Poster session @ IHI Annual Forum

#IHI The poster session at the IHI Annual Forum is a cornucopia of quality and process improvement projects from dozens of hospitals and physician groups. I filmed a few of the presenters and offer them here to give you a sense of the variety.

If you cannot see the video, click here.

Maureen sets the tone

#IHI Maureen Bisognano has just welcomed the 6000 delegates here and 15,000 watching around the world at the opening session of the IHI Annual Forum. The CEO's address establishes the theme for the Forum and for IHI's activities for the coming year and is a highlight of the conference.

Maureen's empathy and kindness come through in all she says and does, and so it was not surprising that her address focused on the patient experience. Some excerpts:

When [my nephew] Robbie was four months old, my sister took him back to his doctor for another routine check-up. During the visit, the doctor told my sister he would be giving Robbie his 4-month DPT shot. My sister asked, “Don’t you remember what happened last time?” The doctor paused. My sister described the hospitalization after the last shot, and the doctor told her that the illness was unrelated. He hesitated for a moment and then said, “I’ll give him half a dose,” and then administered the vaccination. Robbie died within 24 hours.

My sister asked me three questions that changed my life. She asked:

Why did the doctor not have the hospital records on hand?
How did he not know what the right care was?
Why didn’t he listen to me?

[Referring to some 220 patient and family histories for 34 different diseases and conditions taped by the New York Times' Karen Barrow:] I’ve been comparing the burden of illness, the voices of the patients in these videos, the experiences of patients and families I meet traveling around the country, to the clinical encounters I see. The conversations are really quite different, in many cases. I see empathy and technical excellence, but the conversation is medical, focused on the disease and often not on the total burden.

[Citing from Henry Ting and Victor Montori at the Mayo Clinic:] When we can’t lessen or ease the burden of illness, we can redesign to lessen the burden of treatment – they call this “minimally disruptive medicine.”

An ideal health system balances the contributions of science and the strengths and needs of the individual; and most important for achieving the specific outcomes with the patient, it has a robust learning system “for the patient”; “for the science” at all levels to modify plans when changes will help, and to leave things as they are when tampering is expensive and ineffective.

Then there is the personal part of caring and healing. How do we best teach new nurses and physicians, clinicians and leaders, how to care and how to improve?

Sometimes caring is minimally invasive technology that optimizes great advancements in the tools of care and minimizes pain and the length of time a patient has to stay in a hospital. Sometimes caring is minimally disruptive processes that are designed to care with and for the patient. Sometimes caring is just standing there. And sometimes, caring is partnering.

Rather than thinking about our work as caring for illness, Antonovsky offers a model of a continuous variable – a “health-ease” instead of a “dis-ease” continuum. A major factor in producing health is resilience – a sense of control and understanding. This will require new and deeper partnerships between patients and families and their provider teams. For years, we’ve had providers with empathy and a strong sense of caring. But what I’m adding today are processes and new designs to support and accelerate the conversations and to build resilience.

Together, our destination is the Triple Aim. It won’t be easy. It’ll take courage, new leadership skills, new care models, new business models, a commitment to equity, and new assumptions:

-- Health care systems can be sustained with modest annual cost increases; and
-- There is enough capacity in the systems to provide equitable, high-quality care to all; and
-- Solutions to national problems will be designed and implemented at the local level.

The theme of this year’s Forum is Taking Care. With a focus on our health, we’ll be better able to take care of those who rely on us. We’ll be better partners with our patients and families. We’ll take care when we need to strengthen our capacity. We’ll take care of the precious resources of our time and our spirit. We’ll take care of our system. And with the new models we’ll build and share in 2011, I can call my sister and answer her questions about Robbie....

Welcome to the 22nd Annual National Forum. Take care, everyone.

The oatmeal chronicles -- Part 2

#IHI The oatmeal chronicles continue, with the folks at the Marriott displaying impressive responsiveness to the process problems noted yesterday. As you can imagine, revamping things overnight for a crowd of 6,000 people is not easy.

