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  • Meet a Regional Leader: Five Questions for Sarah Miano, RN
    nurses social workers and many patients and their family caregivers You can say that working in health care just fits me I loved the bonds with patients and their families that developed and I loved the holistic approach of caring for people that nursing brings I now work as a pediatric hematology oncology nurse and feel so privileged to be a part of the team that cares for children teens and young adults with cancer and blood disorders Ultimately I went into health care to make a difference in the people s lives both patients and their family members who are beside them through illness and into health 2 Why does quality improvement matter to you Access to high quality health care seems to me to be a right for everyone Just like we learn from our patients on a daily basis about their experiences and their values we should be continuously learning about how to make health care better more efficient and more affordable So quality improvement is more than a catchphrase for me It ties back into why I went into health care to make a difference in people s lives Being part of a community of students faculty and clinicians in the Open School community that also value quality improvement not only for the numbers but for the human impact is awesome and inspiring 3 What was your best moment with the Open School community My favorite moments are when we can come together at the National Forum or during the Student Quality Leadership Academy Since I have to pick a best moment I would go back to my first experience at the Forum in 2009 I travelled with a group of medical and nursing students from my Open School Chapter at Case Western Reserve University We went to the Open School Chapter Congress together and learned about building a public narrative for health care improvement through the Story of Self Editor s note To learn these community organizing skills yourself check out our I CAN initiative These techniques were new to me but so useful in my career now as a nurse and patient advocate We all left the Forum with new ideas for our Chapter activities and improvement projects to implement in our clinical settings 4 Tell us something that most people don t know about you Most people I work with in health care don t know that one of my favorite activities is whitewater canoeing and I spend a lot of weekends in the summer and fall on the rivers near my home in Cleveland 5 What one piece of advice would you give a new Chapter Build a strong relationship with your faculty advisors They can be a great resource to your Chapter and help sustain the momentum in the long term Of course reaching out to the Regional Leader in your area is also key We can connect you with other active Chapters in your region and provide additional support as

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=156 (2016-02-01)
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  • Bringing End-of-Life Conversations Home
    to think about these issues Q How did you adapt the Conversation Ready Community activities since you re not a hospital or a health care system Our team focused on helping our clients complete a health care proxy It s hard to get people into even short term rehab from the hospital if they don t have a health care proxy because the rehabs are very resistant to admitting them without one That became a big driver for us because we want to make sure that everybody s safe has the care they need and they re not staying in the hospital longer than necessary After clients complete a health care proxy if they want to discuss their end of life wishes in more detail with our staff I speak with them I remember two referrals from case managers with clients who wanted to talk about their advance directives but the clients didn t feel like they could talk to their family members about it It was really amazing for me to see that people really do want to talk about these issues Both clients said to me This was really good I feel like I can talk to my family now because I know what I want to do Q You didn t expect those conversations to go so well Both of these particular people have mental health issues and I wasn t sure how I d be able to engage with them But they were very clear They said This is what I want to do This is how I want to talk to my family but I don t know how to do it Initially I thought they d want me to tell them what to do but it wasn t like that They knew pretty clearly what they wanted to do and both of those situations worked out really well Q You gave them a chance to practice having an end of life conversation before they did so with their families Yes I used what I learned from The Conversation Project Starter Kit I asked them What s important to you Both clients wanted to make sure they were the ones in control Once we identified that we discussed how much they wanted their families to be involved Who talks to the doctor you or them We talked about their five wishes We re educating people about the control they have Most of our clients don t feel like they have too much control over anything in their lives If you re elderly or part of a low income group or have mental health issues you may not feel like you control much Our mission is to help people to live as well as they can in the setting that they choose to live in For us our mission is to help our clients live at home and to die at home if that s what they choose to do When we help people talk to

