_______________________________

WIHI Archives

Adverse Events and Their Aftermath: SOS from Clinicians
Date: Thursday, February 4, 2010
Featuring:  Albert Wu, MD, MPH, Professor, Johns Hopkins Bloomberg School of Public Health; Linda Kenney, President and Executive Director, MITSS; Susan D. Scott, RN, MS(N), CLNC, Coordinator, Patient Safety, University of Missouri Health Care

Whenever there's an adverse event or medical error in health care, clinicians are affected, too. As organizations develop more accountable and transparent ways to interact with families and patients who've been harmed, the emotional and professional needs of doctors, nurses, and staff – whether directly or indirectly involved in an incident – also need to be addressed. In a 2000 essay in the BMJ, Dr. Albert Wu coined the phrase “the second victim” to put a face to the health care personnel facing loss of confidence and isolation in the aftermath of a tragic event. Now, a decade later, Dr. Wu's courage in naming a problem and his willingness to openly discuss the “private hell” that can beset even the most talented caregivers have helped many hospitals and health care organizations acknowledge the needs of their staff and create systems to support them. 

Listen to a recording of the program.

Resources mentioned on the program.

Gimme Housing, Not the ED: A New Campaign for Housing the Homeless
Date: Thursday, January 21, 2010
Featuring:  Rosanne Haggerty, Founder and President, Common Ground; Becky Kanis, Director of Innovations, Common Ground; Maria Raven, MD, MPH, MSc, Assistant Professor of Emergency Medicine, NYU School of Medicine; Joe McCannon, Faculty, Institute for Healthcare Improvement

Every winter in the US, volunteers fan out across most major cities to count the number of people residing in shelters and living on the streets. This annual census of the homeless serves many functions, but always reminds us of the complex web of economic, behavioral, and social factors that underlie life without any permanent housing for at least three million Americans at any given time.

Listen to a recording of the program.

Resources mentioned on the program.

Patient Safety Officer: One Person’s Title, Everyone’s Responsibility
Date:Thursday, January 7, 2010
Featuring:  Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement; Doug Salvador, MD, Associate Chief Medical Officer/ Patient Safety Officer, Maine Medical Center

It’s hard to point to a position more central today for making good on the goals of hospital patient safety than that of the Patient Safety Officer (PSO). And yet, perhaps no job is more challenging due to the overarching responsibility for multiple players, layers, and departments in an organization. It’s one thing for The Joint Commission to require that every US hospital have a PSO; it’s quite another to build the systems and teams to make the prevention of errors and injury a living mantra, and everyone’s priority, each and every day. When the national discussion puts more of the spotlight on coordinating care, reducing costs, and reducing readmissions, it’s easy to get distracted. But, that would be a mistake.

Listen to a recording of the program.

Resources mentioned on the program.

Open Notes and the Electronic Medical Record
Date: Thursday, December 17, 2009
Featuring:  Tom Delbanco, MD, Beth Israel Deaconess Medical Center, Harvard Medical School; Mary Merkel, DO, Merrimack Family Practice, Dartmouth-Hitchcock Nashua

If you had the chance to look at what your physician wrote in your medical record about your last visit, would you take advantage of it?  Would this make your relationship with your doctor or primary care provider more collaborative? More effective?  These are just some of the important questions and issues bearing down on our health care system as an online universe and electronic medical records make shared viewing of what are often referred to as the “doctor’s notes” feasible. What’s contained in the notes and does transparency interfere in any way with their value?

Listen to a recording of the program.

Resources mentioned on the program.

Read a description of the Open Notes project.

View sample clinician notes.

All Hospitals in Favor of Saving Money: Say “Patient Flow!”
Date: Wednesday, December 2, 2009
Featuring: Eugene Litvak, PhD, President and CEO, Institute for Healthcare Optimization; James M. Anderson, President and CEO, Cincinnati Children’s Hospital Medical Center; Scott Hamlin, Senior Vice President of Finance and CFO, Cincinnati Children's Medical Center

Imagine this scenario: a hospital CEO, a chief surgeon, and an operations management expert decide there has to be something better than daily overcrowding in the emergency department, no vacant operating rooms, a lackluster occupancy rate, stressed staff, and patients waiting around to be seen. The trio, along with others in the hospital, decide they’re going to dig into the problem and apply the best improvement science available to turn things around. And they do.

Listen to a recording of the program.

Resources mentioned on the program.

Read the case study that explains how Cincinnati Children's redesigned perioperative flow.

Maureen Bisognano and Eugene Litvak see smoothing patient flow as going hand in hand with health care reform.

Responses to chat questions during the broadcast.

