on their work in the Alliance’s Equity Workgroup. In 2018, the Workgroup developed a Call to Action to Achieve Health Equity, pledging to create “a more diverse, inclusive, and equitable workforce in our organizations.” Health system leaders recognize the need to better understand and address the ways in which workplace inequities, e.g., low income or stagnant career growth, impact the health of the communities in which their institutions reside. IHI's Saranya Loehrer kicks off the dicusssion, followed by leaders from Bellin andUAMS who highlight the implementation details of their workplace equity efforts and share their learnings thus far.  

Victor Tabbush, PhD, Adjunct Professor Emeritus, UCLA Anderson School of Management Robert Scott Dicks, MD, FACP, Chief, Division of Geriatric Medicine and Gerontology; Director, Geriatric Me​dicine, Hartford Hospital Christine Waszynski, APRN, Coordinator, Inpatient Geriatric Services, Hartford Hospital Suzanne Engle, RN, BSN, Director of Care Coordination, St. Vincent/Ascension Jennifer Allbright, RN, BSN, Manager, Center for Healthy Aging, St. Vincent/Ascension It hasn't always been easy to talk about the business case for quality improvement, let alone isolate the financial benefit. Now, there's a way to do both, in the context of transformative, age-friendly care. On this episode of WIHI our expert panel discusses a new IHI and Age-Friendly Health Systems (AFHS) report, The Business Case for Becoming an Age-Friendly Health System, and reviews the Report’s two prominent case studies: Hartford Hospital and St. Vincent’s Hospital. The panel discusses the potential to unlock cost savings and generate new revenue through the adoption of the 4Ms Framework, all while providing safer, more appropriate care. If you’re looking to learn more about the financial benefits of being an Age-Friendly Health System, this episode of WIHI is for you.   Short description (for IHI.org preview only): What are the financial benefits of being an Age-Friendly Health System?  

May 30, 2019 Featuring: John Krueger, MD, MPH, Division Vice President for Quality, CHI Franciscan Joan Maxwell, Patient Advisor, John Muir Health Scott K. Winiecki, MD, Director, Safe Use Initiative, US Food and Drug Administration (FDA) The key components of safer acute pain management systems, along with tools and resources to support new practices, are highlighted in a new IHI report, Advancing the Safety of Acute Pain Management​. In this episode of WIHI, we dive into the report with three experts: John Krueger, Joan Maxwell, and Scott Winiecki. John and Joan discuss establishing shared expectations with their video simulation of a doctor and patient discussing her upcoming surgery,​ and Scott shines light on the work being done by the Safe Use Initiative at the FDA. Our WIHI guests all agree that health care needs to create safer processes for a patient population that is becoming more aware of the risks of opioids, more realistic about their ability to tolerate some pain, and more open to non-opioid remedies for pain management. If you’re looking to learn more about how to create these processes, then this WIHI is for you.

Date: April 18, 2019  Featuring: Thomas H. Gallagher, MD, Professor, Department of Medicine, University of Washington; Associate Chair, Patient Care Quality, Safety, and Value Allen Kachalia, MD, JD, Director, Armstrong Institute for Patient Safety and Quality; Senior Vice President for Patient Safety and Quality, Johns Hopkins Medicine Description: When a patient is unintentionally harmed during medical treatment, how should organizations respond?  Not that long ago, steps like these were unthinkable and, from a risk manager's perspective, totally unwise. Today these practices are at the core of what are called communication and resolution programs (or CRPs)​, and their architects say there's been a significant uptick in US health systems using them. Our guests are two leading experts on CRPs, Tom Gallagher and Allen Kachalia. They and a team of researchers have been teasing out the reasons why so many health care leaders are committed to the principles of CRPs, but hesitant to deploy the practices.  If you've been wondering what's been going on with CRPs and new ways forward, this WIHI is for you.

Date: March 21, 2019 Featuring: M.E. Malone, MS, MPH, Deputy Director, Betsy Lehman Center for Patient Safety Rose Hendricks, PhD, Researcher, FrameWorks Institute  William Berry, MD, MPA, MPH, Associate Director and Senior Advisor to Executive Director, Ariadne Labs​ Certain concepts have become hallmarks of improving patient safety and second nature to improvers — for example, systems thinking and building a culture of safety. However, try explaining this work to people outside safety improvement circles and you're likely to confront the reality that the degree to which health care can be unsafe and that medical errors and near misses occur is not universally shared. Or understood. The Betsy Lehman Center has been working on a multi-phase effort to better understand these disconnects and the messaging and terminology that might fix them. They've published a new report​, and we dug into the findings and recommendations on the March 21 WIHI: How to Make Patient Safety Easier to Explain and to Champion.

Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI) Angela A. Shippy, MD, FACP, FHM, Senior Vice President & Chief Quality Officer, Memorial Hermann Health System How much thought and preparation go into how you pitch new ideas and initiatives to leaders in your organization? If you've been frustrated by lack of support or buy-in from a leader, it's possible that you did not win that person over at the start. IHI's President and CEO, Derek Feeley, recently penned a blog? on the ingredients he's found can help an initial pitch succeed and was joined on this episode of WIHI, How to Speak So Leaders Will Listen, Derek was joined by Angela Shippy, Memorial Hermann Health System's Senior Vice President and Chief Quality Officer, to offer feedback on pitches from improvers in the IHI community. Together, Derek and Angela reflected on how challenging it can be to lack the backing or active involvement of leadership to pursui improvement work in health and health care, shared their suggestions and advice for getting the attention of leaders in order to spark meaningful improvement and change.    

Beth Daley Ullem, MBA, President, Quality and Safety First Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI) Ruth A. Mickelsen, JD, MPH, Senior Lecturer, University of Minnesota School of Public Health; Chair, HealthPartners Board of Directors​​​​  How well do health care boards oversee health care quality? Trustee oversight of finances has a long track record, while accountability for health care quality is relatively new and features a steep learning curve. There are hundreds of quality metrics to understand along with dozens of initiatives to improve care. Indeed, board members often complain that they're handed so much information, it's hard to ask hard questions, let alone engage in oversight.  Is there a better way for boards to fulfill their mandate of ensuring health systems live up to theirs on quality? Maybe so. The IHI Lucian Leape Institute​ has just released a white paper, that pairs a new online assessment tool with a new framework, to help boards and health care leaders work together to take a giant step forward with governance of quality. We explored those details and more on the January 17 WIHI: NEW Guidance for Governance of Health System Quality – What Trustees Should Know and Do.

