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How to Talk to Your Patients about End-of-Life Care: A Conversation Ready Toolkit for Clinicians
This toolkit is intended to help clinicians address some of the challenges of engaging with patients and families in end-of-life care conversations over time, with the goal of providing respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.
WIHI: Women in Action: Paving the Way for Better Care
December 20, 2018 | Whether it’s 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, this special edition of WIHI features a panel of outstanding women who are creatively and effectively reshaping caregiving.
WIHI: Connecting Patient Experience to Culture and Strategic Aims
August 9, 2018 | Most hospitals are understandably preoccupied with patient experience scores. But can those same scores help guide an organization to the aims and values it hopes to achieve?
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?
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.
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.
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.
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.
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.
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
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?
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.
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.