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  • Tips for Effective Collaborations Between Clinicians and Finance
    describes the experience of a financial analyst who shadowed his clinical colleagues in this video T he most powerful solutions come when clinicians physicians and financial analysts work closely together aligned in their focus on improving care and reducing costs The challenge is developing teams willing to break down silos in the best interest of their patients In her article Discussing Cost with Clinicians in the March 2015 issue of HFM Magazine Betty A Marton articulates precisely what IHI has discovered about increasing value Gone are the days she writes when financial and clinical staff can stick with what they know best stay on their own turf and maintain silos of responsibility separate from one another We couldn t have said it better ourselves During the Joint Replacement Learning Community IHI worked with 32 organizations for a year to reduce cost while maintaining or improving quality for their hip or knee replacement procedures Teams of financial analysts and clinicians worked side by side to determine the cost of each step of the care process and identify cost reduction techniques High value changes included revamped pre operative preparation cement and implant standardization and scripted discharge with shortened inpatient stays Nearly all of the teams achieved a reduction in total cost while maintaining or improving quality over half of the teams saved at least 5 or more While the cost savings are impressive the real learning was the new way of working participants discovered For many teams this project forever changed the way clinical and financial staff relate to each other This change is not easy but it is worth the effort Here are some tips for building strong working relationships within condition focused teams 1 Ask clinicians and financial analysts to create process maps from their respective perspectives Compare the maps side by side and look for differences These differences can illuminate differences in language opinion and working styles that are important to address before working together 2 Ask counter intuitive questions like these How could we make this procedure cost more How could we really degrade quality How could we ensur e an HCAHPS score in the lowest quartile By looking at cost and quality from a counterintuitive perspective you can unlock the knowledge and influence of the disciplines represented on the team 3 Craft an aim statement together one that the entire team agrees on This is an essential step to ensure buy in and collaboration These simple steps can go a long way toward moving team members away from their comfort zones and closer to unleashing the power of real collaboration and new levels of performance Tags Quality Cost and Value Cost Containment and Reduction Teamwork Blog Home Older Average Content Rating 1 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=132 (2016-02-01)
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  • Rethinking Patient Safety
    be more about the art of service Modifying our approach based on patient condition or patient preference gives us freedom but it also ensures we re all working from the same playbook Health care is a team sport and great teams wouldn t take the field without a shared playbook Q How does improving reliability benefit the care provider We ve been able to demonstrate that we get better outcomes by standardizing and simplifying workflows and every health care worker wants better outcomes for their patients From an operational perspective when we can agree on the way to do our work and who is responsible for executing different parts of the workflow frustration interruptions and inefficiencies decrease This allows clinicians to focus on the patient It makes clinicians work simpler and easier when we implement reliable design principles Q Why is it important to understand human factors to improve patient safety No matter how smart and well intentioned we are as clinicians we cannot change the human condition but we can change the conditions under which humans operate Human factors looks at the conditions under which humans operate and tries to change the interface say between a person and technology or a person and other people or a person and the environment in a way that enables optimized human performance Understanding human factors means understanding the things that can negatively or adversely impact our performance and changing the way that work is designed and teams perform together to optimize outcomes Q How do you think about human factors in terms of health technology Technology can help address human factors but it can also make some matters worse One example of where technology has helped involves counting sponges after intra abdominal surgery We achieved a certain level of performance by relying on humans but now there s technology to help us improve that performance The sponges are radio tagged so we can wand the patient after a human performs the sponge count to verify whether the count is correct In this case technology is acting as our redundancy system to the human operator providing information that helps us identify and mitigate a human error before it potentially causes harm The flip side might be when health technology provides information in a way that s intended to be helpful to the care team but may end up being ignored For example a medication alert system that warns a doctor about an order that may interfere with a medication the patient s already on However when there are too many of those reminders and alerts the doctor might learn to ignore them and when there s a critical alert they might go right past it because they ve learned over time to tune out the multitude of warnings So I think technology is really a mixed blessing for health care and for patient safety and requires us to understand human factors and the causes of failures so we can better use it to