Date: December 20, 2018 Featuring:Mona Hanna-Attisha, Pediatric Public Health WhistleblowerMaureen Bisognano, President Emerita and Senior Fellow, Institute for Healthcare ImprovementVania Deonizio, Healer of Forgotten Wounds Celine Gounder, Storytelling Disease Detective WIHI is pleased to present a Special Edition Podcast, Women in Action: Paving the Way for Better Care, featuring a panel of outstanding women who are creatively and effectively reshaping caregiving, and conversations about health and health care in the US and around the world. Whether itís blowing the whistle on the dangerous levels of lead in drinking water in Flint, Michigan, championing the healing powers of dance and movement in hospitals, or shining a human spotlight on disease outbreaks throughout the world, we learn from the panel that there are multiple ways to act and make a difference today. WIHI recorded this keynote panel, moderated by Maureen Bisognano, on December 11, 2018, in Orlando, Florida, at the Institute for Healthcare Improvementís 30th Annual National Forum on Quality Improvement in Health Care. You can learn more about Maureen Bisognano and the backgrounds of the keynote panelists ñ Mona Hanna- Attisha, Vania Deonizio, and Celine Gounder ñ here. [link to biosÖhave to figure out how to link to specific bios since theyíre spread out on the Forum web pages] The podcast is one hour; we recommend that you have the presentation slides (posted on this page) handy for reference as youíre listening. Vania Deonizio also shared a video about Danciní Power during her remarks. Youíll find a link to the video just below.

November 8, 2018  Featuring: ​Brent C. James, MD, MStat, Clinical Professor (Affiliated), Department of Medicine, Stanford University School of Medicine; Senior Fellow, IHI; Former Chief Quality Officer, Intermountain Healthcare Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement Kavita P. Bhavan, MD, MHS, Associate Professor Infectious Diseases, UT Southwestern; Medical Director, Outpatient Parenteral Antimicrobial Therapy Clinic, Parkland Health & Hospital System  Clinical and administrative leaders in health care know how difficult it is to shape one, unifying workplace culture. And while interdisciplinary team-based care is becoming more common in health systems, the range of people taking care of patients perform their jobs based on very different professional backgrounds and training.  Can quality improvement (QI) break down these silos? Can it nurture a new kind of culture, where QI is the knowledge that unites clinicians in the common pursuit of better clinical decision making and encourages more clinicians to take the lead with improving care delivery? There’s evidence to suggest yes.  Whether the issue is curbing overdiagnosis and overtreatment; reducing waste, costs, and patient suffering; or factoring in “what matters” to a patient when considering treatment options, clinicians who are improvers can lead the way. We explored this topic and more on the November 8 WIHI: Building the Will and Skill to Be a Clinical Improver.

Date: October 25, 2018  Featuring:  Andrea Tull, PhD, Director of Reporting and Analytics, Edward P. Lawrence Center for Quality & Safety, Massachusetts General Hospital (MGH)   Aswita Tan-McGrory, MBA, MSPH, Deputy Director, The Disparities Solutions Center Initiatives to reduce avoidable readmissions are the norm in US health systems today, particularly because Medicare fines hospitals with higher-than-expected rates. Health care leaders also recognize that when patients are readmitted to the hospital within 30 days of discharge, it usually indicates that processes are not what they should be. In addition, health care organizations have come to appreciate that non-clinical issues, often referred to as social determinants of health, have a great bearing on rehospitalizations — everything from poor housing to unstable income to food insecurity. Collecting data to better assess the impact and better address these determinants to prevent readmissions is ongoing. We gained gain some valuable insights into the efforts of a major health care system in Massachuestts and their learning curve on the October 25 WIHI: Lowering Readmissions, Reducing Disparities. 

Date: September 13, 2018 Featuring: Nicole Brandt, PharmD, MBA, BCGP, BCPP, FASCP, Executive Director, Peter Lamy Center on Drug Therapy and Aging; Professor, University of Maryland School of Pharmacy  Florian Daragjati, PharmD, BCPS, Director, Ascension Center of Excellence for Antimicrobial Stewardship and Infection Prevention Lynn Deguzman, PharmD, BCGP, Regional Clinical Operations Manager, Kaiser Permanente Leslie J. Pelton, MPA, Senior Director, Institute for Healthcare Improvement Leanne Phillips, PharmD, BCPS, Clinical Pharmacy Coordinator, St. Vincent’s East, Ascension The ground is shifting for prescription medication in the US and Canada, and in other countries, too. There’s much talk and publicity about weaning people off drugs, or what is referred to as “deprescribing”: a process that entails taking patients off some of their medications or tapering down the dosages. The underlying reasons for deprescribing include concerns about polypharmacy, especially the impact on older and frail adults; antibiotic resistance caused by inappropriate and excessive use; and the ongoing opioid epidemic connected to years of overprescribing highly addictive medicines for pain. A growing number of health care organizations are working with IHI on how to safely implement deprescribing. Learn about their experiences and the future of this work on the September 13 episode of WIHI, The How and Why of Deprescribing,

Date: August 9, 2018   Featuring: Barbara Balik, RN, EdD, Co-Founder, Aefina Partners, and Senior Faculty, Institute for Healthcare Improvement (IHI) Kris White, MBA, RN, Co-Founder, Aefina Partners, and Faculty, IHI Helen Macfie, PharmD, FABC, Chief Transformation Officer, MemorialCare   Most hospitals are understandably preoccupied with patient experience scores. High-performing organizations worry when their scores plateau, and those with mediocre scores wonder why their attention to better "customer service" hasn't improved the numbers. Up and down the rankings, there's discussion about patients as unreliable informants, flawed survey instruments, low survey response rates, and institutions being judged unfairly by these scores.   A decade into publicly reported patient experience data for US hospitals (most notably with HCAHPS​), experts say that health systems are working on patient experience too much in isolation, separate from other organizational strategic aims. If you're tired of the same old discussion about patient experience scores, we hope you'll listen the new ideas and best practices presented on the August 9 WIHI: Connecting Patient Experience to Culture and Strategic Aims.  

