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 this year?

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 improvement.

OS: What were the issues to consider in this year’s case?

NK: This 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 hospital re-admissions.

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 practices.

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 competition.