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• WIHI: Practicing More Careful and Thoughtful Diagnosis
  February 8, 2018 | What's next when the diagnosis process is causing as many problems as it's trying to solve?
• WIHI: The Careful and Kind Patient Revolution
  December 7, 2017 | Victor Montori argues that it is time for providers to look up from strict protocols and guidelines long enough to get curious about their patients' lives and begin to minimize barriers to better health, not add to them.
• WIHI: When Patients Feel as Powerless as Hostages
  November 21, 2017 | Is "hostage" the right way to describe how patients and family members sometimes feel when they're trying to get the care they need?

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• WIHI: Practicing More Careful and Thoughtful Diagnosis
  February 8, 2018 | What's next when the diagnosis process is causing as many problems as it's trying to solve?
• WIHI: The Careful and Kind Patient Revolution
  December 7, 2017 | Victor Montori argues that it is time for providers to look up from strict protocols and guidelines long enough to get curious about their patients' lives and begin to minimize barriers to better health, not add to them.
• WIHI: When Patients Feel as Powerless as Hostages
  November 21, 2017 | Is "hostage" the right way to describe how patients and family members sometimes feel when they're trying to get the care they need?
• WIHI: Greater Satisfaction, Outcomes, and Savings with Self-Administered Care
  July 13, 2017 | 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.
• WIHI: Creating Age-Friendly Health Systems
  April 20, 2017 | Best practices for older or elderly patients aren’t always top of mind, and practitioners don't 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.
• WIHI: Who's Your Health Care Proxy?
  April 6, 2017 | Situations may arise when we need a trusted person to communicate with doctors and nurses on our behalf. And, if facing care decisions near the end of life, a trusted health care proxy can play a crucial role in ensuring our wishes are respected.
• WIHI: What We're Learning about Patients with Complex Needs
  March 23, 2017 | There’s a lot of attention being paid to developing new models to care for and support patients with multiple, complex health problems. And for good reason.
• WIHI: Practicing Respect and Preventing Harm
  February 9, 2017 | Most of us know what it feels like to have an interaction with someone that can feel rushed, incomplete, maybe even abrupt or downright rude. What are the consequences of these encounters?
• WIHI: Engaging and Supporting Family Caregivers
  October 20, 2016 | A lot has been said and written over the years about the important role family caregivers play on behalf of loved ones with various health conditions and disabilities. But acknowledgment of the estimated 42 million family caregivers in the US alone hasn’t always translated into needed support.
• WIHI: Improving Patient Experience: What's Working, What's Not
  October 6, 2016 | With so much focus on improving patient satisfaction scores and patient-centered care, are patients and family members feeling more positive about the experiences they’re having in the US health care system? Are they feeling more connected to their care teams?
• WIHI: The New World of Co-producing Health and Health Care
  March 24, 2016 | When we say patients and clinicians should be “co-producing health and health care,” this requires a paradigm shift and, for medical staff, letting go of seeing themselves as the sole engines and creators of the “product” known as health care. What if health care isn’t a product at all, but a service which both “sides” engage in and have an opportunity to shape?
• WIHI: Morality Matters: How to Reset the Mission of Quality Improvement
  February 18, 2016 | What is the “true north” for the health care quality improvement movement? What are the questions leaders and champions of quality and safety initiatives must periodically ask themselves as a natural part of the process of seeking dramatic change? For IHI’s founder, Don Berwick, the questions, and the answers, are often moral ones.
• WIHI: New Tools and Thinking for Shared Decision Making
  January 28, 2016 | If you work in primary care today, odds are good that you’re seeing patients with multiple chronic conditions. Even if a provider and patient work together to choose the right medications and agree on making some lifestyle changes that will improve health, the best-laid plans often fall apart.
• WIHI: Realizing “What Matters” (to Patients and Families)
  January 14, 2016 | A few years ago, IHI and others began suggesting to providers that instead of routinely asking patients “What’s the matter with you?” they should begin asking “What matters to you?”
• WIHI: Medicare Reimbursement and Meaningful Conversations about End-of-Life Care
  November 19, 2015 | This WIHI explores whether the new US Centers for Medicare & Medicaid Services payment options to reimburse practitioners for talking with Medicare recipients about end-of-life care preferences make advance care planning more likely to happen and encourage health professionals to gain the necessary skills for such discussions.