Scott Zeller, MD, Vice President of Acute Psychiatry, Vituity Robin Henderson, PsyD, Chief Executive, Behavioral Health, Providence Medical Group Oregon and Clinical Liaison, Well Being Trust Vera Feuer, MD, Director of Pediatric Emergency Psychiatry, Northwell Health Mara Laderman, MPH, Director for Innovation, Institute for Healthcare Improvement (IHI)​   ​For all that emergency departments (EDs) do to stabilize individuals and save lives, they’ve never been the ideal place for patients whose crises are related to behavioral health. EDs are designed to address the most urgent, sometimes life-threatening problems, and then discharge or transfer patients to the appropriate next level of care. If a psychiatric or addiction-related admission is needed, however, there may not be any beds. This often leads to boarding patients in the ED or adjacent hallways for hours, sometimes days. ​   In the US, many blame an underfunded mental health system for the shortage of inpatient beds and an inadequate supply of outpatient services that might help patients avoid going to the hospital altogether. Emergency department staff aren't any happier with the status quo. They have begun to look at how EDs might improve the overall care experience for behavioral health patients and contribute to continuity of care.   Promising new practices are being tested in nine hospitals participating in Integrating Behavioral Health in the Emergency Department and Upstream​, an initiative led by IHI in partnership with Well Being Trust​. Improvements these hospital EDs are testing include creating new lines of communication and care coordination, including post-discharge follow-up, with community-based services; standardizing and streamlining processes from intake to discharge for a range of mental health and substance abuse issues; working with both patients and their family members on self-management skills; and educating ED staff on behaviors consistent with a trauma-informed and empathetic culture.   We dicsussed these tests and innovations on the July 12 episode of WIHI: How to Build a Better Behavioral Health in the Emergency Department

Corey Waller, MD, MS, FACEP, DFASAM, Addiction, Pain, Emergency Medicine Specialist; Managing Partner, Complex Care Consulting, LLC; Chair, Legislative Advocacy Committee for the American Society of Addiction Medicine (ASAM) Catherine Mather, MA, Director, Institute for Healthcare Improvement (IHI)   About 5 percent of patients in the US are individuals with complex needs. Many show up at hospital emergency departments with a combination of physical, socioeconomic, and behavioral health issues — only to return, again and again, sometimes in worse condition, because the current system isn't set up to address a multitude of problems. The burgeoning field of "complex care" is trying to break the cycle with new interventions and stronger connections to supportive services.  . But addiction, a common thread among the complex patient population, is often dealt with differently. While the recent opioid epidemic has forced health care providers to change some of their prescription practices and to become more knowledgeable about substance use disorders in general, patients themselves are still typically 'referred out' for treatment — to a much less integrated and accessible system, already stretched to its limits.​ What could the health care system offer that it's not offering now? We explored that and more on the June 21 episode of WIHI: Addiction Treatment Demystified: Proven, Practical Steps for Complex Care.​​

Saranya Loehrer, MD, MPH, Head of the North America Region, Institute for Healthcare Improvement (IHI) Christina Lundquist, BA, MHS, Vice President of Operations, Rainbow Babies and Children's Hospital and MacDonald Women's Hospital at University Hospitals (UH) Health System Lora Council, MD, MPH, Senior Medical Director for Primary Care, Cambridge Health Alliance ​   Health systems face numerous challenges in their efforts to improve population health. Among them, multiple entry points, such as initiating better care management for all patients with chronic asthma, widespread depression screening, or working with the community to address food insecurity. Each initiative is valuable yet, taken together, don't necessarily add up to a comprehensive population health strategy. Is there a logic to what to do first, then second, and so on? How do you know you're on the right track?   There are no simple answers, but there has been enough experience with population health in the US and elsewhere that several groups, including IHI, have come up with four portfolios of work to help organizations become more strategic about their efforts. With the help of new resources​, we discussed these four "pathways" and with two health systems that are deeply engaged in improving population health on the June 7 episode of WIHI: Strategic Pathways to Population Health.

Amar Shah, Consultant Forensic Psychiatrist & Chief Quality Officer, East London NHS Foundation Trust ​Lindsey Bourne, Director of Education, PFCCpartners Barbara Grey, Director SLaM Partners & Quality Improvement (QI), South London and Maudsley NHS Foundation Trust Sarah Davenport, Service User Consultant, South London and Maudsley NHS Foundation Trust ​Gabrielle Richards, Head of Inclusion, Recovery, Occupational Therapy, and Allied Health Professionals, South London and Maudsley NHS Foundation Trust​   Patients and families are playing a greater role in health care quality improvement. Over the last decade participation has grown to include serving on Patient and Family Advisory Committees, or PFACs; regularly meeting with hospital board safety and quality committees; joining co-design and co-production initiatives; and speaking or leading sessions at QI conferences.  Along the way, there's been some exposure to QI principles and methods, but now some organizations believe it's essential for patients and families to have training in basic improvement to enhance their influence and involvement. On the May 17 episode of WIHI, Giving Patients and Families the Tools to Be Health Care Improvers, we discussed getting improvement basics into the hands of patients and their families with East London NHS Foundation Trust and South London and Maudsley Trust and how "service users" have become involved in nearly half the improvement projects happening at their organizations.

Date: May 10, 2018 Featuring: Michael Rose, MD, Anesthesiologist, Vice President of Surgical Services & Chairperson of Community Board of Trustees, McLeod Regional Medical Center ​Kate B. Hilton, JD, MTS, Faculty, Institute for Healthcare Improvement; Senior Consultant, ReThink Health​ Alex Anderson, Research Associate, Institute for Healthcare Improvement For the past 30 years, the Institute for Healthcare Improvement (IHI)​ has worked with organizations around the world to improve health and health care using an approach to quality improvement that's grounded in W. Edwards Deming's System of Profound Knowledge. Dedicated improvers know that, to achieve results, we need to consistently apply systems thinking, an understanding of variation, and theories of knowledge. So, what often stands in the way of adopting and spreading meaningful improvements? Breaking news: People are resistant to change. Deming himself stressed the importance of psychology — or the adaptive, human side of change — in his System of Profound Knowledge. But health care improvers still have a lot of work to do to sharpen our thinking, vocabulary, and tools in this challenging domain. That's why the IHI Innovation Team has been researching and testing "psychology of change" ideas and methods to promote and accelerate successful, scalable, and sustainable improvement work. Kate Hilton and Alex Anderson described how they are working with organizations to implement the IHI Psychology of Change Framework, and Dr. Michael Rose discussed implementing many of these methods to spread the use and adoption of a surgical safety checklist at McLeod Regional Health Center in Florence, South Carolina on this episode WIHI: How to Make Change Happen: An Introduction to IHI's Psychology of Change Framework. 

