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  • Board Members as Stewards of Quality and Safety
    most of the last century trustees of health care organizations generally defined their roles as limited to financial stewardship Safety Quality of care That was considered the purview of the medical or executive staff In recent years this has changed but it has not changed enough Governing boards have a fundamental role to play in quality of care in fact they are legally accountable for it What happens in a boardroom may seem far removed from the patient s bedside But it isn t A recent paper shows statistically significant associations between the adoption of certain governing board practices in not for profit hospitals and quality of care measures See table below These associations may not prove causation but they do suggest that board engagement can make a difference in how organizations approach quality of care This was IHI s experience working on hospital governance through our 100 000 Lives and 5 Million Lives Campaigns Consider the following anecdote about an engaged board in practice At a board Clinical Quality Committee meeting of the Seton Family of Hospitals in Austin TX operational leaders reviewed a patient safety problem and their plans to prevent a recurrence One of the lay board members pushed harder for a reliable plan She noted that the plans proposed were not likely to produce reliability at best known levels and that employing reliability science would be a better solution than working harder That meeting was an important step toward creating a culture of reliability and it began with informed questioning by a board member Today as the data above shows hospital boards are achieving on some measures and doing less well on others We see some important practices quarterly review of quality performance measures for instance inching close to universal adoption But other practices are considerably rarer Just under 40 percent of boards require their organizations to report quality or safety performance to the public And over half of boards surveyed were less involved than management in setting the agenda for the board s discussion on quality Boards have come a long way Gone are the days for most hospitals at least when trustees deemed quality of care to be beyond their job responsibilities But much progress remains to be made If you re a board member we hope you ll take a look at our Boards on Board How to Guide Among our suggestions are conducting an initial audit of 20 patient charts for harm devoting 25 percent of board meeting time to quality and safety and establishing concrete aims for safety and quality improvement We hope to see more and more health care board members making their voices heard and being partners on quality and safety issues Trustees have the power and the responsibility to drive their organizations toward better care As our founder Don Berwick once put it The buck stops in the board room Tags Governance and Boards Leadership Quality and Patient Safety Blog Home Older Average Content Rating 0 user Your

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=12 (2016-02-01)
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  • The Conversation Project
    make it he was also telling me he was getting ready to die He was ready to face death but I wasn t When he was in the hospital for the last time I was sitting with him Doctors and nurses would come and go They d speak over him and about him but almost never to him Then something happened I will never forget A radiation oncologist came into the room and asked my brother the simplest question Johnny what do you want I want to go home Johnny said And I want to be 21 The doctor didn t hesitate He took off my jacket put it on Johnny lifted him from the hospital bed and carried him to my car At home my brother was surrounded by the people who loved him Soon after Johnny turned 21 Six days later he died That one inspired interaction between Johnny and the radiation oncologist taught me so much Yes it is important to provide encouragement and hope But facing reality at the appropriate moment is crucial I wish now that I had had the conversation with Johnny the honest conversation about what he wanted the conversation we all need to have with our loved ones about how we want to deal with our precious time near the end of life It would have been extremely difficult but who knows where it might have led I wonder what might have come from asking Johnny that simple question What do you want I wonder about the people he might have wanted to see I wonder about the conversations they might have had And I wonder about the functionality he could have had outside the hospital But instead of Johnny realizing his wishes for his last year he spent it mostly in the hospital As The Conversation Project launches this month I think about my brother Yes it s a very difficult topic is there anything in health care as intensely personal as how we die Or how the people we love die But having that conversation at the kitchen table is far more productive than in the crisis driven environment where it most often occurs usually in the ICU or other hospital unit I wish I had had the courage to let Johnny have that conversation with me so many years ago so that I could ve helped him live his last months the way he wanted That experience taught me to talk to my loved ones to tell them what I want and to ask them what they want And I hope that The Conversation Project will help and inspire thousands of people to ask their loved ones the simple question Johnny s doctor asked him What do you want Tags Leadership End of Life discussions End of Life Care Blog Home Older Average Content Rating 2 user Your comments were submitted successfully Please enter a comment Please login to rate or comment on this content User Comments by Liny

