The Doctor and the Sheriff - BMJaws-cdn.internationalforum.bmj.com/pdfs/K1_Maureen_Bisognano.pdf ·...
Transcript of The Doctor and the Sheriff - BMJaws-cdn.internationalforum.bmj.com/pdfs/K1_Maureen_Bisognano.pdf ·...
The Doctor and the Sheriff 20th Annual International Forum on Quality and Safety in Healthcare
April, 22, 2015
London, UK
Maureen Bisognano President and CEO
The IHI Triple Aim
A Few Years Ago
“The secret of the care
of the patient is in caring
for the patient.”
-Francis Peabody
Toolkit to Care
1. Curiosity
The Doctor
The Human Cost of Preterm Births
Infant mortality rate for preterm births before
32 weeks of pregnancy is 70 times greater
than the infant mortality rate for infants born
between weeks 37 and 41.
Johnson, Steven Ross. "Mothers' Helpers: Providers, Insurers Use Home Visits to Reduce Infant Mortality." Modern
Healthcare. Modern Healthcare. Crain Communications, Inc. Web. 16 Mar. 2015.
<http://www.modernhealthcare.com/article/20150314/MAGAZINE/303149941>
Average medical cost for a baby from birth
through first year of Life
Healthy, full-term baby from birth through the first year
$5,085 Premature and/or low-birth weight baby (less than 37
weeks gestation and/or less than 2.5 kg)
$55,393
The Financial Cost of Preterm Births
Johnson, Steven Ross. "Mothers' Helpers: Providers, Insurers Use Home Visits to Reduce Infant Mortality." Modern
Healthcare. Modern Healthcare. Crain Communications, Inc. Web. 16 Mar. 2015.
<http://www.modernhealthcare.com/article/20150314/MAGAZINE/303149941>
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Mai
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Archer
Wal
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University
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Newberry
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Hawthorne
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Williston
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Lakeshore
Depot
2082Rocky Point
Millhopper
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G A I N E S V I L L E , F L : M E D I C A I D B I R T H D E N S I T Y A N D C O U N T B Y C E N S U S B L O C K G R O U P ( 2 0 0 7 - 2 0 0 9 )G A I N E S V I L L E , F L : M E D I C A I D B I R T H D E N S I T Y A N D C O U N T B Y C E N S U S B L O C K G R O U P ( 2 0 0 7 - 2 0 0 9 )
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Color Legend:Approximate Number of Medicaid Births per Square Mile
Census Blockgroups with less than 5 Medicaid Births are not labeled.
This map shows the distribution of 2,760 Medicaid Births.
Mobile Outreach Clinic Stops
The Doctor and the Sheriff
High Density Low Density
Density of Child Maltreatment (2005-2008) Density of Domestic Violence
Homeless Children Previous Address (2010)
Mobile Outreach Clinic
Mission
- Provide a clinical education to health students (undergraduate and graduate)
- Promote a culture of service
- Provide health care access to the medically underserved in our community
Health Outreach Quality Improvement (HOQI) Program
Created in Fall 2012 for undergraduate pre-professional students at UF
Unique volunteering opportunity for students
Hands-on learning experiences at clinic
- Provide service that paid employees provide in our health science center clinics
- Key role in coordinating care and services for patients outside of clinic visit
Weekly commitment of 3-4 hours in clinic alternating with care coordination
How to do local needs assessments and
communicate results
How clinicians can screen, diagnose, and
help/hurt victims of Intimate Partner Violence
(IPV)
How to do diagnostics in a low resource
environment
Local food insecurity; “food deserts”
Mobile Outreach Clinic Student Reflections
Understanding literacy among our patients
Transportation barriers for rural Alachua County
and parts of greater Gainesville
Awareness of how to find local resources for
special populations
Broad cultural sensitivity and humility, not
race/ethnicity alone, but social and
environmental disparities as well
Mobile Outreach Clinic Student Reflections
The Importance of Curiosity
IQ – Intelligence Quotient
processing complex data sets and having the mental capacity to problem solve at speed
EQ – Emotional Quotient
the ability to perceive, control and explain emotions; risk-taking, creating resilience and empathy
CQ – Curiosity Quotient
inquisitive, open to new experiences, finding novelty exciting
Chamorro-Premuzic T. “Curiosity Is as Important as Intelligence.” Harvard Business
Review. Aug 27, 2014.
