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  • A Big, Broad Definition of Health Care
    health care not sick care The difference is night and day About 15 years ago leaders in Jönköping started the Esther project to improve patient flow and patient experience Esther isn t an actual person she s an invented persona They invented Esther so leaders and clinicians could imagine an actual person not an abstraction as they considered the effects of process and system redesign Dr Bojestig thought it was important to call this persona Esther It allowed staff in different locations and at different steps in the care chain to imagine their own Esther and by naming the persona they could ask themselves What s best for Esther You can read more about this remarkable project and its clinical results on IHI org here Thinking about patients as whole people is in the blood of the people in Jönköping Long ago before anywhere else I know of they learned that the best route to health is to promote and teach healthy lifestyles not wait for sick people to show up at the hospital Not that they don t do sick care well they provide excellent services in their clinics and hospitals But because they have a limited budget and because their philosophy is so different from the way we think in the US they focus their work way back upstream where the real determinants of health are On my last visit in May I went to a unique family center in the town of Huskvarna in the eastern section of Jönköping County It s a center for pregnant women and women with small children under 6 years old Under one roof they provide maternity care child care psychiatric care physical therapy and a range of social services all in the same place where their children attend pre school It was striking to see the blending of these services effective care both medical and psychological for pregnant mothers and their children a wide array of social supports and services like job placement language classes special parent groups including ones for fathers and ones for parents with adopted children and education It was clear how these all came together to provide a solid foundation for good health for the entire family And it s a perfect reflection of the big broad definition of health care that the Swedes have embraced and practice so well Many of the women at the center were from Somalia The staff at the center use the services they offer as an opportunity and a means of teaching Swedish to the new immigrants And the center gives the Somali women a place to gather with each other I m hopeful about the future of health and health care here in the US because I can sense things changing We re learning slowly how important it is to move from a sick care system to a health care system We re learning how education counseling upstream care and effective prevention can transform the health of our communities It

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=23 (2016-02-01)
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  • Spotlight on St. Charles: Establishing a Sense of Urgency
    don t make the needed and known changes until something terrible happens to prompt them Below are a few examples of high performing health care organizations that used tragedy to create a shared sense of urgency around quality initiatives From Tragedy to Urgency ThedaCare is a top tier health system based in Wisconsin In 2004 one of its surgical units had four wrong site surgeries take place in the span of eight weeks The president of ThedaCare hospitals shut down the surgical suites and wouldn t reopen them until there was a plan to ensure patient safety ThedaCare is now one of the highest performing Lean health care systems in the United States Johns Hopkins is a world renowned academic medical institution and an industry leader in patient safety In 2001 a string of medical errors resulted in the death of 18 month old Josie King Johns Hopkins leadership worked with the King family to create the Josie King Pediatric Patient Safety Program that is now a model for children s hospitals throughout the United States Virginia Mason Medical Center in Seattle was recently named the Top Hospital of the Decade by a well known quality organization In 2004 Mary McClinton a 69 year old woman from Alaska died after she was mistakenly injected with an extremely toxic antiseptic solution Virginia Mason publicly apologized for the error and set out to make sure it would never happen again There is now a prestigious patient safety award that Virginia Mason gives out each year in honor of Mary McClinton St Charles cannot wait for tragedy to spur its transformation into a continuous improvement culture At the same time we recognize that there is a risk of losing caregiver engagement due to the barrage of changes currently taking place in health care The challenge of implementing Kotter s first step in our improvement journey is to create a steady sense of urgency that is neither too banal nor too alarmist In other words if we whisper our message then no one will hear but if we constantly yell then no one will listen The transformational journey to a culture of continuous improvement must be carefully orchestrated to gauge balance and effect At St Charles we are using internal data to help gain support for the IHI Open School program But data alone isn t sufficient to create new paradigms and to catalyze change In order to create the sense of shared urgency we must pair data with context For St Charles this means telling the story of our own near misses and errors We must talk openly about our data and highlight the individual stories that provide invaluable context Data without context does little to create a sense of urgency but a true story that lends credence to data can make all the difference in the world Next month we will begin telling the stories of some of the good and bad experiences that have come about since starting our Open School