    Original URL path: http://www.ihi.org/communities/blogs/_layouts/ihi/community/blog/itemview.aspx?List=81ca4a47-4ccd-4e9e-89d9-14d88ec59e8d&ID=5 (2016-02-01)
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  • Celebrating 100,000 in the IHI Open School: Student Voice
    agree with Dr Berwick viewing the IHI Open School as much more than a movement but as a revolution started by students who are motivated to change the culture of care in the systems where we work We are finding that in order to make the changes we need to achieve higher quality care at a lower cost we must transform entire systems of care One hundred thousand students and residents signed on to the IHI Open School is an incredible number and is certainly a huge milestone These students are entering their respective health professions as natural leaders in quality and safety In many ways they have now become the experts in their systems But our patients need us more than ever We need more students to sign on The systems are not changing quickly enough and we require a small army to teach others how to develop safer more effective patient centered care that is timely efficient and equitable This means teaching the science of quality safety teamwork and communication We must do this together And it must be multi disciplinary Health care delivery is increasingly complex Patients are confused vulnerable and are being harmed more than we would like to admit The IHI Open School is the absolute best way for us to come together connecting with students of all disciplines in our local chapters advocating for IHI Open School courses to be integrated into the curriculum at our schools teaching other health care providers about these important topics and engaging in dialogue with students and faculty around the world through the IHI Open School chapter network I originally thought of the IHI Open School as a motivator an entity designed to encourage students to complete courses on their own time and develop the skills they need However after four years of existence it is now becoming an integrator The concepts we learn through IHI Open School are the threads that connect all health disciplines Every student in every health discipline should have these skills Application of these skills has solved many complex problems and will continue to solve problems and improve patient care on a larger scale So let s bring 100 000 more students to the IHI Open School A hundred years ago Dr William James Mayo stated in his commencement address at Rush Medical College in Chicago The best interest of the patient is the only interest to be considered and in order that the sick may have the benefit of advancing knowledge a union of forces is necessary Indeed our union of forces is the IHI Open School Tags IHI Open School for Health Professions Student Chapter Leader Chapter Network 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

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=65 (2016-02-01)
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  • Celebrating 100,000 in the IHI Open School: School Voice
    the IHI Open School Her first thought in particular really stuck with us Why do I think the next 100 000 students and residents should join the IHI Open School For the representatives from Dundee being members of the IHI Open School helps to give us a sense of pride in our medical school The chance to do useful online leadership and patient safety courses applicable to the clinical environment for free Help and support in starting your first QI project from IHI Open School staff In particular the chance to embark on an IHI Open School Practicum is invaluable thanks to the solid structure and guidance in the program The Practicum enables a deeper understanding of what is involved when working in a clinical team The students gets to be in the clinical environment making QI changes and engaging with health professionals including doctors nurses reception staff porters pharmacists and domestic staff International conferences with a buzzing atmosphere where you can meet with like minded students and staff to learn from each other and share experiences Plus you get to have lots of fun exploring a new city like Paris A once in a lifetime experience to present a QI project as a medical student to an international community that can offer suggestions of how to improve your work The chance to listen to lectures from stars in the field such as Don Berwick The IHI Open School is growing and becoming a major international community of motivated health professionals J oin now to take advantage of endless future opportunities Tags IHI Open School for Health Professions Student Chapter Network International Forum 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

