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 Whistleblower Maureen Bisognano, President Emerita and Senior Fellow, Institute for Healthcare Improvement Vania 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.