After a healthcare organization has improved on a particular quality measure, the tough part comes, which is making sure that the improvement is maintained, and not ignored once the goal has been achieved or "topped out."
7. The Choluteca Bridge
A 1930s engineering feat in Honduras is a metaphor for today's healthcare system, according to several speakers at the December Institute for Healthcare Improvement National Forum in Orlando, including Don Berwick, MD, former CMS administrator, and Scott Weingarten, MD, of director of health services research at Cedars Sinai Health System in Los Angeles.
The Choluteca Bridge was built by the U.S. Army Corps of Engineers with such design strength, it could withstand the worst of hurricanes that affected the area. When Hurricane Mitch came in 1998, it destroyed 150 Honduran bridges, but not the Choluteca Bridge. Instead, the storm rerouted the Choluteca River. So now, the Choluteca Bridge is useless.
Today's healthcare organizations are like the Choluteca Bridge, because they were designed and built for a different river, the heavy-duty, invasive procedures in high volume and serious illness, not for prevention and health, several speakers said during a recent talk at the Institute for Healthcare Improvement meeting in Orlando.
8. Medical Extensivist
These professionals can be internal medicine specialists, hospitalists, or perhaps advance practice nurses who decide to extend their scope of care beyond the walls of a hospital or the intensive care unit to the discharge care setting.
The idea is that for patients with chronic illness, physician or advanced practice nursing expertise may reduce length of stay and keep patients healthier in their homes, board and care, or skilled nursing facilities.
With home visits on a routine schedule, these extensivists may avert the cascade of resource use and deterioration that can come when patients wait to report symptom changes until they call 911, and come back into the healthcare system through the emergency room.