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Bringing Learning Home from D.C.

By IHI Open School | Tuesday, May 22, 2012

Four students—one from Bellin College in Green Bay, WI, and three from Eastern Virginia Medical School (EVMS) in Norfolk—went to the 13th Annual International Summit on Improving Patient Care in the Office Practice and the Community in Washington, D.C., with hopes of bringing home valuable lessons to their respective communities. The Bellin student was seeking inspiration and some new ideas for her Chapter. The EVMS students were seeking information for Health Outreach Partnership for EVMS Students (HOPES), their student-led free clinic. Here are their experiences:

Kimberly Herman, 4th year nursing student, Bellin College

I decided to attend the conference with the hope that I could bring back useful information and proven techniques to assist with the quality improvement initiatives that our Bellin College Open School Chapter has undertaken at area hospitals in Green Bay. Having attended the IHI National Forum in Orlando this past December, I was interested in seeing how quality improvement and patient centered care could translate to office and community settings.

I was not disappointed.

It was inspirational to see all of the people in health care that are devoted and actively working to improve the quality, safety, and experience of patients. (I think that too often health care is seen by the public as a business with its focus on making money instead of caring for people, families, and communities.) I attended sessions on interprofessional communication, individualized care, and the use of e-visits and social media as a way to reach out to patients in different ways. This sort of interaction looked into correcting misinformation, informing patients, providing more individualized information, and offering support for a patient during the course of treatment.

From these sessions, I left with realistic and useful ways of helping to provide safe, appropriate, high-quality care in future day-to-day interactions with patients—and several valuable lessons for my Chapter!

ChengXi Wang, medical student, Eastern Virginia Medical School

My primary goal in attending this conference was to gain insight into models of primary care, which I would then share with the EVMS community. Specifically, I wanted to see successful examples of how care can be coordinated across the various health professions and in community-based settings.

I found everything I was looking for—and more.

I learned about the tiers of influence in health care and realized that health education in the doctor’s office just isn’t going to suffice. I saw examples of what worked, including Communities That Care and NUKA (a model of care from the Southcentral Foundation of Alaska), which will serve as frameworks for how I can do the same, albeit on a smaller scale. I learned about Kano and Lean Principles as applied to health care, and cross-training and its importance to team building. Before the last day of the conference was over, I had already sent out correspondences to members of the EVMS community as to what I learned and what we can apply. I even sent correspondences to former coworkers in the Baltimore City Public School System about several hugely applicable principles! (I taught for 5 years prior to attending medical school.)

To HOPES, I’ve proposed that we revamp the current continuity system so that care coordinators are cross-trained and that at each visit, patients are asked: “What matters to you?” We’ll truly adopt patients as partners in their health care by having a conversation at each visit about contexts and priorities. Utilizing community resources, we’ll help patients with their own goal setting and self-management, celebrate their progress, overcome setbacks, troubleshoot obstacles, and continually re-evaluate their goals and priorities. I hope that this proposal makes its way through the PDSA cycle with results we can then share.

Krishna Aluri and Clay Nelson, medical students, Eastern Virginia Medical School

We went to the conference looking for general ideas and specific strategies for improving the quality and continuity of care in our student-run free clinic that runs on almost no budget and is administered entirely by volunteers. We found applicable and inspiring ideas in talks held by the keynote speakers, in various workshops, and in many other sessions.

Being involved in a clinic that cares for uninsured and underserved patients, we were especially interested in improving continuity of care and ideas for helping patients overcome some of the barriers that they face in receiving and making use of health care. We were inspired by Maureen Bisognano’s discussion of Health Leads and social advocacy (one of our goals and necessities for helping patients), as well as by Dr. Donald Berwick’s explanation of the Health Impact Pyramid— something that we learned to address in the care of patients before I had ever heard of the pyramid itself. In these talks, we learned the importance of assessing each patient’s understanding of their illness and their barriers to care as well as using patient-specific goals, and models for continuity of care to bypass the barriers and get better health care outcomes.

From the learning labs, we took away ideas and goals that included greater automation in our upcoming use of an EMR (such as triggers for e.g. diabetic patients—described by one participant as an IT reminder system for patient care) and the standardization of care using an EMR to achieve specific goals (important for us since the HOPES clinic has continuously changing clinical teams of volunteer students and attendings). Related to social advocacy and continuity of care, we were glad to hear how other clinics and teams improve care coordination by having specific tasks for pre-visit, visit, and follow-up patient encounters that are carried out by a diverse and integrated clinical team (the follow-up, we learned, may have the most significant impact on compliance with treatment plans). Using examples from clinics in underserved areas of the US and abroad, another session showed us how to improve our continuity of care using only limited resources.

In other sessions, we heard about the importance of matching patient materials and education efforts to their health literacy level (which the HOPES clinic and other EVMS programs already strive to do), as well as how to go about assessing barriers and challenges that are keeping patients from reaching their own goals and the goals that their care teams have for them. Along with this, we learned how to study and improve our operations at the clinic by using PDSA cycles to study our efficiency.

We also gained insight into the health care system as it applies to us as a students and future physicians. We were intrigued by comments on sustainable health care and on eliminating the waste in US health care—two major ideas that will affect us as physicians. (Victor Montori’s discussion of patient-centered care was one of our favorite talks.)

Overall, the conference gave us insight into the future of health care implementation that is better designed to meet the needs of the patient population. As a result, we believe we will be able to deliver better patient-centered care and are better equipped to face future health care challenges.



- Kimberly Herman, ChengXi Wang, Krishna Aluri and Clay Nelson


Originally posted on April 10, 2012

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