Toolkit to Care
1. Curiosity
2. Improvement Skills
233,057 students and residents registered on IHI.org
216,794 students and residents have completed 1.6M
courses
41,604 students and residents have earned their
Basic Certificate of Completion
716 chapters in 70 countries
IHI Open School Online Resources
• Improvement Stories
• Tools
• Publications
• Case Studies
• Video Interviews
• Audio Clips
• Posterboards
• Weekly Newsletter
Going Viral
http://www.ihi.org/resources/Pages/AudioandVideo/MikeEvansVideo
QIHealthCare.aspx
https://www.youtube.com/watch?v=jq52ZjMzqyI&list=UUL-
IWPkXQn3JYYYsPnpGlIg
Helen Bevan’s FUNdamentals
Going Massive
A new Coursera MOOC
developed with Fred Southwick
at Univ. of Florida
reached 6,833 students from
150 countries over its eight-
week course.
And IHI is developing its own MOOC in collaboration with HarvardX and
the Harvard School of Public Health. Content for this first course will
include the principles and practices of quality improvement.
We’re planning for future courses on organizational change
management, qualitative and quantitative improvement and research
methods, systems engineering, IT-enabled improvement, and
leadership.
Building Your Own Skills
Learn how to improve in your daily
work
Move from “fix and forget” to “see,
solve, and share”
Learn to ask “what matters to you?”
Hewitt TA, Chreim S. BMJ Qual Saf Published Online First: [10 Mar 2015] doi:
10.1136/bmjqs-2014-003279
Toolkit to Care
1. Curiosity
2. Improvement Skills
3. Teamwork
Saskatoon:
“Forecast model to predict surges in health care demand.” Saskatoon Health Quality Council Blog. Available at:
http://blog.hqc.sk.ca/2015/04/07/forecast-model-to-predict-surges-in-health-care-demand/
Admission-Discharge Ratio
This is knowledge that would be wasted otherwise
Improving With Your Team
Using huddles to:
Innovate
Spread
Exnovate
Innovation
Where are care models and processes broken?
Where do we need new thinking?
Innovation labs, design processes
Harvesting
Spread
Where do we see variation in performance?
How can we reliably spread to ensure that we
can provide the best care to every patient, where
they are?
Transparent data
Curiosity
Spread Model
Exnovation
How do we stop what doesn’t work anymore?
How will we eliminate wasteful practices and
processes?
It takes courage!
IHI Leadership Alliance
Radical Design Principles
Design systems that expect and embrace change
Change the balance of power
Cultivate joy in work
Make it easy
Move knowledge, not people
Cooperate and collaborate
Assume abundance
Return the money
Berwick DM, Feeley D, Loehrer S. Change From the Inside Out: Health Care Leaders
Taking the Helm. JAMA. Published online March 26, 2015.
doi:10.1001/jama.2015.2830.
Primary Children’s Hospital Salt Lake City, Utah
New Team Members
Using all of the assets in our communities
“Altogether Better” – 20,000 young health champions-
working to achieve the Triple Aim
Simon Stevens calls our patients, the volunteers and our
communities are “renewable energy” that are “central to our future”
In Bradford working with other people in Bangladeshi
communities “Seniors show the way”
Young people using social media to talk about health and
happiness
The Future is Now. The King’s Fund. 2015. available at:
http://www.kingsfund.org.uk/reports/thefutureisnow/
Who Recommends Why
Solid tumor oncologist Hormone therapy, Adjuvant
Radiotherapy (aRT)
Right Away
High risk. Stop the cancer
first, worry about side
effects second
Surgeon Watch and Wait. If you get
biochemical recurrence the
do Salvage radiotherapy
(sRT)
Side effects on top of
surgery are not good – and
you may not need radiation
(10%-20% chance). Delay
the side effects.