• WIHI: Getting Right Care, Right!
  October 1, 2015 | There’s growing awareness of the need to curb health care’s overuse of interventions that lack a strong evidence base, unnecessarily subject patients to potential harm, and are more expensive than equally effective, cheaper alternatives.
• WIHI: The Echo Effect of Project ECHO's Access to Specialty Care
  July 9, 2015 | There’s telemedicine, and then there’s Project ECHO. What began in 2003 as a process for improving access to treatment for people in New Mexico suffering from Hepatitis C, now offers support and learning for 30 different diseases and conditions, impacting patients in some 22 states.
• WIHI: Disability Competent Care
  June 11, 2015 | A lot of progress has been made the past several decades for people with disabilities. But, there are still barriers and biases that prevent disabled individuals from leading full lives and fully accessing health care.
• WIHI: Now What? Best Practices for Newly Diagnosed Cancer Patients
  May 21, 2015 | When someone is first diagnosed with cancer, those first few days and weeks can be terribly disorienting. A growing number of providers, patients, and observers believe there are particular ways the health care system can behave, and best practices that can be deployed, to ease this initial, hard part of the cancer journey.
• WIHI: Tread Water No More! Making Sense of Patient Experience Data
  September 11, 2014 | Learn about guiding principles for deciphering patient experience data and the comprehensive picture that emerges from patient surveys, focus groups, patient and family advisory councils, and much more.

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• Patient Experience Data Self-Assessment
  The Patient Experience Data Self-Assessment Tool and corresponding Answer Key challenges knowledge and common assumptions about what the data actually means. The tool can be used to expand your current knowledge on using patient experience data effective.
• Patient Care Experience Observation Exercise
  The purpose of this exercise is to learn about and understand the experience of care in your organization from the patient and family perspective, using observations of care processes to inform improvements to the care experience. The exercise may be used in any care setting.
• Always Events Toolkit
  Always Events are aspects of the patient experience that are so important to patients and families that health care providers must perform them consistently for every patient, every time. The toolkit supports providers in partnering with patients and family members to co-design, reliably implement, and sustain and spread Always Events to dramatically improve the care experience.
• Transplant Guardian Angel Always Event
  The Transplant Guardian Angel program was developed to ensure that patients and families are supported through the transplant surgical process by providing them with accurate, real-time updates and clinical information, thereby reducing anxiety and increasing effective communication between care delivery teams.
• MyStory Always Event
  MyStory is an interprofessional effort designed to personalize the care provided to pediatric patients and transform the hospital experience for the patients and families by capturing each pediatric patient’s “story” and use the story to personalize the care provided and involve them in care planning and decision making.
• "Same Page" Transitional Care Resources for Patients and Care Partners
  These resources and tools were developed for patients and their caregivers or care partners to use when planning for care or during a stay in a hospital or skilled nursing facility. The goal is to support patients, their care partners, and the team of health care providers to all be “on the same page” in understanding the patient’s health and health care needs when the patient is transitioning from one setting of care to another.
• Always Use Teach Back!
  The Always Use Teach Back! tools can be used to confirm patient understanding of care instructions by asking patients to repeat the instructions using their own words.
• PAIR Parent Mentor Program
  PAIR — Parents Assisting Inspiring Reassuring — is a program created to help parents of children with cancer connect with other parents, who serve as mentors. The team at St. Jude’s developed a number of tools, including a detailed presentation about the program and tools for recruiting and onboarding mentors, matching mentors with mentees, and training mentors.
• ISHAPED Patient-Centered Approach to Nurse Shift Change Bedside Report
  ISHAPED (I=Introduce, S=Story, H=History, A=Assessment, P=Plan, E=Error Prevention, and D=Dialogue) focuses on making bedside shift reports more patient- and family- centered. The goal is to always include patients in the ISHAPED nursing shift-to-shift handoff process at the bedside to add an additional layer of safety by enabling the patient to communicate potential safety concerns.
