IHI Forum Reflections: 10 'Aha' Moments

3. Trish Cruz, manager of evidence-based care in the Quality Management Department at 525-bed St. JosephHospital, Orange, CA.

"My 'aha' moment was to learn that having a respiratory therapist instead of a nurse teach medication and inhaler use to patients with COPD could prevent readmissions. Often, physicians don't know the system well enough to know what medications are covered and which ones aren't, but respiratory therapists do. We've had to have medications changed because patients were never really getting the right ones. And in addition, patients can use inhalers incorrectly for years."

4. Terry Howell, chief quality officer, 450-bed Hennepin County Medical Center in Minneapolis.

"We need to be more diligent about the use of evidence-based medicine, eliminate variation, and not allow doctors to opt out. You know, doctors who say, that the standards we have in healthcare are good for the rest of you, but I don't have to do it that way.

"And trying to find a way to fix our homeless problem, perhaps have a patient advisory council to do that. We have 42 patients who cost us $10 million dollars one year, and one of them who was admitted 28 times.  We could buy him a home and hire him a full-time assistant for that kind of money."

5. Bob Ladenburger, president and CEO of Exempla Healthcare, a 1,000-bed three-hospital system in Denver.

"Hospitals need to promote a culture of patient safety, and most organizations, ours included, have an opportunity to elevate that. There's going to be more time spent at board meetings on quality and safety, and at management meetings, more accountability."

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