Why It Matters
It has been a year for considering new ways of taking on perennial health care challenges while also getting back to basics.
As Institute for Healthcare Improvement (IHI) President and CEO Kedar Mate wryly noted during his 2023 IHI Forum keynote, one could have said, “today we live in a challenging time” during every one of the last few years. This does not make the statement any less true as we look back on the past 12 months.
It has been a year for considering new ways of taking on perennial health care challenges while also getting back to basics. We hope you find these Insights posts, resources, and publications useful, thought-provoking, or even inspiring. Here, in no particular order, are IHI’s top picks of the year:
Advancing Safety
- This year IHI launched our “Turn on the Lights” podcast hosted by IHI’s Kedar Mate and IHI President Emeritus and Senior Fellow Don Berwick. Patient advocate Sue Sheridan of Patients for Patient Safety US was the featured guest on one of the most downloaded episodes of the year, “What Happened to Patient Safety.”
- Regarding workforce safety, in an interview with RamaOnHealthcare, Jeff Salvon-Harman, IHI Vice President, Safety, asserted that health care has been too reliant on individual resilience programs and not focused enough on addressing moral injury and distress. “We cannot expect highly qualified professionals to outperform poorly designed systems in any industry, and health care has been slow to invest in systemic change to reduce friction, frustration, and moral distress of its clinical workforce,” he said.
- In Africa, more than 600,000 people die every year after surgery, mostly from causes that are relatively easy to treat. In fact, more patients die from post-surgical complications in Africa than all deaths from tuberculosis, HIV, and malaria combined. Early in 2023, IHI launched a QI demonstration project with 10 hospitals in Ethiopia, South Africa, Tanzania, and Uganda to test how to support the reliable implementation of the “5Rs for Rescue,” five sequential care steps projected to cut post-surgical mortality by 25 percent.
Taking Equity to the Next Level
- We miss a crucial piece of the patient safety puzzle when we do not incorporate an equity lens when analyzing adverse events. In one of the year’s most popular posts, NYC Health + Hospitals, the largest municipal health system in the United States, described how to embed equity into every step of adverse event analysis.
- The Joint Commission elevated health equity to a new National Patient Safety Goal (NPSG) for health care organizations this year. According to The Joint Commission, “The new NPSG increases the focus on improving health care equity as a quality and safety priority, but the requirements for accredited organizations are not changing.”
- Over 100 million individuals in the US have health care debt. In another popular “Turn on the Lights” episode (“Penalized for Being Sick: The Uniquely American Crisis of Medical Debt”), Berneta L. Haynes, Attorney with the National Consumer Law Center, talked about how medical debt disproportionately affects historically and currently marginalized groups and can infiltrate all aspects of an individual’s life.
Joy in Work and Well-Being for the Health Care Workforce
- IHI’s Kedar Mate openly confronted the skepticism he sometimes encounters from health care leaders in one of the most popular posts of the year, “Don’t Talk to Me About Joy in Work.” While admitting to his own initial doubts about the concept years ago, he countered its most common criticism. “Far from being out of touch,” Mate noted, “leaders who work to reconnect the health care workforce to a sense of purpose and restore the meaning behind what we do and how we do it are facing some of health care’s biggest challenges head on.”
- The American Association of Critical-Care Nurses and American Nurses Association issued their “Nurse Staffing Task Force Imperatives, Recommendations, and Actions” report this year. They cited IHI’s Safer Together: A National Action Plan to Advance Patient Safety and the IHI Framework for Improving Joy in Work white paper in the “Reform the Work Environment” section of the report.
Rethinking Quality
- Generative artificial intelligence (AI) undeniably hit the mainstream this past year after OpenAI released an early demo of ChatGPT in late 2022. In a preview of his IHI Forum 2023 keynote address, Peter Lee, Corporate Vice President of Research and Incubations at Microsoft, remarked, “A generative AI system like GPT-4 is both smarter than anyone you’ve met and dumber than anyone you’ve met. I think we both assume too much and too little about its potential in health care.” An IHI research team conducted a 90-day innovation project on the present and future of AI and quality improvement (QI) and shared a list of recommendations for health care leaders to build on the interest and mitigate the risks of using AI tools for QI.
- QI alone is insufficient to manage the many priorities and demands placed on our current health care systems. Another of the year's most popular posts made the case for embedding quality control (“The Misunderstood Essential for Improvement”) into daily work to help internally monitor performance, assess progress, and help systems to direct improvement resources to where they are needed most.
Leadership Lessons
- Health care leaders have increasingly come to recognize that we cannot continue to make inroads in improving patient safety and workforce well-being, tackle health equity, reduce the cost of care, and strengthening population health without attending to the causes and effects of a changing climate. An article in Healthcare Executive describes steps health system leaders can take to reduce greenhouse gas emissions through effective governance systems; diverse stakeholder engagement, including environmental impact as a key dimension of quality and safety; and establishing more sustainable supply chain practices.
- Building on the findings of an IHI Health Improvement Alliance Europe workgroup, Derek Feeley, IHI President Emeritus and Senior Fellow, shared “5 Simple Rules for Curious Leaders” in one of IHI’s most popular interviews of 2023. “We are more likely to find solutions closer to the point of care than the executive suite. If [leaders] ask questions first, before stating our opinions and thoughts, we will hear ideas and a range of views we might not otherwise receive,” Feeley said.
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