• SMART Discharge Protocol
  The SMART Discharge Protocol (Signs, Medications, Appointments, Results, and Talk with me) was developed to improve care for patients and families and to improve the discharge process. The tools include the SMART Discharge Checklist for patients and families, FAQs for health care staff and clinicians about implementing the SMART Discharge Protocol, a presentation, and a self-learning packet.
• Always Events Blueprint for Action and Always Events Healthcare Solutions Book
  These tools guide organizations in creating a more person- and family-centered culture through the development and implementation of Always Events, defined as aspects of the patient experience that are so important to patients and families that health care providers should always get them right.
• Integrated Care Pathway for Total Joint Arthroplasty
  This Care Pathway provides recommended ideas to improve care for patients receiving total joint arthroplasty (TJA) and includes safe, effective, efficient, and patient-centered TJA care processes. The Pathway is designed for use by all members of the orthopaedic community who are responsible for the TJA process, including those at surgical practices, hospitals, and other care settings.
• Perinatal Ticket to Discharge
  This communication tool is given to patients by maternity center staff to help guide educational discussions and to provide a "to do" list of items that need to be completed prior to discharge from the hospital.
• Toolkit: Getting Started in Video Ethnography — A Catalyst for Guiding and Motivating Quality Improvement
  This toolkit contains instructions, examples, resources, and tools for combining ethnographic techniques of interview and observation with video recording to more fully understand patients' experiences in health care, an essential step in providing patient-centered care.
• How-to Guide: Improved Care for Patients with Congestive Heart Failure — Rural Hospitals Supplement
  The goal of this How-to Guide, which has been tailored specifically for rural hospitals, is to significantly improve care and reduce readmissions for patients with congestive heart failure by reliably implementing the recommneded components of care.
• How-to Guide: Improved Care for Patients with Congestive Heart Failure
  The goal of this How-to Guide is to significantly improve care and reduce readmissions for patients with congestive heart failure by reliably implementing the recommended components of care.
• Script to Orient Patients and Families to Family Activated Safety Team (FAST)
  Hospital staff can use this script to orient patients and families to the Family Activated Safety Team (FAST), a hotline to obtain extra help when concerns about care arise.
• Hospital Self-Assessment Inventory for Patient- and Family-Centered Care
  This assessment tool allows hospital leaders to gauge the readiness of their organization to provide patient- and family-centered care.
• Patient Self-Management Tools: An Overview
  From the California HealthCare Foundation, this paper describes technologies used by consumers to manage their health.
• Self-Monitoring Symptom Log
  This tool helps patients track how changes in diet, medications, activity, emotions, or other factors are affecting their symptoms and can be used as a communication tool with health care providers.

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• Discharge to Assess: “Flipping” Discharge Assessment from Hospital to Home
  Discharge to Assess (D2A) (also referred to as "flipped discharge") is a redesign of the care process at Sheffield Teaching Hospitals in the UK that involves assessing a patient’s needs after discharge in the patient’s own home rather than in the hospital. Activities that traditionally happen at the end of a hospital admission are instead performed successfully and safely at home, thus enabling patients who are medically ready to go home earlier and spend less time in the acute care setting.
• Experience-Based Co-Design of Health Care Services
  This case study from the IHI/Commonwealth Fund International Program for US Health Care System Innovation describes experience-based co-design (EBCD), developed in the UK, which brings together narrative-based research with service design methods to catalyze a process wherein patients and staff work together to design, implement, and test improvements to health care services.
• Postal Service “Call & Check Visits” for Isolated, Frail Elderly in the Community
  This case study from the IHI/Commonwealth Fund International Program for US Health Care System Innovation describes the "Call & Check Visits” program developed by Jersey Post in Jersey, British Channel Islands, in which postal service workers check on isolated, frail elderly residents in the community, deliver prescription refills, remind clients of upcoming medical visits, and ask about their health and social needs.
• Personalized Perfect Care
  The authors propose measuring quality from the patient’s perspective as an expression of his or her personalized health needs. The Personalized Perfect Care Bundle combines several distinct measures into one and is scored as “all-or-none,” with the patient’s care being counted as complete if he or she has met all of the quality measures for which he or she is eligible.
• The Age-Friendly Health System Imperative
  The article gives an overview of how five early-adopter US health systems — working in partnership with IHI and The John A. Hartford Foundation as part of the Creating Age-Friendly Health Systems initiative — are testing prototype models for age-friendly care using continuous improvement efforts to streamline and enhance new approaches to geriatric care.