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=115 (2016-02-01)
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  • Behind the Scenes at Emory University's Quality Improvement Training Day
    addition to activities from the IHI Open School 5th Annual Student Quality Leadership Academy and the Telluride Patient Safety Summer Camp We designed a very demanding curriculum Although each of us had previous teaching experience we knew we should consult with accomplished teachers of QI For help we turned to some of our mentors at the Atlanta VA Medical Center including the chief of quality medicine the site director for postgraduate training in quality and safety the VA National Quality Scholar Fellows and the chief resident of quality and patient safety They were just as enthusiastic as we were about the potential of the training day But they thought our plan was too ambitious Instead they encouraged us to choose goals and objectives that we could measure They also recommended based on their experience to use examples unrelated to health care for our audience of QI neophytes After our meeting Erin Tana and I met again to settle on our event objectives We decided that the overall purpose of the Healthcare Quality Improvement Training Day Skills Lab would be to inspire critical thinking about health care systems and to equip graduate students with QI skills that they can apply to their current and future work in health care systems We were just getting started Next we developed the curriculum for our three hour long sessions Each session would be student led with faculty support We also designed pre and post tests to measure the success of our event We arranged all of the logistics including reserving rooms and buying supplies and securing funding for breakfast and lunch from IHI Open School and the Emory Graduate Student Senate At the same time we publicized the event in an e mail message to all graduate students We were pleasantly surprised by the overwhelming response within a few days of sending out our event flyer more than 100 students said they were interested in our event In the end we accepted 50 students 10 from each of the five graduate schools During the month before the event we finalized the curriculum and prepared the materials for attendees We divided all 50 participants into 10 interdisciplinary teams We thought this would be important to fostering engaging conversations and camaraderie among members of different health care fields Finally it was Saturday November 8 and we welcomed all 50 participants into the lecture hall for the first session I was amazed to see they were so committed to learning about QI that they had willingly given up a Saturday morning to join us In the first session the participants worked in small groups to discuss case studies in health care and explore human factors that lead to errors In the second session the skills lab portion they learned about the components of an aim statement and practiced writing aim statements They also learned the purpose of a plan do study act PDSA cycle and participated in a hands on team building exercise to illustrate the stages

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=155 (2016-02-01)
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  • Tips for Safely Managing Multiple Medications
    describe treatment for patients who take more than a certain number of medications I heard one nurse describe polypharmacy as More medications than a patient can handle To paraphrase a song another colleague uses the phrase It s raining meds I m seeing firsthand what this issue means because over the past few years I have become increasingly involved in my mother s care Although she still lives independently my sister and I now manage our mother s medications I m continually struck by how difficult it must be for older people taking many prescription drugs They must manage what is often a wide array of medications They have to remember when to take them and when to refill their prescriptions They must ensure their medication list is up to date They wonder if the feelings of discomfort they sometimes experience are due to the medications they re taking Those feelings of discomfort may not be unwarranted Older people are more likely to be harmed by medications because of how their organs function they often have co morbidities and they may have multiple physicians caring for them who each prescribe medications without necessarily consulting one another The lack of communication between specialists and primary care doctors is one of the challenges in managing polypharmacy It s estimated that over 4 billion prescriptions were written in 2011 Unfortunately that represents many opportunities for error How can we help our patients more safely manage the problem of polypharmacy Focus first on elderly patients Simply put certain medications should not be prescribed for elderly patients Using tools like the Beers criteria and STOPP Screening Tool of Older Persons Prescriptions and START Screening Tool to Alert doctors to Right Treatment tools will help The Choosing Wisely Campaign also suggests which medications should be avoided for the elderly Think twice before prescribing Carefully consider if a medication is really needed and will provide benefit There are some medications that help younger people When taken by elderly patients however they are likely to cause unintended effects or even harm Statins are one example Start low and go slow Initial dosing should be carefully considered and titration should be gradual Keep it simple Limit your formulary and whenever possible use simple regimens with minimal frequency of dosing Medication reconciliation and adherence to medication therapies are hard enough Why not try to simplify each by reducing the number of medications and frequency of doses a patient is taking When used appropriately medications can help keep people from needing hospital care for longer periods of time so I am not advocating that doctors should avoid prescribing a necessary medication In fact Dr E Robert Feroli Medication Safety Officer in the Department of Pharmacy at Johns Hopkins Hospital suggests that we should focus less on polypharmacy which for some patients may be needed and put more emphasis on better medication management At every visit to the doctor s office my mom her doctor and I discuss opportunities to discontinue a