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=63 (2016-02-01)
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  • Another Health Care Workshop? Five Reasons Why SQLA is Worth Experiencing
    literally never interacted and may not have for much longer if not for SQLA For too long there has been an unfortunate dearth of cross disciplinary collaboration among our segregated health schools and SQLA breaks down these barriers 2 Unbeatable Expertise All of the weekend s presenters were seasoned veterans of health care leadership and innovation Each one holds or has held very senior positions in national policy advising and or academic medical centers This year s presenters were predominantly current or past leaders from Beth Israel Deaconess Medical Center in Boston one of the most respected innovative health care organizations in New England The only one without at least 20 years of professional health care experience was Dr John Halamka who is merely the youngest chief officer in the history of BIDC had served as a key health information technology HIT advisor to the Obama Administration and was recently contracted by Japan to assist development of a new HIT system across their Northern region following this year s devastating earthquake and tsunami To say his knowledge and perspective are expansive is a serious understatement and each presenter was of equally strong caliber 3 Gaining Essential Management Skills Take a walk in the woods to build rapport with your opponents and identify shared values Use interest based negotiation methods to manage and overcome conflicts Implement double loop learning to learn from and prevent future conflict situations Carefully choose when to identify people instead of numbers when quantifying problems Learn how leadership vision and operations management can foster an environment that minimizes conflict The Transition Curve framework offers a method for managers to conceptualize and facilitate change processes with minimal staff resistance Before embarking on a difficult conversation ask those involved about their understanding of a situation and let this guide your approach and language These are just several of many examples to evidence that SQLA actually covers concrete management techniques that any of us can apply to improve our team s performance morale and ability to adopt innovations 4 Assessing Personal Strengths and Needs Through exposure to new management concepts personal anecdotes from presenters and group and individual exercises the weekend at the Leadership Academy gave me the time and tools I needed to identify where I may struggle and succeed as a new manager in the health care industry This self understanding will be handy for upcoming job interviews and also in identifying positions where I m most likely to succeed 5 Having Fun Of course after days full of challenging sessions self evaluation and passionate presentations on health innovation we were able to unwind Harvard Square and the rest of nearby downtown Boston offers a plentiful assortment of interesting activities and quality spots to pass the time with good people and entertainment This year featured a public dance party in front of Cambridge City Hall which closed down the largest roadway through town and featured thousands of locals partaking in a good old fashioned outdoor celebration After three

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=18 (2016-02-01)
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  • Lessons Learned from the IHI Open School Student Leadership Academy
    long learning and how there are three equally important components of it The continuous acquisition of knowledge Personal experiences Reflection on the first two parts So just for you Dr Reinertsen these are my reflections on the incredible amount that I learned and the wonderful experience I had during those two days in Harvard Square The easiest but perhaps most complicated place to start is to ask What did I learn Through didactic sessions I learned conflict management I wasn t surprised to find that I m an avoider and how to take a walk in the woods a negotiation technique actually Through the lectures and anecdotes from the invited speakers I learned about how to lead through a crisis like a massive computer system crash how to lead without authority and the benefit of a fancy job title Through exercises I learned how to effectively have awkward conversations like dumping a guy or firing an employee and how to assess the safety of a patient care unit by observing its teamwork All of these skills I anticipate using throughout my career and life While the lectures were useful and enlightening I would be greatly remiss if I didn t discuss everything I learned from the other participants the other students We were assigned seating right from the start to force us to meet people we might not have interacted with otherwise I ended up sitting with one other medical student a psychology student two nursing students and three healthcare administration students This medley of backgrounds and people s unique experiences made the discussion very lively It was eye opening to hear everyone s perspective on a problem because they could be so different from my own Looking back it makes me really appreciate a drawing that Dr Barry Dorn one of the speakers made of a cone in a box which highlighted an important lesson Where you are looking from greatly influences what you see Needless to say I learned a lot this past weekend both from the speakers and from my peers The lessons I learned are not found in textbooks or medical school lectures even though they are critical to our future work I am extremely grateful that I had the opportunity to attend the Leadership Academy The knowledge and experiences that I gained are definitely going to stick with me as I continue on my path toward becoming a physician Aubrey Samost medical student University of Massachusetts Originally posted on June 30 2011 Tags IHI Open School for Health Professions Student Quality Leadership Academy Leadership Teamwork Communication 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 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