• Creating Age-Friendly Health Systems: A Vision for Better Care of Older Adults
  This article describes the background, evidence-based changes, and testing, scale-up, and spread strategy that are part of the design of the Creating Age-Friendly Health Systems initiative to improve care for older adults.
• When Patients and Their Families Feel Like Hostages to Health Care
  A power imbalance often still exists in the patient-provider relationship, particularly when high-stakes health decisions have to be made. This article explores this dynamic, likening it to “hostage bargaining syndrome” — that is, the patient behaves as if negotiating for their health from a position of fear and confusion -- and suggests ways to counteract this behavior.
• Respecting End-of-Life Care Wishes
  This article presents five core principles to guide providers and health care organizations in developing more reliable systems to receive, record, and ultimately respect patients’ wishes for end-of-life care.
• The Value of Teaching Patients to Administer Their Own Care
  Some patients are learning how to administer their own treatments outside of the health care setting — from pain management, to dialysis, to intravenous antibiotics. This article describes five keys to a successful approach to implementing patient-administered self-care and provides examples of organizations that have established such initiatives.
• Patient-Administered Self-Care
  For specific procedures and treatments, health care providers can train individuals to administer their own self-care, on their own time, without supervision or dependence on a licensed professional. Patient-administered self-care can occur either in traditional health care facilities or another location of the patient's choosing outside of a facility.
• Reliably Addressing "What Matters" Through a Quality Improvement Process
  A practical quality improvement approach can help to ensure that processes are in place to assist nurses in devoting time to reliably inquire about “what matters” to each patient at every encounter
• Supporting the Supporters: What Family Caregivers Need to Care for a Loved One with Cancer
  Patients with cancer who live at home often need to lean on family members for support. Not surprisingly, family caregivers themselves also require support, so that they can be effective and maintain their own well-being. This article presents a four-part framework for supporting cancer patient caregivers.
• Building a Culture of Improvement at East London NHS Foundation Trust
  East London NHS Foundation Trust (ELFT) in the UK provides mental health and community services to a diverse and largely low-income population. By establishing an organization-wide culture of continuous improvement, and integrating quality improvement methodology and training at every level of work, ELFT has significantly reduced incidents of inpatient violence and improved staff satisfaction, among other achievements.
• Essentials for Improving Service Quality in Cancer Care
  Informed by site visits to cancer care centers and interviews with cancer patients, family members, clinicians, and health care leaders, the authors formulate six essentials for improving cancer care service quality.
• When the Customer Is Stressed
  This article uses the example of cancer care to illustrate four guidelines for better design of high-emotion services (i.e., those that elicit strong feelings like fear and anxiety): identify emotional triggers, respond early to intense emotions, enhance customers’ control, and hire and rigorously train people who can communicate respectfully.
• "Conversation Ready": A Framework for Improving End-of-Life Care
  This white paper presents a framework built on five core principles to help organizations begin the process of becoming "Conversation Ready" — that is, to develop reliable processes to engage patients in conversations about their wishes for end-of-life care, steward that information, and then respect those wishes at the appropriate time.
• Patient-Reported Measures
  Patient-reported measures help clinicians and patients assess whether a patient’s symptoms, lifestyle, daily activities and functional status have improved as a result of care provided, and are a mechanism for patients to have a voice in their treatment planning and decision making based on their own self-assessments.
• Flipping Primary Health Care: A Personal Story
  This article describes the experience of one of the authors as he experienced having to “flip” his primary health care (i.e., putting the person, not the disease or the condition, at the center of improving health and health care), and describes enabling factors and lessons for patient-centered primary care redesign.
• Flipping Health Care
  The authors argue that to meet today’s health care challenges, we need to flip our thinking to develop innovative models of care that can improve health, improve care delivery, and lower costs — the goals of the Triple Aim.
• A Focus on Always Events
  The IHI Always Events framework is a strategy to help health care leaders identify, develop, and achieve reliability in a person- and family-centered care delivery process. This article describes Always Events, provides examples, and identifies specific leadership actions to support organizations in implementing Always Events.