Date: April 19, 2018   Featuring: Julie Kennedy Oehlert, DNP, RN, Chief Experience Officer, Vidant Health Jermaine McNair, Executive Director, NC CIVIL Jafet Arrieta, MD, MMS, Director, Institute for Healthcare Improvement (IHI) Meghan Hassinger Welch, MBA, Senior Project Manager, IHI   Eight health systems are working with IHI to broaden their impact on health equity as part of the two-year Pursuing Equity initiative​. These systems are working to elevate health equity to a strategic priority, confront institutional racism, and improve the livelihood and health of their patients, employees, and surrounding communities. Vidant Health​, based in Greenville, North Carolina, is a 1,447-bed health system serving more than one million patients each year from 29 eastern North Carolina counties. This part of the state is largely rural, poor, and home to a racially diverse population. Vidant's health equity priorities are centered on improving the health and wellbeing of their patients and — as the largest employer in Greenville — some 12,000 employees, many of whom live in nearby cities and towns. Vidant's efforts to improve equity also benefit from a strong partnership with NC CIVIL​, a nonprofit grass roots community development organization in Greenville. Jermaine McNair, its Executive Director, will discuss their focus on strengthening economic, social, political, and legal processes in the community and how working with Vidant Health is helping on all these fronts on this episode of WIHI, Pursuing Equity in North Carolina.

Date: April 5, 2018 Featuring: James L. Reinertsen, MD, The Reinertsen Group Ronette Wiley, RN, BS, MHSA, CPPS, Executive Vice President, COO, Bassett Medical Center Helen Mackie, MB, ChB, FRCP, Consultant Gastroenterologist, University Hairmyres Hospital, NHS Lanarkshire; National Clinical Advisor for "Realistic Medicine," Scottish Government The safety huddle​ has become an important way for hospitals to surface safety concerns affecting patients and the workforce. The best huddles are multidisciplinary, highly structured, brief (15 minutes or less), take place early in the morning and focus on incidents from the day before and risks to safety in the day ahead. Is the safety huddle effective? Have organizations grown lax with the process over time? Some participants have observed that, over time, safety huddles tend to become "just another meeting" or "another box to check off." Dr. James Reinertsen, who has spent decades coaching clinical leaders and staff about safety, says too many huddles allow department leads to report "no safety issues today." That's impossible, says Reinertsen. Every department has safety risks; it's a matter of being proactive and looking for them. On this episode of WIHI, Sustaining and Strengthening the Safety Huddle, we discussed two strong examples of safety huddle programs at two different health systems: Ronette Wiley shared the story of the turnaround with the safety huddle​ and the tools they use​ at Bassett Medical Center in upstate New York, and Dr. Helen Mackie educated us about the safety huddle at Hairmyres Hospital in Scotland where issues are flagged daily in a rigorous process known as The Onion​. 

Date: March 22, 2018 Featuring: ​Mary Tinetti, MD, Gladys Phillips Crofoot Professor of Medicine (Geriatrics) and Professor, Institution for Social and Policy Studies; Section Chief, Geriatrics (co-chair) Marie Cleary-Fishman, BSN, MS, MBA, CPHQ, CPPS, CHCQM, Vice President, Clinical Quality, Health Research & Educational Trust (AHA) J. Michelle Moccia, DNP, ANP-BC, CCRN, Program Director, Senior Emergency Center, St. Mary Mercy Hospital (Trinity Health) Belinda Dokic, CPht, BA, MBA, Quality Performance Improvement Leader, St. Mary Mercy Hospital (Trinity Health)  Preventing injuries from falls, especially among the elderly, has been a flagship issue for health care quality improvement and patient safety for nearly two decades. The complications that can follow broken bones at an advanced age, most notably a broken hip, can literally be deadly. This reality, numerous programs, and reporting requirements have kept falls prevention front and center across the health care continuum. Now a new initiative wants to emphasize the physical and mental health benefits of mobility, and encourage greater mobility for older patients in conjunction with falls prevention, as part of a broadening vision of "age-friendly" care​. We explored what this looks like in practice, starting with the hospital setting, on the March 22 episode of WIHI: Mobility Matters for Age-Friendly Care.

Date: March 8, 2018 Featuring: Kate FitzPatrick, DNP, RN, ACNP, NEA-BC, FAAN, Chief Nursing Officer, University of Vermont Medical Center Teri Pipe, PhD, RN, Dean, College of Nursing & Health Innovation and Chief Wellbeing Officer, Arizona State University​ Part of the appeal of mindfulness​ is the simplicity of its central tenet: bringing awareness and focused attention to the present moment. Mindfulness also offers a measure of control when everything else feels out of control. As stress-reduction and other health benefits of mindfulness become better known, clinicians are discovering that they, too, need new ways to deal with stress…often on the fly. Practicing mindfulness can be restorative in the middle of a hectic day, create mental space to be more tuned into patients, and reduce the likelihood of medical errors. So, what does practicing mindfulness look like, in practice? On the March 8 episode of WIHI, Mindfulness and Patient Safety, we learned from two leading experts on how mindfulness can intersect with the health care workforce, their tasks, and their interactions with patients.