We arrived at the food area this morning to find friendly people serving the oatmeal. You can't expect a hotel to replace all the bowls and serving utensils at the drop of a hat, so this was a successful fix for the time being.

A member of the management nabbed me and graciously thanked me for pointing out the problem yesterday. "That's the best way for us to improve," she noted. "Thank you." A very good attitude!

So, for my readers, what would you do next on this issue? Is this the optimum solution? Is there a way to fix the underlying problem that is not so labor intensive? What else would you consider, and how would you do it?

Something tells me that this is going to be a case study at the next hospitality association annual meeting!

Dancing with the Safety Stars

#IHI Speaking of fun videos to promote safety, here's one produced by the folks at the Carondelet Health. Thanks to Scott Kashman, CEO of St. Joseph Medical Center, for reminding us that you don't need the resources of Universal Studios to produce an engaging, helpful guide for your staff. As he notes on his blog:

There was great participation in the making of the video, and while it's entertaining, it also carries serious reminders about the importance being safe in the care we provide to our patients. It is played to Men Without Hats' popular 80's song, Safety Dance.

If you cannot see the video, click here.

Universal safety

#IHI The transformation of health care from a cottage industry characterized by the artistic efforts of individual practitioners to a self-improving system of care delivery will be aided by lessons from other high performance industries. The IHI Annual Forum recognizes the potential for this learning opportunity. So, before the formal sessions start, the organizers arrange excursions to some local businesses in the Orlando area.

What does a theme park like Universal Orlando offer to clinicians and health care administrators? Well, it turns out that the resort has an exemplary safety record, both for the tens of thousands of daily visitors and for the actors and stunt people who perform every day. A group of us spent the better part of today in a conference room at the park, learning of the firm's principles and techniques. The lessons were a direct parallel to those I have discussed on this blog: Framing issues in the context of the purpose of the organization; standardization to avoid variability; encouraging front line staff to call out problems and near misses; prompt reporting of adverse events; and use of root cause analysis when failure occurs.

In the slide shown, note the parallel between the phrase, "No such thing as an accident," and Joe Gavin's comment from the Apollo space program, "There is no such thing as a random failure."

Each organization must adopt techniques that support these goals, techniques that are consistent with the culture of the organization. In the case of Universal, for example, "safety bucks" are handed out to staff members who report safety hazards. These coupons can be used to purchase food at the staff grill.

The company has also prepared an introductory safety video for its staff. It makes ample use of the movies and actors from the firm's cinema productions. It also has a good dose of humor thrown in, consistent with the desire for all activities to support an environment of fun in the park. Here is an excerpt from the Safety Man film.

If you cannot see the video, click here.

Oatmeal, the movie

#IHI Following up on the post below, here is a short video demonstrating one work-around that was invented to deal with the misdesigned breakfast serving system at the IHI Annual Forum. Notice that the inventor preferred to call it "innovation!"

My sources tell me that things will be different tomorrow morning. Stay tuned.

If you cannot see the video, click here.

Oatmeal work-arounds

#IHI Even at a process improvement conference, you encounter failed processes. Have you ever noticed, in a cafeteria or buffet line, that the serving ladle for oatmeal is often too large for the bowl into which it is being put? Such is the case at the Marriott in Orlando here at the IHI Annual Forum.

I captured this problem this morning at breakfast. What's interesting is to see the rapid development of work-arounds. One person abandoned the ladle and used a coffee cup to extract the oatmeal. In so doing, she put her fingers in very close vicinity to the food that would be taken by the following persons. And she then left a goopy, oatmeal covered coffee cup on the table -- in the way of the next person and too dirty to be reused. Other people tried different serving techniques, but they ran into problems because oatmeal just doesn't flow very well!

In the manner of some surgeons who resist acknowledging systemic problems, one person said that he is able to overcome the design problem because he has "a steady hand."