From left to right, Eric Sid, Nicole Kim, Huong Le, and Juan Magana, members of the IHI Open School Chapter at the University of Washington, won a national case competition this spring.
Harlan Reeves’s heart is failing.
He’s 69, and his family is struggling to pay its medical
bills. His grown children disagree about whether he should live at home or move
to an assisted living facility.
How can the providers improve his care?
This April, health students analyzed this fictional case in
the annual Clarion National Case Competition in Minneapolis, MN, USA. For the last
nine years, the University of Minnesota Academic Health Center has invited
interprofessional students from around the nation to analyze a case study that
highlights safety and quality issues. The teams conduct a root
cause analysis and present their findings to an interprofessional panel of
judges who evaluate their analysis and proposal, as well as its practicality
within the health care system.
This year, the interprofessional IHI Open School Chapter at the University of
Washington won. We reached out to Nicole Kim, a MD/MPH candidate
on the winning team, to learn more about their success.
Open School: For starters, congratulations to your team! What an
amazing accomplishment. Can you tell us about yourself and the people who
joined you in Minnesota?
Nicole Kim: Sure! I’m an MD/MPH
candidate, and my team included Juan Magana, a MD/MHA candidate; Eric Sid, a MD/MHA
candidate; and Huong Le, a PharmD candidate. Juan, Eric, and I are dual degree
students. We enrolled between our third and fourth years of medical school to study
for our MPH and MHA degrees. When we competed in Minnesota, we represented four
different disciplines: medicine, pharmacy, public health, and health administration.
Our team advisor, Dr. Brenda Zierler, also joined us in Minnesota.
OS: Was being a part of the Clarion competition a goal for your Chapter
NK: The IHI Open School Chapter
at the University of Washington is relatively new. Our school competed in the Clarion
competition for the first time several years ago, and we were the second team
to represent the University of Washington. There’s a big push for interprofessional
teamwork on campus right now, and sending a team to Clarion is just another
example of our campus’s commitment to interprofessionalism and quality
OS: What were the issues to consider in this year’s case?
year’s case involved the story of Harlan Reeves, a gentleman with advanced
heart failure living in Oregon. While the case involved improving the health
system in a community, Harlan’s story provided an example of some of the
challenges patients faced — things like poor care coordination between
providers, lack of affordable medications, and caregiver burden. Our job was to
conduct a root cause analysis of the contributing factors and then offer a
strategy to improve the health care provided to patients with advanced heart
failure in the community, keeping in mind the three components of the Triple
Aim: quality of care, population health, and cost-effectiveness.
OS: Tell us about the analysis your team created. Why do you think it
stood out as the winner?
NK: Our team really tried to
focus on Harlan’s and his wife’s experience of health care as we analyzed the
case. We understood that his health was not only dependent on his motivation to
care for himself, but also his wife’s ability to care for him and the
availability of patient-centered programs in the hospital and clinic setting. We
designed and proposed an Advanced Care Transition team (ACT), based on several
different best practices and tailored it to the information we were provided in
the case as a way to provide additional
support to patients like Harlan. [Sources included the Kaiser TriCentralPalliative Care Toolkit, Sutter Health AIM Program,
and the Kaiser IHPC Program.]
The ACT team not only prioritized the
patient’s quality of life, but also used a systematic approach to allocate
resources toward patients with high health care needs to reduce preventable
OS: What did you do before the event to prepare?
NK: We met as a team quite often
to brainstorm our proposal. We also met with leading heart failure care
providers at the University of Washington to learn more about existing
practices. Our IHI Open School Chapter also helped organize a practice
presentation session in front of faculty and students. The feedback we received
was very helpful as we prepared for the competition.
OS: How did your mix of disciplines influence your work on the case?
What did you learn from the collaboration?
NK: We’re all upper-level
students in our four disciplines, so having the clinical foundation was
extremely helpful as we analyzed the case and prepared for the competition. We
each brought different strengths to the group — knowledge of heart failure
management, medication reconciliation, the ability to interpret best practices,
and health administration and budgeting. The collaboration taught me both how
much and how little I knew about improving health care quality. My teammates
taught me about Medicaid and Medicare reimbursements, value-based purchasing,
and existing medication programs that I otherwise wouldn’t have known about. In
return, I was able to offer ideas about addressing caregiver stress and best
OS: What would you say was the biggest challenge your team encountered
in the competition?
NK: Finding the time to meet as a
group! All four of us had busy schedules because of our coursework and clinical
rotations, so it was hard to coordinate our schedules. Another challenge was
making sure we were realistic with our proposal. We brainstormed multiple ideas
to improve patient care, but recognized that feasibility was important for
hospitals and clinics to buy in to our proposal. For example, how will hiring
another clinical provider affect the department’s budget or patient safety? We
had to think like real health care providers as we prepared for the