Radiation oncologist Hormone Therapy, (aRT)
Right Away
Young, High Risk
AUA aRT right away High Risk
Pelvic floor physical
therapist
Think very carefully before
having radiation
Deals with side effects
everyday
Fragmentation: A Patient’s View
East London
WHO Collaborating Centre:
Unit for Social and Community Psychiatry
Toolkit to Care
1. Curiosity
2. Improvement Skills
3. Teamwork
4. Taking Care of Yourself
100 Million Healthier Lives
Mission:
100 Million People Living Healthier Lives by 2020
100 Million Healthier Lives
Who We Are
100 Million Healthier Lives is an unprecedented
collaboration of change agents pursuing an
unprecedented result:
100 Million People Living Healthier Lives by 2020
Well-being At
HealthPartners
Toolkit to Care
1. Curiosity
2. Improvement Skills
3. Teamwork
4. Taking Care of Yourself
“Fit to play, fit to learn”
St Ninians Primary School
Stirling Scotland
Ms Elaine Wyllie [email protected]
The Improvement Issue
The Provocation St. Ninians 2012: A school volunteer commented on how unfit the children looked P.E teacher confirmed that many pupils were exhausted by the warm up stage of the P.E class.
An inconvenient truth
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•Our School friend ....81 •He has his own castle and estate •Hosts Famous Five nurture days •2 chess clubs + individuals • Storytelling, poetry, recitation penny whistle
I wonder? (Test 1)
• Could the children run round the field
a few times each day to get fit?
• Took 1 class on 1 day out to run round the field a few times to see what would happen?
• Many ‘couldn’t run the length of themselves.’
• Almost all of the children could only manage scout’s pace. It was true – they were not fit.
How the Daily Mile Works
• Children go out in almost all weathers • Context driven time chosen by the teacher • Easy to fit in to the day -fifteen minute turnaround max -no need to change into Exercise kit -no training for teachers – it is simple -it’s FREE! • regularly refreshed – e.g. links to national sporting
events and to the curriculum • Integrated with policy educational activities (IDL)
many links made
Linked to the curriculum
Health and Well Being , Better movers and Thinkers, maths, topic: the polar bear big swim, world city marathons, The Daily Nile, etc, etc….
Measurement
• Each child / class plans their own approach to the Daily Mile and tracks their own performance.
• measurement and goals vary and are suggested by the children and the class teacher.
• Qualitative feedback from pupils, teachers and parents.
The Impact
• Inclusive of all children
• Improved focus
• Children thrive on being outdoors – experiencing the fresh air, the weather, the sights and the sounds
• ALL 420 Children in the school are fit and able to get the most out of their PE sessions
• Running and building relationships
• Children are very positive about it
and proud of it
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• Parents are grateful that the school keeps their children fit and that it relieves feelings of guilt
• Children are sleeping better • Children are eating better • Parents from two classes not
doing the Daily Mile regularly enough!
• Parents lead our running club • The new school
Parental feedback
58
• The children love being outside
• Cross-curricular learning benefits – e.g. Maths / Topic work
• It supports the rhythm of the classroom and the day
• the children’s confidence has increased
• Children are focussed and ready to learn when they come back into the classroom
• Relationships
Feedback from staff
Aim: To create an opportunity to get children fitter by running a mile
everyday at St Ninians School, Stirling in Scotland by June 2012
A P
S D
A P
S D
Cycle 1a: Begins with ME! Test the Daily mile with Head Teacher and 1 class on 1 day at a Scout Pace (20 running 20 walking)
Cycle 1c:Test the daily mile with 1 class for 1 week adjustments for clothing and footwear
Cycle 1e:Test the daily mile for 3rd week and get other classes ready for testing
Cycle 1d:Test the daily mile with a measurement system for 2 weeks more running than walking
Cycle 1b Test the daily mile with one class for 1 day with a willing teacher Primary 6 Class
Process Change: To introduce the Daily Mile with the Primary 6 Class
Changes
A P
S D
A P
S D
Cycle 2a:Test the Daily mile with 2 classes new classes start at a Scout Pace
Cycle 2c: Test the daily mile including all classes
Cycle 2e:All classes participating including nursery
Cycle 2d:Test the daily mile with Nursery class
Cycle 2b Test the daily mile with 4 classes
Process Change: To introduce the Daily Mile ALL other classes
Changes
Aim: To create an opportunity to get children fitter by running a mile
everyday at St Ninians School, Stirling in Scotland by June 2012
Essence of the Change
Keep people well
Keep people whole
Support health and well-being
Make it easy
When needed, best care in hospital
Ask, “What makes a good day?”
Caring at the End of Life
“What’s a good day for you?”
Toolkit to Care
1. Curiosity
2. Improvement Skills
3. Teamwork
4. Taking Care of Yourself
Thank You!
Maureen Bisognano
President and CEO
Institute for Healthcare Improvement
20 University Road, 7th Floor
Cambridge, MA