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=0f316db6-7f8a-430f-a63a-ed7602d1366a&ID=48 (2016-02-01)
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  • Gundersen Is Walking the Talk
    work in light of the Leadership Alliance vision that s now been laid out in a March 26 2015 Online First Viewpoint published in the Journal of the American Medical Association JAMA To improve is to change to be perfect is to change often Winston Churchill Gundersen Health System s involvement in IHI s Leadership Alliance is a natural fit Innovative systems and organizations from across the country have come together to collaborate by exchanging ideas experiences and knowledge with a commitment to continuously improve and transform the health care delivery system to do what s right for patients and the communities we serve The inaugural Online First JAMA Viewpoint Change From the Inside Out drawing on the vision and thinking of the Leadership Alliance sets out the Alliance s principles and goals for continuous improvement Participating in the IHI Leadership Alliance will help organizations like Gundersen get better faster and continue working to achieve the Triple Aim better care better health at lower cost Gundersen Health System demonstrates that it is possible to face challenges embrace change and make progress toward the goals and principles outlined in the IHI Leadership Alliance s inaugural piece Our comprehensive interdisciplinary advance care planning program changed the way care is designed to ensure that patients wishes and goals regarding end of life care are honored it is a model for the nation now used throughout the world Our change and improvement efforts are guided by What matters to you one of many important questions our providers and staff ask patients and their families every day creating a partnership to achieve better outcomes and better care Through our Envision program we achieved energy independence the first health system in the country to do so by investing in efficiency renewable energy and reduced fossil fuel consumption Gundersen refused to accept that sustainability is an either or choice We reduced waste developed community partnerships and insisted upon programs and initiatives that improved environmental conditions for our patients and lowered our costs while also investing in and supporting the local economy Our 500 Club partnership with local businesses convenience stores schools and restaurants offers a menu of local healthy food choices throughout communities in western Wisconsin The culture of our organization has pushed boundaries in transforming care outside the walls of the health system Our initiatives demonstrate that it is possible to make progress toward the principles illustrated in Change From the Inside Out However our efforts to improve population health and lower cost are not aligned with how government pays us for services But we cannot wait for government to fix the health care system or wait for what happens with the Affordable Care Act There is no doubt that policy making has a critical role in transforming the delivery system from volume to value to reward and incentivize efficiency and quality Despite this we as health care leaders must continue to drive forward towards the Triple Aim and be willing to break down traditional barriers

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=66 (2016-02-01)
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  • Can a Triple Aim Approach Deliver? Caring for the 5% and Paying It Forward
    in the Eastwood area accounted for more than 169 million in health care use and costs in 2009 2010 Note The costing data were compiled from several different sources including the Alberta Health Care Plan Insurance Plan Registry the physician claims database the inpatient Discharge Abstract Database DAD the National Ambulatory Care Reporting System NACRS database and census data by various groups in Data Integration Measurement and Reporting and Population and Public Health An examination of root causes among the Eastwood population of individuals with high emergency department ED visits revealed the determinants of health to be an obvious factor the Eastwood area has the lowest socioeconomic status highest health risks and highest prevalence of homelessness in the city Health care providers often work in silos rendering health services fragmented complex and frustrating to patients who report feeling disrespected and lacking close trusting relationships with their care providers Rather than helping some of those who make frequent use of the health care system use fewer services the health care system tends to aggravate and even intensify the health care use That s because in Canada publicly funded health care favours acute episodic hospital based care which comprises 30 percent of total health spending in the country based on recent national health care expenditures whereas what many patients in the 5 percent category need are longer term community based primary health based and home based supports The 1 750 older adults with addictions mental health issues and chronic disease are one of AHS Edmonton s patient population clusters The average annual per capita health spending in Alberta is 6 783 however for older adults in this patient cluster their annual 35 000 average per capita health care bill results in total annual spending of more than 60 million By talking to patients and asking What matters to you a far more progressive question than the standard What s the matter with you service providers learned to re prioritize their efforts Build trusting relationships with patients clients and families Address the basic necessities of life e g managing addictions housing personal care medication management acute medical needs Communicate and coordinate a care plan based on the person s priorities among all service partners inside and outside of the health system and Provide emotional support peer family social network By doing so AHS Edmonton is learning it s possible to reduce overall per capita cost of care and shift away from a reliance on acute based care to a more community based model Although this success at AHS Edmonton is limited to a small group of patients and has not yet led to material savings it shows promise Firstly it s possible to reduce reliance on costly facility based care while increasing reliance on in this case less costly community based care for the highest risk highest need patients Secondly while the hospital dividends are not yet flowing to community care nor to other sectors e g housing the AHS Edmonton example shows

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=131 (2016-02-01)
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  • You do like online courses. Phew.
    case studies and games We also try to keep you updated on new resources through social media this blog and our newsletter And every now and then we think we should try out a new format such as a podcast Around the Open School pod we were all addicted to Serial So we wanted to know Which of these formats is most helpful to you and which should we be doing more of Here is a graph showing the results of the survey question greater scores mean more helpful We were very happy to see that online courses came in the lead That is after all what we spend most of our time creating and improving The popularity of case studies made us brainstorm how we could create more of these We d love to work with you on them especially based on your own experience in the field Drop us a line at openschool at ihi org if you have an idea for a case And let us know what you think of these results in the comments We d love to know why certain formats are valuable to you and how you use them Thanks for your feedback Tags interprofessional learning Quality Improvement Patient Safety Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully There was an error reporting your complaint Follow Me Subscribe Blog Archive 2016 2 January

