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  • Three Lessons from Malawi
    Down we all have a great deal to learn from lower income countries Last week I traveled to Malawi with Pierre Barker and Nneka Mobisson Etuk to meet with our partners there MaiKhanda Together we aim to reduce maternal and neonatal mortality in a country overwhelmed by poverty and with few resources for health I returned from Malawi with three lessons I think have particular resonance for us in the US First take a look at this photo As we made rounds through a busy health clinic I noted that all patients carried their own medical records the blue folder above Patients and staff alike affirmed the need to have and examine all family medical histories and have these records travel between various facilities and providers with the patients Every patient had their record in hand and the visits began with a look at history and progress together The second lesson is a commitment to using data In a system with scarce resources and increasing demands the staff find incredible value in tracking data over time learning from PDSA cycles and studying improvement And the third lesson is a key lever that everyone everywhere can use for success in reducing neonatal mortality getting out into the community These are photos of a task force in the Maganga region of Salima in the central part of Malawi Each month task force members identify pregnant women in their communities and ensure that they get proper prenatal care They also make sure they can deliver their babies in a safe place and facilitate proper newborn screening There are 21 task forces surrounding the Maganga Health Center with an average of 12 members in each The task forces help ease the strain on the health center which is responsible for supporting 240 villages The results are inspiring In just a short time they ve improved their rate of newborn screening from just over 55 percent to over 95 percent So these three lessons Records owned by patients with access to all providers Reliable systems to collect and analyze data to drive process changes and Seeing the care system beyond the walls of the clinic or hospital can serve as design principles for all of us no matter where we live Let us know some lessons you ve picked up in your daily life or work that can help everyone improve care If you want to read more about Malawi and the transfomative efforts of their remarkable new president Joyce Banda check out this piece from the New York Times Maureen Bisognano Tags Leadership Triple Aim Population Health Individual Care and Cost Control Optimization Low and Middle Income Countries LMIC MaiKhanda in Malawi Patient Family Centered Care 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 by Edward Moses 3 8 2013 4 05 23 AM what a wonderful summary of the 3 days loading Did

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=15 (2016-02-01)
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  • Engaging Employers (Including IHI!) in Improving Health and Lowering Costs
    of care At so many of the places I visit I see inspiring progress on both the health of the population and on the patient experience of care As we all know however the big barrier is cost I hear this everywhere I go and I see organizations everywhere working on the issue Many of these organizations have turned to IHI for help so we ve been thinking about how to simultaneously engage employers health plans and health care providers to work together to improve employee health and lower insurance premium costs This past fall we began collaborating with employers in a new program called Healthy Employees Lower Premiums Costs The program aims to combine individual sector focused approaches into a coherent system with the aim of lowering costs to employers and their employees while improving employees health and their experience within the health care system in other words IHI s Triple Aim One of the reasons I m so excited about this new program is that we re engaged in this work as an employer as well as a convener Like any employer IHI has a keen interest in having the healthiest possible workforce and in controlling the costs of our health care needs and health plan premiums We kicked the year off by inviting IHI employees to fill out a Health Risk Assessment HRA that can be used to identify key areas for each employee to focus on to improve their health I am happy to say I was the first person in line to take the HRA Learning more about how to improve our own health is crucial but the HRAs also allow us to learn a great deal more about the health needs of our population This will give us better insight into our past costs enabling us to work with our insurer to better design benefits that will drive us toward the Triple Aim The motivation of employers throughout the United States from small companies to global corporations to control costs while improving the health of their employees has never been greater It is one of the truly burning issues in the business world The Healthy Employees Lower Premiums Costs work is structured to achieve significant rapid results by engaging various shaped alliances that work closely together These alliances could take the form of a large self insured employer partnering with two major health care providers in their region and their third party administrator or ten small to medium companies with the same health plan vendor joining together to increase their influence with local health care providers Regardless of the form they take the commitment of each alliance is to reduce overall costs As with all improvement work genuine learning depends on shared transparent data Participants in the initiative have agreed to share data both on costs and on outcomes The outcomes we ll be looking at come straight from the Triple Aim we ll be measuring cost patient experience and population health And we