    Original URL path: http://www.ihi.org/education/ihiopenschool/blogs/_layouts/ihi/community/blog/itemview.aspx?List=9f16d15b-5aab-4613-a17a-076c64a9e912&ID=16 (2016-02-01)
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  • Acute Myocardial Infarction
    Pacific Europe Latin America Middle East North America Engage with IHI Engage with IHI Overview Collaboratives Initiatives Membership Programs Fellowship Programs Strategic Partnerships Customized Services Blogs and User Groups Home Topics Acute Myocardial Infarction Acute Myocardial Infarction Acute Myocardial Infarction Topics Explore this topic in Resources IHI LR Wide Acute Myocardial Infarction Page Content Great strides have been made in the past twenty years in the treatment of acute myocardial infarction AMI and mortality from this typically sudden onset and emergent condition has reduced dramatically Improvement has been the result of rigorous research into the most effective interventions and setting critical timeliness goals for interventions to reperfuse affected cardiac tissue Timely intervention is the key to reducing risk of mortality and permanent cardiac damage Application of reliability principles reducing steps and complexity standard approaches and effective communication has been employed by many hospitals to improve time from patient arrival to reperfusion In fact some hospitals are working towards even higher levels of performance by improving time from start of symptoms to reperfusion Recommended Resources first last Annotated Bibliography for Improving Care for Acute Myocardial Infarction This annotated bibliography presents selected literature for improving care for acute myocardial infarction patients Cardiac Discharge Contract This hospital discharge form is designed to be used at discharge for acute myocardial infarction patients to ensure that all appropriate medications are prescribed and that the patient understands and is engaged in developing a plan for post discharge activity How to Guide Improved Care for Acute Myocardial Infarction This How to Guide describes key evidence based care components that should be provided to all acute myocardial infarction patients Getting Started How to Improve Learn about the Model for Improvement forming the improvement team setting aims establishing measures and selecting and testing changes Go to How to Improve

    Original URL path: http://www.ihi.org/Topics/AMI/Pages/default.aspx (2016-02-01)
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  • Behavioral Health
    by each of the different models The aim is to understand the core principles underlying successful integration of behavioral health services into primary care Integrating Behavioral Health into Primary Care This article discusses ideas for overcoming common challenges in treating patients with medical and behavioral issues in a more integrated fashion presents a set of Collaborative Care Components for Integrated Care that have shown results in reducing cost and improving outcomes and satisfaction and describes layers of service in full spectrum integrated care View All Audio Loading Pages first last WIHI When Everyone Knows Your Name Identifying Patients with Complex Needs January 29 2015 A relatively small percentage of the US population accounts for the largest share of health care costs Everyone knows who we re talking about right Well not exactly WIHI The Road to Team Based Primary Care and Behavioral Health December 4 2014 Primary care practices across the US are facing a number of important challenges right now prominent among them is doing a much better job at recognizing and helping patients with behavioral health issues WIHI Mental Health Care in the Hospital Preventing Harm Promoting Safety October 9 2014 This WIHI explores work that s underway in hospitals to prevent harm and promote safety for patients with psychiatric conditions and needs WIHI Integrating Physical and Behavioral Health July 25 2013 This WIHI showcases leaders and organizations that are at the forefront of redesigning care for patients and populations in need of primary care and mental health services Research has begun to demonstrate that this approach leads to improved chronic conditions and fewer trips to the ED View All Other Resources Where Is the Frontier in Behavioral Health Integration This blog post by IHI s Mara Laderman and Kedar Mate discusses four areas of innovation for integrating behavioral health into primary care Behavioral Health Integration Capacity Assessment Tool This tool enables behavioral health organizations to evaluate their processes related to three approaches to integrated care coordinate care co locate care or build primary care capacity in house It also allows organizations to assess their existing operational and cultural infrastructure to support greater integration Approaches to Integrating Primary Care Services into Behavioral Health Organizations The guide lays out a continuum of primary care and behavioral health integration beginning with engaging individuals with severe mental illness in discussions about their physical health to full integration AHRQ Integration Academy Offering numerous resources and tools for providers and organizations to advance the integration of behavioral health and primary care the Academy also helps connect its members with the integrated behavioral health and primary care community Center for Integrated Health Solutions Provides useful resources for providers and organizations to better meet the needs of individuals with behavioral health conditions in both behavioral health and primary care settings Integrated Behavioral Health Project The project s mission is to accelerate the integration of behavioral health and primary care throughout California Their website contains a virtual library for organizations interested in integrating behavioral health and

    Original URL path: http://www.ihi.org/Topics/BehavioralHealth/Pages/default.aspx (2016-02-01)
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