Date: February 22, 2018 Featuring: Sarah L. Szanton, PhD, ANP, FAAN, Associate Director for Policy, Center on Innovative Care in Aging, Department of Health Policy and Management, & Johns Hopkins Bloomberg School of Public Health Judith Kell, MPA, Manager, Pathways to Better Health, Mercy Health Gary Felser, ME, Construction Supervisor, Elder Services at Civic Works One of the biggest challenges facing older patients with disabilities is that the care and support services needed to function optimally at home are often fragmented — and not always obtainable. Thi​s is especially true for low-income disabled adults whose home circumstances may not fit the bill, literally and figuratively, for what public insurers such as Medicaid and Med​icare will cover. In a handful of communities in the US, a program called CAP​ABLE​ is demonstrating low-cost, practical ways to fill the void. The research into the health benefits and cost savings associated with CAPABLE are yielding impressive results. Learn how the model works and how it might be spread to other communities on this episode of WIHI: Aging in Place with a Disability and Dignity

Date: February 8, 2018 Featuring: Gordon Schiff, MD, Associate Director, Brigham and Women's Center for Patient Safety Research and Practice; Quality and Safety Director, Harvard Medical School (HMS) Center for Primary Care Christine K. Cassel, MD, Executive Advisor to Founding Dean, Kaiser Permanente School of Medicine Bruce Lambert, PhD, Director, Center for Communication and Health, Northwestern University We don’t like to think of the diagnosis process as causing as many problems as it’s trying to solve. But when the complaints are more chronic than acute, there’s growing concern that a plethora of diagnostic tests and procedures have raised expectations of always finding a precise answer or explanation. When that's not possible, or tests aren't recommended as the first line of attack, a provider's clinical observations and reasoning can seem less than satisfactory. It’s this complexity of diagnosis and the difficulty of sometimes having to admit "there's no way to know for sure" that we explored on the February 8 WIHI: Practicing More Careful and Thoughtful Diagnosis. Our guests shared new thinking about better ways to engage with patients when diagnostic certainty isn't possible and how to create strong, trusting relationships that break from the mold of  “doing something” or “doing nothing at all.”

Date: January 25, 2018 Featuring: ​ David M. Williams, PhD, Executive Director for Improvement Capability, Institute for Healthcare Improvement (IHI) Petrina McGrath, RN, MN, PhD, Executive Transition Lead: People, Practice and Quality, Saskatchewan Health Authority James Moses, MD, Chief Quality Officer and Vice President of Quality and Safety, Boston Medical Center  Health care systems are under tremendous pressure to create and sustain transformative changes on multiple fronts: patient and worker safety, overall quality of care, moving from volume to value, and population health, just to name a few! The job of overseeing these efforts, and nurturing the culture and vigilance required to stay on track, is increasingly the province of the Chief Quality Officer or CQO.  In many ways, the CQO functions as symbol, sense maker, and keeper of the flame for constant, unwavering, system-level change. The CQO also often marries quality aims with an organization's financial and strategic goals. He or she cannot spearhead these efforts alone, and field research suggests that having a designated CQO position sends the message to staff that leadership takes quality seriously.  The CQO role is relatively new and still evolving​; in some organizations CQO-like responsibilities reside with an Executive Vice President, CMO, or CNO. Regardless of who is serving in this leadership position, it's important to ask: What do CQOs need to focus on most? We learned how some CQOs define their roles and priorities on the January 25 WIHI: What's in a Name? Health Care's Chief Quality Officer. ​​  

Date: January 11, 2018   Featuring:  ​​Glenn Crotty, Jr., MD, FACP, Clinical Associate Professor of Medicine, West Virginia University; Executive Vice President and COO, Charleston Area Medical Center (CAMC) Robert B. Saper, MD, MPH, Associate Professor Family Medicine, Boston University; Chair, Academic Consortium for Integrative Medicine & Health Shane Coleman, MD, MPH, Division Medical Director, Behavior Services Division, Southcentral Foundation​ Mara Laderman, MSPH, Director, Innovation, Institute for Healthcare Improvement (IHI)​​ As efforts continue to curb the opioid addiction epidemic in the US and reduce deaths from overdoses​, the underlying problem of overprescribing remains very much in the spotlight. There's growing evidence that clinicians writing prescriptions for Vicodin, Percocet, OxyContin, and the like are adhering to new, stricter guidelines, and doing a better job keeping track of their patients taking opioids.    But with these changes in prescribing, experts and providers are now looking to alternative ways to treat chronic and severe pain, especially for people vulnerable to addiction. On the January 11 episode of WIHI, we talked to providers from West Virginia, Alaska, and Massachusetts about new processes to help providers make careful decisions about the use of opioids, including expanding the use of physical, traditional, and integrative medicine as alternatives to prescribing opioids. We were joined by IHI Director Mara Laderman, co-author of IHI's ​Addressing the Opioid Crisis in the United States white paper​,  who helped draw connections between improving pain managemnt and the other critical drivers of the opioid crisis in America.    We looked at what these providers and organizations are doing to improve pain management and combat the opioid crisis and more on this episode of WIHI: Opioid Crisis: Changing Habits and Improving Pain Management. ​

Date: December 21, 2017 Featuring: Steve Spear, DBA, MS, MS, Principal, The High Velocity Edge, LLC; Author; IHI Senior Fellow WIHI is pleased to present a Special Edition Podcast, Discovering Your Way to Greatness, featuring author and operations expert, Steve Spear. Steve Spear, DBA, MS, MS, is principal of The High Velocity Edge, LLC, which provides advisory services and has developed software that enables accelerated problem solving, particularly with distributed workforces. His book, The High Velocity Edge, has won numerous awards. Dr. Spear is a Senior Lecturer in MIT’s Management and Engineering schools, a faculty affiliate at Harvard Medical School and a Senior Fellow at the Institute for Healthcare Improvement. He is an internationally recognized expert on leadership, innovation, and operational excellence, and an authority on how select companies in various industries generate unmatchable performance by converting improvement and innovation from inspiration to repeatable, broad-based, skill-based disciplines. WIHI recorded Steve Spear’s remarks on December 11, 2017, in Orlando, Florida, at the Institute for Healthcare Improvement’s 29th Annual National Forum on Quality Improvement in Health Care. Dr. Spear has a well-deserved reputation as an engaging speaker who equally draws on his own life experience and work with multiple industries to point out that better ways to do things are absolutely within reach. Solutions often reside in the new behaviors we’re willing to adopt. Steve Spear is passionate about improving health care so great care occurs as advertised, every time, all the time.   The podcast is one hour; we highly recommend that you have the presentation slides (posted on this page) handy for reference as you’re listening. 