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=14 (2016-02-01)
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  • Out of the Blocks: Where Does Health Care Go From Here?
    bring people together hundreds of times each year to tackle a wide variety of health care challenges For me one of the most exciting gatherings came just two days after the recent presidential election when we brought together more than 100 health care leaders in Washington DC for a session we called Out of the Blocks What an amazing day There was clearly a sense of excitement over the affirmation of the Affordable Care Act As former Senate Majority leader Bill Frist MD put it so aptly Nothing has changed in terms of who controls the House Senate and White House but in health care everything has changed Our mission for the day was to define where we now stand in health care in America where we need to go and how we get there People attended from Capitol Hill and the Obama Administration as well as from hospitals physician groups think tanks insurance companies and safety net organizations I was fascinated by the powerful sense of ambiguity that seemed to develop almost organically throughout the day Initially there was a sense of relief that the election was over and the Affordable Care Act was thus solidly affirmed But the group had barely paused to enjoy the sense of relief and stability when the sentiment in the room began to shift to a second reaction Un certainty Where do we go from here What precisely are we aiming for In the staggering complexity of the system that is American health care how do we find a pathway through the thicket Perhaps the most foundational consensus of the day however was the urgent need to drive down costs and to do so quickly and thoughtfully No one defended the status quo No one said I need to expand my budget or else This theme continued to echo throughout the Forum in Orlando as well I left the session in Washington with a sense of crystal clarity that our job at IHI is not only to convene these great thinkers and innovators but to work cooperatively with them to identify the way forward to find the way to the new American health care system we all want And to me that speaks directly to the Triple Aim which was outlined nearly six years ago here at IHI by John Whittington Tom Nolan and Don Berwick In fact when I think about the discussion during the day I think it is fair to say that the consensus solution would align quite well with the Triple Aim To improve the health of the population To enhance the patient experience of care including quality access and reliability and To reduce costs Discussions around cost were dynamic not only because no one defended the status quo but because some people are setting very aggressive cost goals Susan DeVore CEO of the Premier Health Care Alliance which comprises 2 600 hospitals said that many of her members are determined to run their operations at Medicare rates while

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=13 (2016-02-01)
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  • Leadership, Courage, Vision — Mary Brainerd, CEO, HealthPartners
    and the radiation oncologist all of whom had slightly different recommendations for follow up Well as a patient what that leaves you with is I don t know who to trust I don t know who to believe and why aren t these people talking to each other Mary realized that the delivery system needed to be rewired as she put it And she went about doing just that She has relied in her work on both the IHI Triple Aim improving the individual experience of care improving the health of the population and reducing cost and the IOM s six aims care that is safe effective patient centered timely efficient and equitable The Triple Aim and the IOM s six aims come together naturally in the transformational work Mary has led at HealthPartners Take for example the work she s done on patients with diabetes As we all know any measurable outcome improvement in treating patients with diabetes tends to also demonstrate leaps forward in improving health and controlling costs Mary s clinical team established the Optimal Diabetes Measure aimed at keeping diabetes well controlled The measure includes five elements Blood pressure under control 129 79 Healthy cholesterol low density lipoprotein 99 Blood sugar under control hemoglobin A1c 6 9 Non smoker Regular aspirin user When the work started in 2003 Mary and her team discovered that fewer than 5 percent of HealthPartners patients with diabetes met the standard We thought we were hitting on all cylinders then we found out that only 5 percent of our patients met the optimal measure she told me That was a sorry day It took courage to push forward from that low point and that is exactly what Mary did Persistent well organized primary care teamwork and outreach has enabled HealthPartners to go from less than 5 percent of their patients hitting the mark to 43 percent today When I visited Mary again in late September I got to see her vision for the recently announced collaboration with Park Nicollet I spent a morning with Mary and the team working with her on improvements to mental health care They are amazing and will serve as a national model I m sure As always with Mary the meeting I attended included a multi disciplinary and multi professional team along with patients and families At one point a patient spoke up Can I ask what was the spark that started all of this change the patient said Everyone in the room looked at Mary The impact of her courage and vision and her relentless commitment to hearing the voice of the patient in design was clear as I visited the new care unit When I asked What parts of the design changed as a result of the patients input many people answered simultaneously The impact ranged from visiting homes to get a sense of a good design and feel of the space to planning daily goals with patients even the availability of meals Mary