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=0f316db6-7f8a-430f-a63a-ed7602d1366a&ID=41 (2016-02-01)
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  • IHI’s Ten Picks from 2014
    The Conversation Project leads us right to the joy and heart of patient and singer Dolly Baker Dolly says that for her a good day is one where she is able to sing The Conversation Project in partnership with IHI has developed a Conversation Starter Kit including a pediatric version to help you have conversations with loved ones about end of life wishes Comparing Lean and Quality Improvement and More Capability Building Resources IHI offers lots of key resources for helping your team and your organization build their skills and capability to improve but here are just three of our top picks for this year Comparing Lean and Quality Improvement IHI White Paper QI 102 The Model for Improvement Your Engine for Change IHI Open School online course and Science of Improvement on a Whiteboard videos Eliminating Mother to Child Transmission of HIV eMTCT A Six Country Collaboration in Africa Using QI methods six countries in Africa have formed a learning network to test changes and rapidly scale up effective eMTCT and nutrition programs The network regularly engages in cross country learning and sharing of best practices and challenges A brief storyboard tells the whole story about this work that is part of the Partnership for HIV Free Survival The Stuff That Is Killing Us What if there were national goals in the US for zero inequity and health disparities What impact would they have What would be the work necessary to achieve these ambitions In a post to RWJF s Human Capital Blog Ron Wyatt MD MHA former IHI Fellow and current Medical Director in the Division of Healthcare Improvement at The Joint Commission urges us to consider the improvement possibilities if we make an even deeper commitment to better health and health outcomes for minority communities Empathy for Patients Afraid and Vulnerable Empathy is not the same thing as sympathy We can all work on expressing more empathy Everyone needs it at times and one way that caregivers discover the important distinction between empathy and sympathy is when they themselves become patients Check out this powerful video series from the Cleveland Clinic on Empathy Populations Population Health and the Evolution of Population Management Making Sense of the Terminology in US Health Care Today In the years since IHI first began developing the Triple Aim concept the words Triple Aim and the terms that are part of its lexicon have become widely used but often incorrectly Some of the terminology such as population population health and population management needs ongoing clarification That s why Ninon Lewis Director of IHI s Triple Aim for Populations focus area wrote this blog post which you might want to keep handy See also A Primer on Defining the Triple Aim There s one more 100 Million Healthier Lives by 2020 An unprecedented coalition of leaders called the Guiding Coalition for 100 Million Healthier Lives has committed to improving health by joining efforts around an audacious shared goal 100 million people living healthier lives

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=114 (2016-02-01)
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  • A Student’s Story: Building a Better Future for People with Diabetes
    pies full of saturated fat butter oil sugar and high fructose corn syrup These foods were a traditional part of my family culture As I got older I witnessed my great aunts suffer from diabetes as a result of their diet and environmental factors Every morning one of my great aunts had to inject insulin in her thigh or stomach area I remember the fearful look in her eyes when she experienced dizziness shaking confusion and a pounding heartbeat due to low blood sugar Another great aunt along with the other family members had to make a life changing choice to have both of her lower limbs amputated These complications of diabetes reduced my great aunts quality of life significantly Through these experiences I have become determined to advocate for diabetes prevention through tailored innovative interventions improved access to health care diabetes self management programs in underserved populations and better exposure to health education i e importance of consuming fresh fruits and vegetables and engaging in physical activity The Open School community consists of students residents health educators and faculty throughout the United States This community brings an array of knowledge skills and expertise with a shared value of exercising leadership to improve the health of populations Additionally this community shares the value of systems thinking which is a critical skill in understanding the root causes of a problem Furthermore as leaders in the Open School community we have experienced a loved one or heard of someone who has suffered from chronic diseases such as diabetes With diabetes being an incurable disease with adverse health complications we share the experience of promoting healthy behavior and lifestyle and environmental changes for example access to transportation health care and affordable fruits and vegetables and supporting policies that help individuals effectively manage their diabetes and prevent discrimination Diabetes is one of the leading causes of morbidity and mortality in the United States At present 25 8 million Americans are living with diabetes both diagnosed and undiagnosed according to the Centers for Disease Control and Prevention Unfortunately these individuals are at a higher risk of developing diabetes related complications such as lower limb amputation kidney disease and cardiovascular disease There is work that must to be done to save and improve individuals lives in our communities I ask you the Open School community to go to the American Diabetes Association website www diabetes org right now to become a diabetes advocate As diabetes advocates we can support and fund the needed research to stop diabetes Additionally we can empower those individuals at risk for developing diabetes and those individuals diagnosed with diabetes on prevention and diabetes management through accessible evidence based culturally appropriate resources tools and programs My vision is for the Open School community to encourage discussion of the burden of diabetes in their communities and collaborate with individuals affected by diabetes to employ solutions that will improve health outcomes and quality of life By acting together we can make a difference for