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=169 (2016-02-01)
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  • What will be the Open School’s next course?
    of our learners We re hoping to use the insights to inform our work to create new educational resources for you Today we re sharing the results of our question about new courses We have several ideas for courses from a variety of sources and we asked survey takers to rank them higher scores correlate to greater interest See the graph of our results below We re able to see the survey results by type of learner students professionals and faculty We didn t see much variance in the rankings by group except that students were more interested in a course on burnout in health care than the other two groups And frankly that surprised us Wouldn t you guess that professionals are more concerned about burnout Let us know your thoughts in the comments below Tags Quality Improvement Patient Safety Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments Show More Comments Loading You are about to report a violation of our Terms of Use All reports are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful Copyright Violation Other Please select a reason for this report Add a Note Your comments were submitted successfully There was an error reporting your complaint Follow Me Subscribe Blog Archive 2016 2 January 2 2015 44 December 2 November 5 October 2 September 4 August 1 July 4 June 5 May 4 April 3 March 6 February 4 January 4 2014 14 December 3 November 1 October 1 August 3 July 1 April 2 March 1 January 2 2013 44 December 2 October 1 September 1 August 1 June 5 May 7 April 10 March 6 February 9 January

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=168 (2016-02-01)
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  • We didn’t expect these results in our survey of Open School learners
    Here is a graph of the results In our internal quality improvement work we make predictions before we run tests to see what we learn In this case our best guess was that quality improvement would be ranked first That s what we re known for after all Improvement is in our name And it represents the methods and tools we use to make care safer lower cost and more patient centered for example So we d like to know from you why do you think we got these results If you took the survey why did you give the answer you did Please leave your thoughts in the comments And look out for more results from our survey in future blog posts Tags education IHI Open School for Health Professions Blog Home Older Average Content Rating 0 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Susan Salmond 4 7 2015 9 32 57 AM Quality improvement is the vehicle to getting to patient safety and patient and family centered care The metrics that we are looking at reflect safety and engagement loading Did you find this user comment useful people found this user comment useful Report This by Giulio Pieve 4 2 2015 2 41 44 AM Patient safety is one of the most important priority in my agenda but it is simply a part of the quality improvement field I could have chosen the latter but my focus remains on patient safety Regards Giulio from Hygiene school of Turin Italy loading Did you find this user comment useful people found this user comment useful Report This Show More Comments Loading You are about to report a violation of our Terms of Use All reports

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=167 (2016-02-01)
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  • Fellows Snapshot: Timmy Ho, MD, 2013-2015 Harvard Pediatric Health Services Research Fellow
    to work and we would do things in a certain way and I d think There must be a better way to do this Over and over and over again Once I started my NICU Neonatal Intensive Care Unit fellowship I m now a third year NICU fellow taking care of babies and premature infants as part of fellowship training we have to do some kind of scholarly work And I thought I would be a basic science researcher because that s what I was trained to do I think I would have been okay at it It has its own set of challenges but it isn t where my heart is My heart is in how to take better care of our patients and make sure the parents are involved and invested and how to be more efficient doing this that is a lot of my research career is now focused on the Triple Aim so it was a natural fit I ended up as a fellow at IHI as a result of circumstance and really good mentorship My mentors in my fellowship program knew I was interested in improvement and in quality and one thing led to another we set up meetings with Don Goldmann IHI s Chief Medical and Scientific Officer and executive lead for fellowships Don was wearing two hats one in the Harvard Pediatric Health Services Research Fellowship and one here at IHI and he agreed that it would be a fantastic opportunity for me What s one thing you ve learned already A key thing is that I vastly underestimated the influence of building will and getting people to buy into the message I ve tried to change policies from the traditional top down approach I ve pivoted through some of my projects keying in on certain clinical champions And the projects that have worked the ones that have stuck haven t come from me They ve come from people I work with I ve learned that taking time to build those connections and relationships can make a big difference in the work we do What s something that has surprised you The biggest surprise is how much I ve learned about myself in this process Taking a couple of steps back as I was growing up I always worked really hard but I was very shy I was the one who sat in the back of the classroom and knew a lot of the answers but never participated A lot of it is fear of what other people will think of me That introverted quality I now view as a strength I think it s also part of the training that I ve undergone to become a doctor The way I listen the posture I take the echoing back of what I m hearing from people It s definitely something I value now I m rarely one to speak first but it seems like when I do speak people like what they hear

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=113a95c2-dffe-41ec-abee-93b4088068ac&ID=27 (2016-02-01)
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