Date: December 7, 2017 Featuring:  ​​Victor Montori, MD, Professor of Medicine, Mayo Clinic Maggie Breslin, MDes, Director, The Patient Revolution Kerri Sparling, Diabetes Advocate; Creator and Author, Six Until Me When Dr. Victor Montori first started talking about Minimally Disruptive Medicine ​more than a decade ago, he shook the establishment. Dr. Montori, who works with patients with diabetes, had come to believe that shared decision making – an effort to help patients make informed decisions about managing their health problems – wasn't proving all that effective. Dr. Montori felt doctors and nurses weren't factoring in the burden of being a patient with a chronic condition, and the real life challenges – social, economic, or personal – of following prescribed treatment plans. It was time, he argued, for providers to look up from strict protocols and guidelines long enough to get curious about their patients' lives in order to minimize barriers to better health, not add to them.    Fast forward to 2017 and Dr. Montori is more convinced than ever that health care providers need to learn from patients and not the other way around. And to appreciate the circumstances in patients' lives that can compete with managing a chronic condition. This outlook is fundamental to the work of the KER Unit​ Dr. Montori founded at Mayo, the more patient-driven shared decision making​ he now promotes, and a new effort he's dubbed "a patient revolution for careful and kind care." The latter is the focus of a new website​ with recommended reading, tools, and activities.   Dr. Montori and his colleagues joined us to discuss this revolution on the December 7 WIHI: The (Careful and Kind) Patient Revolution.

Date: November 9, 2017 Featuring: Lindsay A Martin, Founder, I-Squared Consulting Group; Instructor, T.H. Chan School of Public Health, Harvard University Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement (IHI) John Whittington, MD, Senior Fellow, IHI; Lead Faculty, IHI Triple Aim ​ The health care quality improvement movement has rallied around some significant innovations over the years, many of which have had a lasting impact. The failure of most hospitals to make real progress on reducing hospital-acquired infections led IHI to launch the 100,000 Lives Campaign​ in 2004. The IHI Open School​ was launched in 2008 to fill in for what too many medical educators were failing to do: incorporate quality and safety into their health professions educational curricula. Frustration with the slow pace of change is often grist for innovation. Ten years ago IHI chartered an R&D team to engage in a regular, rigorous process of examining and testing new ideas and models for their potential to further QI and improve health and health care. To acknowledge the anniversary, we took a look back at some of what's been catalyzed by IHI's Innovation team, IHI innovations that predate the team's work, and where we still need new approaches. This and more on the November 9 episode of WIHI: Health Care Innovation and R&D - Taking Stock at Ten Years.

Date: October 26, 2017 Featuring: Fred E. Shapiro, DO, Chair, ASA Committee on Patient Safety and Education; Founder, Institute for Safety in Office-Based Surgery ​Alexander Hannenberg, MD, Faculty, Safe Surgery Program, Ariadne Labs; Chief Quality Officer, American Society of Anesthesiologists Jennifer Lenoci-Edwards, RN, MPH, Executive Director, Patient Safety, Institute for Healthcare Improvement These days, no one thinks twice about getting a mole removed or undergoing cataract surgery outside of a hospital. Heading to an office practice or an ambulatory care center for what's considered "minor surgery" tends to be more convenient for the patient and often more cost effective. According to recent figures, upwards of 20 million outpatient procedures are performed in the US each year — everything from cosmetic to knee to eye surgeries. As the numbers rise, so do concerns about safety. While serious harm, including deaths, remains uncommon in outpatient settings, adverse events can and do occur. When anesthesia is part of the surgical procedure, clinicians and staff need to know about the complications that might arise requiring immediate, lifesaving steps. What are the complications? What are the specific steps? It's all laid out in a new checklist on this episode of WIHI: A New Emergency Checklist for Office-Based Surgery.    

Date: October 12, 2017 Featuring: Jake Maguire, MA, Principal, Community Solutions, Built for Zero Beth Sandor, Principal, Community Solutions, Built for Zero Nate French, Senior Improvement Advisor, Community Solutions Ninon Lewis, MS, Executive Director, Institute for Healthcare Improvement On any given night of the year, the nation's homeless veterans number around 40,000; another estimated 84,000 fit the definition of chronically having no place to live. Frustrated by the seemingly entrenched situation, a group called Community Solutions​has been using tools and methods and campaign-style momentum adopted from IHI and the health care quality improvement movement to decrease homelessness in the US. Their improvement science approach coupled with a strategy called Built for Zero​ is leading to impressive results. Community Solutions has taken a rigorous, relentless, real-time, data-driven approach — including careful tracking of individuals by name, and the engagement of a wide range of social services and supports — and they're demonstrating that homelessness can be dramatically reduced. On this episode of WIHI, Jake Maguire, Beth Sandor, and Nate French from Community Solutions  describe communities how they have increased their monthly rates of housing homeless individuals by an average of 266% over four years.

Date: September 28, 2017 Featuring:  Derek Feeley, President and CEO, Institute for Healthcare Improvement (IHI) Jessica Perlo, MPH, Director, IHI Barbara M. Balik, EdD, MS, RN, Co-Founder, Aefina Partners, and Senior Faculty, IHI Julie Mann, CNM, MSN, Assistant Director of Midwifery, Project Manager of Quality Improvement on Labor and Delivery, Mount Auburn Hospital ​Burnout among health care professionals is quite real. At times the extent of reported stress and discontent​ seems so overwhelming, it's hard to know how to intervene in any meaningful way. Yet, many are trying.   IHI and improvement colleagues have been looking hard at the issues surrounding burnout in health care for the past three years. The result is an action-oriented framework and a new IHI White Paper, IHI Framework for Improving Joy in Work, to help leaders and managers more effectively engage with physicians, nurses, and staff in order to find out what gets in the way of joy in work — and to develop solutions together. We assembled a great panel to address these issues and more on this episode of WIHI, How to Beat Burnout and Create Joy in Work.  

