WIHI: Reports from the Frontlines of Effective Crisis Management

Date: April 7, 2011


  • James Conway, MS, FACHE, Senior Fellow, Institute for Healthcare Improvement; Adjunct Faculty, Harvard School of Public Health
  • Anthony A. Armada, FACHE, President, Advocate Lutheran General Hospital, Advocate Lutheran General Children’s Hospital
  • Michael A. Fisher, President and CEO, Cincinnati Children’s Hospital Medical Center (CCHMC)
  • Uma R. Kotagal, MD, MBBS, MSc, Senior Vice President, Quality, Safety and Transformation, CCHMC; Executive Director, James M. Anderson Center for Health Systems Excellence
  • Michelle Hoppes, RN, MS, President, American Society for Healthcare Risk Management; Senior Vice President and National Director for Healthcare Risk Management and Patient Safety, Sedgwick Claims Management Services

When IHI published a white paper last year written by Jim Conway and three colleagues, there was little doubt that health care organizations were seeking guidance on the best and most transparent ways to prepare for and respond to serious medical crises. However, the September 2010 publication of Respectful Management of Serious Clinical Adverse Events, hit a nerve (in the best sense) that even the authors couldn’t have predicted: there have been thousands of downloads of the white paper from IHI.org, and dozens of organizations and health care providers have been eager to spread its guiding content far and wide.

Not only that, the compilation of tools and best practices — from having a plan ready to be implemented, to enacting the plan, to ensuring that everyone affected has what they need, when they need it — wound up serving as a resource for several hospitals facing unfortunate clinical occurrences. Leaders from two of the affected hospitals — Michael Fisher and Uma Kotagal from Cincinnati Children’s and Tony Armada from Advocate Lutheran — join Jim Conway to discuss what they learned, in real time, about the critical importance of making crisis management a part of every organization’s culture of quality and safety. Among other things, patient- and family-centeredness must anticipate those moments “when things go wrong.”

Michelle Hoppes also joins the program to offer her perspective and that of the changing world of hospital risk management to align with a respectful response to serious adverse events.

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