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Why Focusing on Professional Burnout Is Not Enough
With professional burnout rates in health care at an all-time high, IHI suggests shifting the focus from “burnout” to “joy in work.” This article describes the role of leaders and four proven steps to create joy in work.
Transforming Health Care: A Compendium of Reports from the NPSF Lucian Leape Institute
A guide for health care leaders in assessing where their organizations stand in the journey to safer care and what steps they can take to make greater progress.
Shining a Light: Safer Health Care Through Transparency
This Lucian Leape Institute report offers sweeping recommendations to bring greater transparency in four domains: between clinicians and patients; among clinicians within an organization; between organizations; and between organizations and the public. It makes the case that true transparency will result in improved outcomes, fewer medical errors, more satisfied patients, and lowered costs of care.
Safety Is Personal: Partnering with Patients and Families for the Safest Care
This Lucian Leape Institute report is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care. It identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health care.
Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care
This Lucian Leape Institute report details how workplace safety is inextricably linked to patient safety. It highlights vulnerabilities common in health care organizations, discusses the costs of inaction, outlines what a healthy and safe workplace would look like, and offers seven recommendations for actions that organizations need to pursue to effect real change.
Order from Chaos: Accelerating Care Integration
Too often, care integration — the planned, thoughtful design of the care process for the benefit and protection of the patient — is lacking. This Lucian Leape Institute report addresses the issue of care integration with the aim of outlining the major barriers to effective integration and providing a framework for further consideration and action among stakeholders.
Unmet Needs: Teaching Physicians to Provide Safe Patient Care
Unmet Needs is the culmination of three Lucian Leape Institute roundtable discussions and makes key recommendations for reforming medical education in order to improve patient safety. The paper was the first in a series of such reports on issues identified as top priorities in ongoing efforts to improve patient safety.
Highly Adoptable Improvement: A Practical Model and Toolkit to Address Adoptability and Sustainability of Quality Improvement Initiatives
This article presents the Highly Adoptable Improvement Model, a practical model and supporting tools developed on the basis of existing theories to help quality improvement (QI) programs design more adoptable approaches that lead to more sustainable improvement.
Leading a Culture of Safety: A Blueprint for Success
Creating a culture of safety in health care settings has proven to be a challenging endeavor, and there is a lack of clear actions for organizational leaders to take in developing such a culture. This guide provides chief executive officers and other health care leaders with a useful tool for assessing and advancing their organization’s culture of safety, and can be used to help determine the current state, inform dialogue with the board and leadership team, and help leaders set priorities.
Is Your Organization Highly Reliable?
This article presents common high-reliability organization (HRO) characteristics that apply to all health care organizations seeking to improve patient safety, and cross-walks them with the IHI Framework for Safe, Reliable, and Effective Care to help leaders build a culture and learning system to support HRO characteristics and safer systems of care.
Moral Choices for Today’s Physician
In this essay, Don Berwick considers moral choices physicians face personally, organizationally, and globally and exhorts them to understand that the health of humanity depends on their speaking out against the social injustice of overpricing drugs and services, mass incarceration, and the lack of environmental responsibility.
Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human
This report assesses the state of patient safety in health care, advocating for a total systems approach across the continuum of care and establishment of a culture of safety, and calling for action by government, regulators, health professionals, and others to place higher priority on patient safety improvement and implementation science.
Measuring Patient Safety in Real Time: An Essential Method for Effectively Improving the Safety of Care
The continuing evidence of preventable deaths due to medical error has led to recent calls to improve measurement of safety in hospitals. This need can be adequately addressed by harnessing health information technology.
Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era
The recommendations outlined in this publication are designed to help standardize the ways in which primary care practitioners activate referrals to specialists, and then keep track of the information over time. It describes a nine-step, closed-loop process in which all relevant patient information is communicated to the correct person through the appropriate channels and in a timely manner.
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.
Creating Age-Friendly Health Systems: How to Meet the Needs of a Growing Population of Older Adults
This article explains an emerging care model for older adults focused on the “4Ms” of Age-Friendly Health Systems — What Matters, Mobility, Medications, and the Mentation of older adults — that is in the testing phase at five health systems, as part of the Creating Age-Friendly Health Systems initiative led by IHI.
10 IHI Innovations to Improve Health and Health Care
This curated publication highlights 10 ideas that have emerged from IHI's systematic 90-day innovation approach, including reflections on the Triple Aim, the concept of a health care Campaign, the Breakthrough Series Collaborative model, and other frameworks and fresh thinking that have been replicated around the world.
How to Attribute Causality in Quality Improvement: Lessons from Epidemiology
This article proposes quality improvement and implementation initiatives in health care, regardless of scope and resources, can be enhanced by applying epidemiological principles adapted from Bradford Hill Criteria to strengthen evidence of effectiveness.
Are Quality Improvement Collaboratives Effective? A Systematic Review
In a systematic review of the literature on quality improvement collaboratives, a widely adopted approach to shared learning and improvement in health care, the authors conclude that, overall, the QI collaboratives included in their review reported significant improvements in targeted clinical processes and patient outcomes.
A Simple Way to Involve Frontline Clinicians in Managing Costs
This article describes the building blocks of a value-management system in health care. The approach that IHI co-developed includes a simplified method to understand quality, cost, and workforce capacity on a weekly basis; a visual management system to present and analyze this data regularly; and daily, point-of-care communication to support continuous improvement.
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.
Reducing Inappropriate Medication Use by Implementing Deprescribing Guidelines
This case study from the IHI/Commonwealth Fund International Program for US Health Care System Innovation describes how a multidisciplinary team of clinical experts in Ottawa, Canada, created a credible, low-cost process for developing and implementing evidence-based deprescribing guidelines and tools for assessing, tapering, and stopping medications that may cause harm or no longer benefit patients.
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.
Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database
A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. This article finds a high frequency of blame in a random sample of safety incident reports in the UK, suggesting that there are still opportunities to shift toward a more systems-focused, blame-free culture in health care.