Getting Down to Business…and Health Care Reform
Date: November 19, 2009
Featuring: Helen Darling, President, National Business Group on Health; Raymond J. Zastrow, MD, FAAFP, President, QuadMed, LLC

If you’re a US employer providing health care benefits to your employees, there’s no sitting still anymore or sitting on the sidelines and accepting whatever comes next. Even in the midst of possibly historic health care reform, insurance premiums continue to rise and take a far greater chunk out of a company’s bottom line; employees are being asked to pay more out of pocket, too.

Listen to a recording of the program.

Resources mentioned on the program.

New Ways to Reduce Diagnosis Errors
Date: November 5, 2009
Featuring:  Gordon Schiff, MD, Associate Director, Center for Patient Safety Research and Practice, Brigham and Women’s Hospital; Pat Croskerry, MD, PhD, Professor in Emergency Medicine at Dalhousie University, Halifax, Nova Scotia

It’s an all too familiar story: The initial diagnosis of a patient’s condition turns out to be wrong; or there’s an incorrect interpretation of a test result; or a patient never learns of a test result; or a physician relies too much on memory to form a diagnostic opinion, forgetting about other important clues. Each of these diagnosis errors can be traced back to a system failure or an overreliance on cognitive skills (ignoring decision supports), and often, both. Thankfully, many years’ worth of robust research on diagnosis errors is finally receiving greater attention, and is starting to lay the groundwork for improvement across the US and internationally.

Listen to a recording of the program.

Resources mentioned on the program.

The Future of Nursing
Date: Thursday, October 22, 2009 
Featuring:  Donna Shalala, PhD, former US Secretary of Health and Human Services, President, University of Miami; Sue Hassmiller, PhD, RN, FAAN, Director of the RWJF Initiative on the Future of Nursing, Institute of Medicine; Pat Rutherford, RN, MS, Vice President, IHI

There may be a shortage of nurses in many parts of the US, but there’s no shortage of rethinking and redesign underway to strengthen the profession and to help nurses be more effective providers of quality patient care. Health care reform, along with a greater emphasis on primary care and prevention, are just some of the forces that point to a more prominent, satisfying, and critical role for nurses in the near future.

Listen to a recording of the program.

Resources mentioned on the program.

Quality Care During Advanced Illness: What Do Patients Want That Works? 
Date: Thursday, October 8, 2009 
Featuring: Diane Meier, Director, Center to Advance Palliative Care; Jim Conway, Senior Vice President, Institute for Healthcare Improvement

Between the care that patients and families want when faced with advanced illness, and what is often made available, “lies not just a gap but a chasm.” Those words, associated with the IOM’s groundbreaking blueprint, Crossing the Quality Chasm, are as apt a rallying cry as ever for transforming US health care, including what patients need at the end of their lives. Yet, patients and families often find themselves at odds with or abandoned by their medical providers at this stage of their care, forced to seek others who will respect their wishes.

Listen to a recording of the program.

Resources mentioned on the program.

Run, Don’t Walk! The Urgent Need for Patient Safety
Date: Thursday, September 24, 2009 
Featuring: Don Berwick, IHI President and CEO; Sorrel King, Author, Josie's Story, co-founder, Josie King Foundation

In the same year that IHI’s Don Berwick helped write the groundbreaking Institute of Medicine report, Crossing the Quality Chasm, outlining a prescription to rid the US health care system of errors, inefficiencies, and indignities, Sorrel King lost her 18-month old daughter at a major teaching hospital due to a medical error. Sorrel became a patient safety activist practically overnight and, in the process, gained the attention of people on the frontlines of patient care and improvement leaders like Don. Each has logged a lot of miles and spoken to a lot of audiences, and together they have a unique view of where we stand as a nation when it comes to safer care. Sorrel's new book, Josie's Story: A Mother's Inspiring Crusade to Make Medical Care Safe, chronicles a parent's journey to transform American medicine. 

Listen to a recording of the program.

Resources mentioned on the program.

Reducing Avoidable Visits to the Emergency Department
Date: September 10, 2009 
Featuring:  Roger Resar, MD, IHI Senior Fellow, Expert Lead on Reliability; Robert Lowe, MD, MPH, Department of Emergency Medicine, Oregon Health and Science University

Emergency Department overcrowding remains a serious problem in the U.S. despite attention being paid to the issue and many attempts at innovative solutions. One weakness of current approaches may be an overemphasis on “medical” redesign at the expense of focusing on social factors and other community forces. Now some improvement teams are hard at work trying to build broader coalitions to tackle overreliance on the ED and to better appreciate the needs and outlooks of particular populations.

Listen to a recording of the program.

Resources mentioned on the program.