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=129 (2016-02-01)
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  • Obstacles and Successes: Reflections on My First Improvement Project
    the consult rate for all patients in the ICU had dropped from 9 percent to 6 percent Translation We were no longer meeting our aim As we started to think about the process and balancing measures affecting our outcomes we found some other issues to address Looking at the trends since week 6 we found that fewer patients were meeting criteria for a palliative care consult 26 percent of patients in the first six weeks versus 18 percent of patients in the last four weeks In reviewing the screening tools during the past four weeks I found that many tools were completed incorrectly so many patients did not receive positive screens who should have In addition one patient had two admissions to the ICU during our study period during the first admission her scores ranged 7 8 a positive screen is 5 or above but on the repeat admission she only had a score of 2 How many other patients were now being underscored on our tool We had started to drift away from our peak progress after six weeks As we started to think about what might have changed we realized that There were new nurses in the medical ICU who had not been exposed to the tool and therefore weren t sure how to complete it The ICU census had been higher in recent weeks the nurses were busier with less time available to complete paperwork like our screening tool Our physician champion was not around these past four weeks he was getting married so we may have lost some momentum by not having him in the unit In summary our interventions hadn t become a true part of the daily workflow While it was discouraging to see this negative drift we are still highly motivated to continue the initiative because we know it is best for patient care In the past four weeks Dr W my faculty advisor and her colleagues on the Cancer Committee looked more closely at the patients who received palliative care consults They retrospectively analyzed pain scores of palliative care patients pre and post palliative care consult and found that the pain scores were significantly better for patients after the palliative care team got involved That was good evidence for physicians and administrators and many in the committee meeting were enthusiastic about using palliative care Also this week Dr W presented the summary of our initiative to the ICU committee consisting of many ICU physicians Many of the physicians were excited about the initiative although some still expressed resistance to palliative care As I look back on the last 10 weeks I am excited about what we have accomplished We have increased the discussions about the benefits of palliative care for patients in the intensive care unit and convinced many nurses physicians and hospital administrators that palliative care is beneficial for many patients and families While we are not meeting our aim right now we are optimistic that the culture change is happening

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=128 (2016-02-01)
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  • Ask Berwick: How can students drive improvement?
    Dr Berwick talks about how any caregiver can drive improvement within their own role In an article titled Preparing Nurses for Participation in and Leadership of Continual Improvement that Dr Berwick wrote for the Journal of Nursing Education he further discusses the challenge of constantly doing a job and simultaneously improving that job The capacity to make my job better is not inborn Nor is it usually taught in professional education What professional education including nursing education has more reliably focused on is the content of the job the subject matter knowledge and cognitive and manipulative skills to care for patients in existing processes and institutions You can read the full article here Make sure to check back next week when Dr Berwick answers a question from Cathy Ellis PT about how outcomes could change if US health care was provided seven days a week and not shut down to a large extent on weekends Do you have a question Join the conversation and Ask Berwick Tweet IHIOpenSchool using AskBerwick email openschool ihi org or comment on Facebook Tags Ask Berwick medical student Improvement Quality Improvement Intern Resident Junior Doctor Communication IHI Open School for Health Professions Leadership Physician Nurse 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

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=127 (2016-02-01)
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  • Follow the Fellow —And Send Your Questions!
    attached There in bold print Kaiser Permanente Announces New Fellowship Opportunity at the Institute for Healthcare Improvement for an Emerging Safety Net Leader An IHI Fellow An IHI Fellow that represents Safety Net Systems WOW that is incredible What an amazing opportunity I was filled with excitement and overcome not only by the confidence my county executive had in me but by the possibilities for professional growth that entered my head Then I heard another voice How utterly impossible What are you thinking Margo You can t possibly move 3 000 miles away and study Quality Improvement in health care for one full year Disappointment set in and I promptly hit reply and composed a note extending my deepest gratitude to him for thinking of me and my regrets that it would not be possible He promptly replied Just speak to Ana Roth before you decide Ana Roth is a former IHI Fellow and is now the CEO for Contra Costa Regional Medical Center Health Centers I spoke to Ana early the following morning We spoke for only about seven minutes before I realized that I would miss the opportunity of a lifetime if I didn t apply for this IHI Fellowship Hmm I thought I could at least throw my hat in the ring After all there s only one spot in the United States What are the odds I d get it I could just complete the application and see what happens I submitted my application and written supplemental in October 2011 In November I was invited to interview in person at the IHI National Forum in Orlando Florida in early December By mid December I was notified that I had been selected as the first IHI Kaiser Permanente Safety Net Fellow It was what many refer to