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=154 (2016-02-01)
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  • Report from the Field: Unique Training Session on Undoing Racism
    session and emphasizes the importance of the workshop to the staff That s a lot of time dedicated to this issue in tight financial times So why do they do it The literature documenting disparities in health care and health care outcomes among minority populations in the United States is vast Our outcomes are dismal Life expectancies between blacks and whites differ dramatically and many more measures of health line up the same way We need new strategies As health care improvers when addressing medical errors we have been trained to go further upstream to re engineer systems that are producing errors rather than focus only on educational campaigns trainings and incentives As systems thinkers we need to remember that every system is perfectly designed to get the results it gets The system that we have now is producing disparities in health care and health outcomes Learning about racism is one way the entire staff at St Thomas Community Health Center can truly increase their empathy for their patients and think in more sophisticated ways about improving the health of their community In health care today a number of strategies are being implemented to address disparities improving cultural competence hiring more staff from underrepresented minorities increasing capacity to identify and address disparities focusing interventions on at risk communities and more Over the course of the workshop we became convinced that addressing unintentional racism in the delivery of health care is another important strategy to be added to our list of interventions Racism can be overt but more often takes the form of subtle attitudes and behaviors Racism can also refer to institutional racism We learned that the system we have now that produces disparities is an example of institutional racism No one is intentionally trying to create disparities but the system is creating disparities For two days at the workshop we alternated between educational activities and reflection We learned important facts about disparities and about the experience of people of color The history and analysis were compelling but just as important were the interactions among the multi racial group at the workshop Most powerful was observing the different responses of the whites and the people of color to the same material When a presenter talked about the definition of racism as relating to power we white people found ourselves thinking must we go there Then we looked around the room All the black people were steadfastly nodding and commenting with affirmations We realized we needed to reconsider and expand our understanding In an environment of safety and trust in the workshop we frankly shared our experiences regarding race such as black peoples common experience of how white people act around black people and white peoples lack of awareness of their privilege When we all described our experiences of being black white Hispanic Asian etc the group would sometimes laugh out loud at shared experiences And we would tear up at times as well at some of the touching stories One

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=113a95c2-dffe-41ec-abee-93b4088068ac&ID=23 (2016-02-01)
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  • Five Takeaways from the 26th IHI National Forum
    The Forum reminded us of all the work we health care improvers still have ahead of us So let s get to it Here are five takeaways and action steps from the 26th National Forum Improving health care is critical but we can t stop there The IHI Open School along with IHI aims to create a culture of health At the IHI Open School Chapter Congress Dr Don Berwick laid out a challenge for Open School students Take part in the next phase of the Open School s Improvement Change Agent Network I CAN movement We re offering a new eight week course on leadership and community organizing that guides students to take action in their communities Learn more and apply here And is the new or Instead of choosing between improving quality or reducing costs creating joy for patients or for staff or thinking about health care or health we can and must do both IHI CEO Maureen Bisognano and Executive Vice President Derek Feeley illustrated this approach with a joint keynote to kick off the Forum Students are amazing improvers This year students and trainees made up one out of every 10 Forum attendees and they presented 123 storyboards the largest number ever Check out the great student work on the virtual storyboard tour here Patients are people Robin Roberts a host of Good Morning America who survived breast cancer and a rare blood disorder shared intimate moments from her experience as a patient What mattered to her was finding a human connection with a team of caregivers She felt restored by the hospital custodian who looked after her and the doctor who whispered a prayer under his surgical mask as he performed a procedure How can you build relationships with your patients Don Berwick is back In a rousing closing keynote Dr Berwick described the injustices he saw while he was away from IHI on the campaign trail for governor of Massachusetts and called for health care providers to broaden their view of health Why does our medical system spare no expense to save the life of a gunshot victims but not invest in the job training or counseling required to save them from the bullet in the first place Dr Berwick laid out three action steps 1 Reduce health care costs so we can afford proven prevention programs 2 Broaden our engagement to address issues like mass incarceration that are destroying the health of communities 3 Vote As an organization dedicated to improvement IHI works to make each year s Forum better than the last What did you take away from your Forum experience and how can we better serve you next year Leave your thoughts in the comments Tags Improvement National Forum Triple Aim for Populations Student 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

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=153 (2016-02-01)
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