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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.
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 (Second Edition)
This white paper presents a framework built on five core principles to help health care organizations and clinicians develop reliable processes to engage patients in conversations about their wishes for end-of-life care, steward that information, and provide respectful end-of-life care that is concordant with patients’ stated goals, values, and preferences.
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.
Promising Care: How We Can Rescue Health Care by Improving It
This book collects 16 landmark speeches given by Donald M. Berwick (including all of his speeches delivered at IHI’s annual National Forum on Quality Improvement in Health Care from 2003 to 2012) that clearly show why our medical systems don’t reliably contribute to our overall health. Berwick offers a vision for making our systems better — safer, more effective, more efficient, and more humane.
Is Your Organization "Conversation Ready"?
Health care providers and organizations need to be “conversation ready” — that is, capable of asking about and understanding what matters most to patients, and respecting every individual’s end-of-life wishes. This article articulates emerging conversation-ready principles.
Improving Graduate Medical Education: Innovations in Primary Care and Ambulatory Settings: IHI 90-Day R&D Project Final Summary Report
This report includes best practices and practical examples of graduate medical education programs that are redesigning training to equip residents and students with the skills needed for primary care practice in a rapidly changing US health care landscape.
Patient-Centered Leadership: More Than a Score
There is much more than a semantic difference between being patient-centered and being focused on patient experience, and when leaders focus solely on satisfaction scores they are sending the wrong message to staff and missing the opportunity to build sustainable change at the front line of care.
Improving Health Through Health IT
Beacon Communities are testing health information technologies that foster health and contribute to a new vision of patient-centered care, and four areas are emerging as vital to their success.