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=11 (2016-02-01)
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  • The Power of Stories: Two New Documentaries You Should See
    potential solutions in health care and they do it by telling stories I urge all of you to set aside time to watch them Money Medicine an hour long film by Roger Weisberg premiers on PBS on Tuesday September 25 at 8pm ET check local listings It examines the ethical medical and financial challenges of reining in spiraling health costs We ve all heard the harrowing statistics we spend 2 7 trillion on health care each year in the US 75 percent of it on managing chronic diseases And it s getting worse fast By exploring the wide variations in care and costs at the beginning of life and at the end Money Medicine tells the story of a health care system that s not serving the needs of patients and threatens national prosperity It features commentary by some of the leading figures in the improvement community including two of IHI s current board members Dr Brent James and Dr Elliott Fisher One of the stories from Money Medicine that resonated with me was of a son dutifully caring for his ailing mother in an ICU His commitment to his mother and faith in a possible miracle despite a negative prognosis remind us all how personal and emotionally charged these issues around end of life care can be Escape Fire The Fight to Rescue American Healthcare is a feature length documentary by Matthew Heineman and Susan Froemke It premieres in select theaters across the country on iTunes and via Video on Demand on Friday October 5 The title is probably familiar to a lot of you since it s inspired by Don Berwick s 1999 National Forum keynote in which he recounts the use of a radical approach to wildfire survival setting your own smaller fire to prevent the larger fire from overwhelming and consuming you and offers this disruptive even counterintuitive innovation as a metaphor for what s needed in health care Don appears in the film along with journalist Shannon Brownlee prevention advocate and wellness expert Dr Andrew Weil and a host of other innovative leaders in health care The film closely follows the often heart breaking challenges patients and clinicians face as they try to treat and be treated in a fragmented costly and often ineffective system I was particularly struck by the account of a young primary care physician from Oregon and her agonizing decision to leave a practice that was not meeting the needs of her patients and not satisfying her professionally The hope and renewed energy she found in pursuing a fellowship and practicing in a new model underline the power and promise of redesigned systems of care We all get frustrated by the slow pace of change in health care and these two new films tell many stories that confirm that frustration But they also offer hope You can and will find hope in the dedication and determination from leaders innovators and front line care givers who share our passion to improve We

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=10 (2016-02-01)
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  • What Matters to You? The healing power of a canine prescription
    cost Not long ago I visited Gundersen Lutheran health system in La Crosse Wisconsin and their wonderful Care Coordination unit I talked with nurses and social workers there who have successfully moved to What matters to you They told me about a 94 year old woman named Ethel who began to deteriorate last summer after her husband died She lost weight stopped walking became chair bound and was completely dependent on her care givers She was alone without any family After weeks when it was clear things were headed in the wrong direction a nurse asked Ethel What do you want Ethel knew exactly what she wanted what mattered to her She wanted a dog We don t do dogs in health care of course But we all know how profoundly enriching a relationship with a pet can be so after Ethel kept asking for a dog the nurse did something special She recognized that patient centered care in Ethel s case meant something very different than typical medical interventions So the nurse drove to the pound and got a dog And she brought the dog named Baby to Ethel For Ethel Baby was the ideal prescription with more healing power than any amount of pharmaceuticals Within weeks of Baby s arrival Ethel became almost independent She walked 125 feet on her own Even more amazing three mornings a week she played the violin for patients coming through the hospital lobby So what are the financial implications of the Baby prescription Baby was free at the shelter and eats just a few cans of food a week Compare that with the cost of round the clock home care When care givers ask What matters to you beautiful things can happen Tags Leadership Patient Family Centered Care Triple Aim Population Health