The Medical Home
Date: August 6, 2009 
Featuring:  Doug Eby, Vice President of Medical Services, Southcentral Foundation, Alaska; Jim Hester, Director, Health Care Reform Commission, Vermont

A cacophonous chorus is calling for much better coordination and delivery of health care services across the continuum of care. That’s good news for patients with chronic health problems especially, who often benefit from a person, place, or system that has the complete picture of their needs. The “patient-centered medical home” and “accountable care organization” are two important concepts and models that are emerging to jumpstart this system redesign and they’re now the basis for multiple demonstration projects across the country, including ones spearheaded by the Centers for Medicare and Medicaid Services (CMS).

Listen to a recording of the program.

Resources mentioned on the program.

Next Waves of Health Care Reform
Date: July 23, 2009
Featuring: Paul O’Neill, former US Treasury Secretary; Jim Conway, IHI Senior Vice President and Member, Health Care Quality and Cost Council, MA

The current discussion and debate in the US over the best way to insure all its citizens and to pay for health care reform has more dizzying price tags attached to it than any of us can possibly keep track of. It’s easy to get lost in talk of CBO scoring and $1 trillion here and $2 trillion there — whether it’s the cost of enacting reform or the savings that might be found over the next ten years. However it all finally computes, on the ledger sheet or among legislators, the hard work of fundamental redesign of US health care is still on the “to do” list. That’s what IHI’s Jim Conway and former US Treasury Secretary, Paul O’Neill, invite you to think through with them on WIHI.

Listen to a recording of the program.

Read the New York Times opinion piece by Paul O'Neill.

Read Jim Conway's testimony on national health care reform to the Massachusetts Senate Committee.

Resources mentioned on the program.

Raising Joy in the Health Care Workforce
Date: July 9, 2009
Featuring: Joanne Watson, IHI Fellow and Consultant Endocrinologist, NHS; Katie Bell, Partner and Lead, Gallup-Healthways Well-Being Index

There are a lot of good intentions when it comes to the health care workforce and most health care CEOs work hard to create an environment that will lead to both high levels of job satisfaction and good quality patient care. But what, precisely, are the principles and processes that can lead to a joyful organization instead of a demoralized one? Why do some hospitals enjoy reputations as great places to work and receive care, and others limp along as merely average? How would you evaluate your own workplace right now?

Listen to a recording of the program.

Resources mentioned on the program.

The Alert Mind and Patient Safety
Date: June 18, 2009
Featuring: Doug Bonacum, Vice President of Safety Management, Kaiser Permanente; Carol Haraden, PhD, Vice President, Safer Patients Initiative (UK) and Quality Improvement Scotland, IHI

It’s been ten years since the Institute of Medicine published its groundbreaking report, To Err Is Human. We haven’t made nearly enough progress this past decade to prevent medical errors. Yet the knowledge needed to build patient safety into all aspects of health care delivery, and to reduce harmful complications, has grown exponentially. “Risk resilience” and “mindfulness” are just two of the innovative concepts now shaping the strategies of enlightened health care organizations.

Listen to a recording of the program.

The Blogosphere's Hospital CEO
Date: Thursday, June 4, 2009
Featuring: Paul Levy, President and CEO, Beth Israel Deaconess Medical Center

He started blogging in 2006, laying claim to cyber territory that was practically unheard of for a hospital CEO. Today, Paul Levy’s blog, “Running a Hospital,” is must reading, not only for senior leaders, but for any health care leader, administrator, or clinician, interested in building cultures of improvement, and safety, and transparency. As Paul Levy has learned on several occasions, once the commitment to transparency especially is made, you don’t always get to choose the topic.

Listen to a recording of the program.

Running a Hospital blog.

Wanted! An EMR That Works
Date: Thursday, May 21, 2009
Featuring: John Halamka, MD, MS, Chief Information Officer, Beth Israel Deaconess Medical Center; Brian Robson, MBChB, MRCGP, DRCOG, Clinical Director for eHealth, NHS National Services Scotland

The drumbeat for quality health information systems to improve care for patients and to reduce costs has never been louder…and now there’s money on the table (19 billion), in the form of an economic stimulus, to help more health care providers in the U.S. get online. The migration to electronic medical records has a lot of moving parts and can be daunting, but many organizations have already made the plunge and are working out the bugs for the rest of us. In other words, don’t worry about EMRs alone!

Listen to a recording of the program.

Breaking the Cycle of Readmissions
Date: Thursday, May 7, 2009
Featuring:  Amy Boutwell, MD, Content Director, IHI; Thomas H. Lee, PhD, CEO, Partners Community Healthcare, Inc.

No one welcomes a return trip to the hospital once you’ve been sent home. And that’s certainly not what health care providers intend. Yet, for a significant number of patients, bouncing back into the hospital happens all too frequently — for costly reasons that could be better anticipated and avoided. So, what to do, especially in a notoriously fragmented system? 

Listen to a recording of the program.