​Date: September 15, 2017 Featuring: Tejal K. Gandhi, MD, MPH, CPPS, Chief Clinical and Safety Officer, Institute for Healthcare Improvement (IHI) James B. Conway, MS, Current Board Chair of Quality of Care Committee, Lahey Health System; Trustee, Winchester Hospital; Former Senior Vice President, IHI; Former COO and EVP, Dana-Farber Cancer Institute Stephen E. Muething, MD, Co-Director, James M. Anderson Center; Professor of Pediatrics & Michael and Suzette Fisher Family Chair for Safety, Cincinnati Children's Hospital Medical Center What do we need and expect from trustees of health systems when it comes to their oversight of quality and safety? It's a question that's getting increased attention because board members aren't typically sought out or sufficiently trained for this type of expertise. Greater granularity and constant exposure aren't always the answer. Indeed, board meetings are often filled with lots of quality and safety data and other metrics that many members can't easily navigate, let alone discuss and act upon. With a growing consensus that quality and safety must become a more prominent part of board education and continuous shared learning among all leaders, this doesn't have to be the case. The latest thinking on effectively engaging boards in quality and safety was our topic of discussion on the September 15 WIHI: Tuning Up Health System Boards for Patient Safety.

Date: August 24, 2017 Featuring: Michael Hanak, MD, FAAFP, Associate Chief Medical Informatics Officer, Ambulatory Care & Assistant Professor, Family Medicine, Rush University Medical Center Michelle Morse, MD, MPH, Founding Co-Director, Equal Health; Assistant Program Director, Brigham and Women's Internal Medicine Residency Program Abigail Ortiz, MSW, MPH, Director of Community Health Programs, Southern Jamaica Plain Health Center Amy Reid, MPH, Director, Institute for Healthcare Improvement (IHI) While there are many ways to improve health equity, few recognize the importance of curiosity as part of this work. For instance, you may have a lot of solid data pointing to outcomes disparities in your health system by race, ethnicity, and other factors. But what's behind the numbers that may be contributing to health inequities in your specific patient population and community? Are there dynamics in play that no one's considered before? Our guests are from health system teams participating in IHI's two-year initiative known as Pursuing Equity​, which is focused on deepening and broadening work to improve health equity at the clinical, institutional, and community level. At Rush University Medical Center in Chicago, this means taking steps to uncover what's behind pronounced racial and ethnic disparities in cardiovascular outcomes and care. In Boston, Brigham and Women's Hospital has teamed up with the Southern Jamaica Plain Health Center, a nearby community clinic, to tackle health equity and the complex relationship that exists between big teaching hospitals and surrounding low-income neighborhoods, including the local health center. It's no small feat when leaders from big institutions decide that in order to more effectively work together on health equity for patients, they need to first look at themselves to reduce power imbalances and institutional racism. Why is this a groundbreaking step? And What does health equity look like in your community and where you work? In what ways is your organization making health equity a strategic priority? We addressed these questions and more on the August 24 WIHI: Pursuing Health Equity with Curiosity — Notes from New Initiatives.

Date: August 10, 2017 Featuring:  Pat Folcarelli, RN, PhD, Interim Vice President, Silverman Institute for Health Care Quality and Safety, Beth Israel Deaconess Medical Center (BIDMC) Marsha Mauer, RN, MS, Chief Nursing Officer and Senior Vice President, BIDMC Christopher Casey, Director of Security Services, BIDMC Violence against medical staff is on the rise in the US. The circumstances, sources, and types of violent behavior vary — everything from verbal threats to deadly shootings. According to the Bureau of Labor Statistics, around 50% of all workplace assaults occur in health care settings and some studies​ put the number even higher. While most health care-related incidents occur in hospital emergency departments or on psychiatric wards, violent acts and threats can happen in any care setting and caregivers are increasingly concerned for their safety.    In response to this situation, The Joint Commission​, the American Hospital Association​, the American Nurses Association​, the American Medical Association​​, and other major health care organizations are developing new violence-prevention resources, highlighting health systems with notable programs and solutions. Beth Israel Deaconess Medical Center (BIDMC) in Boston is one such organization and joined us on WIHI to share the solutions they've developed on this episode of WIHI: Workplace Violence in Health Care Can't Be the Norm

Date: July 13, 2017 Featuring: Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement (IHI) ​Kavita Bhavan, MD, MHS, Director of Infectious Diseases/OPAT Clinic, Parkland Center for High Impact Clinical Outcomes Studies, Associate Professor Internal Medicine, UT Southwestern Medical Center​ Alex Anderson, Research Associate, IHI Patients undergoing dialysis typically do so in a hospital or health care facility. Most people don't question the need to have experienced health care staff on hand or what's considered a safe environment for the treatments. But that might be changing. A growing number of patients in Sweden have 24/7 access to special units at health systems where they schedule and conduct their hemodialysis themselves. And, inspired by Sweden, a small number of US nephrology centers are trying something similar. Even more ambitious: One of the largest safety net hospitals in the US has been teaching a few thousand patients how to administer their own IV antibiotics at home. A team at Parkland Health and Hosptial System in Dallas, led by WIHI guest Dr. Kavita Bhavan, wanted to see if a population of patients without health insurance, whose multiple hospital days on an antibiotic drip weren't being reimbursed by anyone, might do as well and maybe even better than patients with insurance, receiving nurse-assisted IV antibiotic therapy at home, at an infusion center, or skilled nursing facility. The answer seems to be, "Yes." This is patient engagement at a whole new level. Listen to this episode of WIHI to hear more about this groundbreaking quality improvement work.

Date: June 29, 2017 Featuring: Soma Stout, MD, MS, Vice President, Institute for Healthcare Improvement (IHI) Aimee Budnik, Director, Summit County Pathways HUB, Akron Summit Community Action, Inc. Kim Fairley, Care Management Supervisor, North Colorado Health Alliance Paul Howard, MPA, Director of Community Initiatives, 100 Million Healthier Lives, IHI Learning from failure is an important part of the quality improvement process in health care. Groups focused on improving the health of communities are equally discovering the value of "failing forward," as it's sometimes called — that is, leverage the learning from failure to accelerate progress — especially as many are going about the work in decidedly new ways. On the June 29 WIHI, How to Fail Forward (Quickly) On the Road to Population Health, we looked in on two communities who emerged from a boot camp of sorts known as Spreading Community Accelerators through Learning and Evaluation, or SCALE. Funded by the Robert Wood Johnson Foundation and part of the larger 100 Million Healthier Lives initiative, SCALE comprises 24 communities who have spent the past 24 months learning new leadership skills and, for the first time, improvement methods to deepen their work on a range of community health issues. SCALE communities are engaged with everything from reducing chronic disease among homeless women and decreasing teen pregnancy, to replacing food deserts with affordable, healthy options, to building greater resiliency among children traumatized by violence.  