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=6 (2016-02-01)
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  • Let’s Go!
    the impending decision When the news finally broke we experienced a range of emotions There was surprise relief confusion joy and more But by the end of the day we had all settled back into our work with a renewed determination The Supreme Court ruling on the Affordable Care Act is a wonderful moment not only because it will do so much good for so many but also because it provides an opportunity to put political squabbling behind us and accelerate the work of redesigning care Since the ACA was enacted into law in March of 2010 we ve witnessed an unfortunate and unconstructive political debate But at the front lines of care great things are happening In my travels I meet countless health care professionals who are passionately pushing ahead with an effort to provide better more efficient and more affordable care And the ACA helps us do that We ve already seen tangible benefits from the law and by 2019 more than 30 million Americans without coverage will have it Children with pre existing conditions will not be excluded from coverage Medicare will help nudge us away from fee for service waste by providing incentives for better care not just more care Providing access to care for tens of millions of Americans including access to vital preventive services and care for chronic conditions is hugely important But we know that increased access to care alone is not the answer That s why this is the perfect time to accelerate the innovation in health care by pursuing the IHI Triple Aim better experience of care better population health and lower per capita cost Maybe the best thing about my job is getting to see the growing evidence that organizations and communities can simultaneously achieve all three dimensions of the Triple Aim Charlie Kenney and I recently wrote a book about a number of these innovative organizations PURSUING THE TRIPLE AIM Seven Innovators Show the Way to Better Care Better Health and Lower Costs highlights an array of exceptional work that gets at the Triple Aim The more I m out in the field the more health care professionals I meet who see the Triple Aim as the health care goal for the United States Many provisions of the ACA will help us get there but in the meantime our job is to accelerate innovation at the front lines to redesign the way we provide care to improve quality and cut costs At the IHI Forum last December Don Berwick gave us a dose of his customary optimism He said I have never seen nor had I dared hope to see an era in American health care when more is possible than at this very moment He also said that it s our moral duty to rescue American health care the only way it can be rescued by improving it I couldn t agree more Let s go Tags Leadership Triple Aim Population Health Individual Care and Cost Control Optimization

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=4 (2016-02-01)
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  • An Eloquent Voice for Health Care Improvement and Patient Engagement
    member Connie Davis provides a moving tribute to Jessie Gruman President and Founder of the Center for Advancing Health who leaves a legacy of brilliance and a drive to improve health care and patient engagement Connie Davis An eloquent voice for health care improvement and patient engagement was silenced this week with the passing of Jessie Gruman PhD the founder of the Center for the Advancement of Health CFAH based in Washington DC Members of the IHI community may remember her as patient faculty for the IHI seminar Transforming Primary Care Practice As a colleague Jessie had the unique combination of intellectual brilliance and impatience required to advance the field And that she did With her guidance CFAH founded the Health Behavior News Service a trusted source for news on health and supporting healthy lifestyles She advocated for policy change and worked tirelessly within and across organizations for change She wrote voluminously and pointedly from her unique perch about what needs to happen how it can happen and how it does happen She convened meetings that brought together leaders to not only puzzle through the knotty problems of engaging patients in health and health care but to move forward from top to bottom It is impossible to catalog her contributions Jessie Gruman Jessie spoke not only from her academic training but also from lived experience As a young woman Jessie was successfully treated for lymphoma and those heroic treatments lead to later cancers She strove to help others with her 2010 book Aftershock What to Do When the Doctor Gives You or Someone You Love A Devastating Diagnosis When she sent me a copy she told me to pass it on when I was done I admit that I have kept the book but I am now passing it on I am holding on to Jessie s words as inspiration to continue her work Comments about Jessie s life and legacy as well as an archive of her blog postings are available at http www cfah org blog 2014 in memoriam jessie gruman Tags Person and Family Centered Care Engage Patients and Families in Improvement Quality Improvement Primary Care 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 9 January 9 2015 64 December 7 November 6 October 5 September 3 August 10 July 8 June 1 May 6 April 4 March 7 February 4 January 3 2014 50 December 9 November 3 October 3 September 4 August 3 July 9 May 2 April 2 March 12 February

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=87 (2016-02-01)
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