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=113a95c2-dffe-41ec-abee-93b4088068ac&ID=8 (2016-02-01)
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  • Ask Berwick: What's your greatest legacy as a pediatrician?
    s life In his commencement speech for Harvard Medical School s class of 2012 he talks about the impact of another patient named Isaiah There is a way to get our bearings When you re in a fog get a compass I have one and you do too We got our compass the day we decided to be healers Our compass is a question and it will point us true north How will it help the patient You can read the full speech here Make sure to check back next week when Dr Berwick offers tips about how to better communicate with patients Berwick President Emeritus and Senior Fellow at IHI and Former Administrator of the Centers for Medicare and Medicaid Services answers one of your questions every week in our new blog series Ask Berwick You can catch up on previous Ask Berwick Q A s here Do you have a question Join the conversation and Ask Berwick Tweet IHIOpenSchool using AskBerwick email openschool ihi org or comment on Facebook Tags Ask Berwick Don Berwick Medical Education Leadership 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

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=123 (2016-02-01)
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  • Spotlight on St. Charles: Becoming a High-Performing Health System
    attributes that are common to high performing health systems The attributes and behaviors above show how high performing health systems are learning organizations with a robust culture of continuous improvement Like many other health care organizations St Charles demonstrates these attributes to a certain degree but not as much as is needed to transform care In particular the absence of a shared improvement framework has made it difficult to initiate and sustain change at the pace demanded in today s health care environment For this reason the executive leadership at St Charles has chosen the IHI Open School for Health Professions to serve as the primary framework for quality improvement training and education across the health system Our executives have completed the first six learning modules and we are initiating additional programs for complimentary training education and quality improvement By the end of 2013 every caregiver at the manager level or above will have completed the IHI Open School Basic Certificate For St Charles the Open School is both a foundation for learning and a conduit for creating the internal change agents needed to transform our system So what can you expect in the coming months in this series of blogs It is a travel journal written in the spirit of love and compassion and colored by our values of Service Integrity Excellence and Accountability It is our story of change improvement and caring I hope you ll join us Editor s Note This is the first post in an occasional series by Kyle Johnson about how the IHI Open School courses are helping to transform the culture at St Charles Health System Tags Quality Improvement Leadership Communication Teamwork 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 Sara Mosher 5 16 2013 9 09 59 PM I will look forward to future blogs from you Kyle As a current leader at St Charles I have seen the amazing transformation our culture has had just over the past few months after we have all embarked on this journey of improvement together The IHI open school was extremely educational and the courses St Charles more specefically Kyle Johnson has created and put together have been so enlightening The speakers and presenters have been so knowledgeable in their content and the passion and support they all bring is really helping to shape and create our new culture of safety and processes of improvement I am honored to be a part of this journey and Kyle I can t thank you enough for bringing so much enthusiasm and attention to this important initiative Keep up the great work loading Did you find this user comment useful people found this user comment useful Report This by Monica Vanbuskirk 5 16 2013 2 29 52 PM Kyle I love that you re using this framework and look forward to seeing tangible examples of how St

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=122 (2016-02-01)
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  • Ask Berwick: How would you accelerate global change for health care quality?
    patient and continual improvement For leadership tips Dr Berwick recommends that all students read Edward Deming s 14 Points on Total Quality Management The most essential point Dr Berwick says is actually the first Create constancy of purpose for improving products and services Make sure to check back next week when Dr Berwick answers a question from AnnWilliams6 submitted via Twitter about whether or not employing more staff could help improve quality You can join the conversation and Ask Berwick Tweet IHIOpenSchool using AskBerwick email openschool ihi org or comment on Facebook The next question he answers could be yours Tags Ask Berwick Quality Improvement Patient Family Centered Care Don Berwick Leadership Improvement 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 Rick Botelho 5 1 2013 9 10 37 PM The epidemics of unhealthy habits are the greatest threat to patient safety Population health improvement PHI is by far the weakest link in the Triple Aim To develop innovative synergies between top down leadership approaches and bottom up social movement approaches we need to develop open innovation health enterprises See podcast prototype https vimeo com 63048876 to explain this concept feedback welcomed for the next version I am writing an e book related to this topic and am looking for reviewers If anyone is interested in open innovation and social movements for health drop me a line at Rbotelho me com 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 are strictly confidential Reason Select One Contains profanity or violence Spam Defamatory Illegal Unlawful

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=120 (2016-02-01)
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