Date: June 14, 2017 Featuring:  Christina Pagel, PhD, MSc, IHI Fellow and 2016-2017 Harkness Fellow in Health Care Policy and Practice (Commonwealth Fund) Jennifer Reed Beloff, RN, MSN, APN, Executive Director of Quality, Brigham and Women's Hospital Dorien Zwart, MD, PhD, 2016-2017 Harkness Fellow in Health Care Policy and Practice (Commonwealth Fund) ​Learning from failure is an important part of quality improvement in health care. But what can we learn from improvement efforts that languish or stall due to the inglorious nature of the work itself?  This issue has caught the attention of a researcher and a physician who argue in arecent article in NEJM Catalyst that not all QI initiatives are created equal; some are inherently more interesting and enjoy a higher profile in an organization (e.g., reducing sepsis), while other projects, no matter how necessary (e.g., decreasing patient no-shows), occur out of the spotlight, are tedious and, sometimes, just plain boring. Is that a fair characterization of what goes on in your organization? Would you put it another way?  Of course, what's boring is often in the eye of the beholder. Developing the technological and administrative processes needed to get information from primary to acute care — and the other way around — in a timely, accurate fashion may cause the eyes of some members of your clinic staff to glaze over, while others are completely energized. We discussed navigating that dynamic with our guests on the June 14 episode of WIHI.

​​​​​​​​​​​​Date: June 1, 2017 Featuring:  Bob Wachter, MD, Chair, Department of Medicine at the University of California, San Francisco Tejal Gandhi, MD, Chief Clinical and Safety Officer, Institute for Healthcare Improvement Technology is everywhere in health care — and for many reasons, that's a good thing. It's fast, it's efficient, and it can reduce errors. And yet, technology is not a cure-all. It can make people complacent, introduce new errors, and get in the way of meaningful face-to-face interactions.   World-renowned patient safety experts Bob Wachter and Tejal Gandhi shared what they're learning about technology's impact (both positive and negative) on our industry. Wachter, the author of The Digital Doctor, discussed the computer's role in the exam room, the potential of electronic health records, the exciting world of wearables, and the patient and provider frustrations technology is causing. Gandhi, former president of the National Patient Safety Foundation and part of the expert panel that created Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human, honed in on technology's growing influence on patient safety.    Technology is here to stay and we need to learn how to get the most value from the digital world that health care increasingly relies upon. That was the  focus of our conversation on the June 1 WIHI, The Digital Transformation: How Technology Is Helping (and Hurting) Health Care. 

​Date: May 18, 2017 Featuring:  ​David M. Williams, PhD, Executive Director & Improvement Advisor, Institute for Healthcare Improvement Susan Hannah, Head of Improvement Programmes, Early Years Collaborative & Raising Attainment for All, Scottish Government At IHI, we do our best to keep our fingers on the pulse of the health care improvement world — what trends are emerging, what projects are happening, and what improvers need to do their work. And improvement tools clearly make a difference. In fact, in March of this year, in just one month, you downloaded IHI’s tools about 16,500 times. So, for this WIHI, we want to make sure you’re getting the most out of them, and when to use these tools in your improvement work. With guidance from improvement experts David Williams and Susan Hannah, we tackled those questions and more on the May 18 WIHI, Seven Popular Improvement Tools: How (and When) to Use Them. Wondering what improvement tools we focused on? ​PDSA Time Series Charts: Run Chart and Control Chart Process Map Scatter Diagram Driver Diagram Pareto Chart Cause and Effect Diagram Download IHI's QI Essentials Toolkit with instructions and templates for 10 key improvement tools.

Date: May 3, 2017 Featuring: John E. McDonough, DrPH, MPA, Professor of Practice, Harvard TH Chan School of Public Health John B. Chessare, MD, MPH, President and CEO, GBMC Healthcare (Baltimore, Maryland) A lot of the quality and safety improvements that have taken place in recent years in the US — think reducing hospital-acquired infections, creating safety cultures, implementing team-based primary care — have occurred regardless of what was or wasn't happening in Washington, DC. While political debates raged on, somehow the health care quality improvement movem​​ent continued to move ahead. However, with the enactment of the Affordable Care Act in 2010, government became more of a force for change, expanding access to care and insurance, and steering health care toward better value and performance. To understand what continues to keep some health care leaders up at night, we turned to GBMC Healthcare President and CEO, John Chessare. A member of the IHI Leadership Alliance and a strong proponent of population health and pursuing the Triple Aim, Dr. Chessare says many systems like his are changing for the better in ways most of the public knows nothing about. Dr. Chessare was joined by John McDonough, a prominent and prolific health care policy expert with decades of experience shaping, engaging with, and explaining health care policy. With the health care policy landscape changing on a daily basis, the May 3 WIHI: The High Stakes of Health Care Policy is a great place to start to understand the journey from the Affordable Care Act to where we may be heading.     

Date: April 20, 2017 Featuring:  ​Terry Fulmer, PhD, RN, FAAN, President, The John A. Hartford Foundation Kedar Mate, MD, Chief Innovation and Education Officer, Institute for Healthcare Improvement Lillian Banchero, MSN, RN, Senior Director, Patient Flow/Nursing Operations/Geriatrics, Anne Arundel Medical Center ​This spring, five health systems in the US are embarking on an initiative​ to discover how they can reliably deliver the best care to older adults. It’s not that they’re failing to provide high-quality care now — far from it. But even at exemplar institutions, best practices for older or elderly patients aren’t always top of mind, nor do practitioners always know how they might do things differently. Now, a small group of health systems is about to test some new, evidenced-based interventions that promise to model for the rest of the industry the types of changes needed. IHI has the fortunate role of guiding this initiative for the next few years, thanks to support from The John A. Hartford Foundation. The Foundation has been pursuing ideal care for older patients for a while now, and has concluded that age-friendly health care should focus on four high-level goals: What Matters, Mobility, Medications, and Mentation. We’d like you to learn what’s in store and consider your own improvement opportunities on this episode of WIHI, Creating Age-Friendly Health Systems.