I've spent the last three days at the Institute for Healthcare Improvement's 22nd annual quality forum in Orlando, a significant experience this year for these reasons.
First, it is the first IHI forum to be held since the passage of the Patient Protection and Affordable Care Act. Now, the realization that the way care is provided and paid for will undoubtedly change cataclysmically has sunk in for many providers. The bar has been lifted, and they may be nervous or invigorated by the idea, but they know they need to learn more.
That may be why a near-record number of almost 6,000 plus physicians, hospital chiefs, nursing executives and others responsible for quality and patient satisfaction attended from 44 countries.
Second, it is the first held without Don Berwick, MD, its co-founder, President and CEO. Berwick was appointed by President Obama to head the Centers for Medicare and Medicaid Services, which will in effect promulgate regulations that set forth many quality initiatives Berwick and his IHI colleagues conceptualized over the last 20 years. Health and Human Services Secretary Kathleen Sebelius, one of the keynote speakers said, Tuesday, "I had to go and apologize to IHI staff personally for stealing Don Berwick." But Berwick "is absolutely the right leader at this historic moment," in part because many of his ideas about improving care are now embedded in the new healthcare law.
Third, more than previous IHI forums, this one provided far more input from the patient perspective, and even included a morning devoted to Patient Activists and Partners in Quality and Safety. The idea was to empower activists to tell the healthcare system how it must change to lower cost, reduce waste, and improve their care without harm, and not mince words doing so. Many hospital chiefs say they are now preparing to put patients on their boards.
As attendees readied to return home, I stood in the hallways and randomly asked attendees—nearly all who responded were doctors and hospital officials—for their "Aha!" moments. I asked them to tell me, specifically, what excited them the most about what they heard, from a practical standpoint, and what they would try to change first when they returned home.
Here's what they said:
1. Steven Linn, MD, chief medical officer, 429-bed South Jersey Healthcare.
"I'm going to spend as much time as I can with as many patients as I can in the morning. And the other thing I'm going to do is bring all my clothes into the hospital and stay for a week, to see what really goes on in the hospital. I'll stay in the call rooms and roam the halls."
Linn says that's something he had previously considered, but was inspired by forum keynote speaker, Cory Booker, now Newark mayor. Booker described how as city councilman a decade ago, he went on a 10-day fast and slept in a tent outside a housing project to protest drug deals and violence that police wouldn't stop. Booker says he was told by an elderly woman that he "had to do somethin'," so he did. "I listened to his passion and will, and I made a commitment to do somethin.' Kinda like Cory Booker's fast," Linn said.
2. Marvin Rice, MD, head of safety at 329-bed Presbyterian Intercommunity Hospital in Whittier, CA.
"I was impressed by the presentation about making sure that board meetings start with stories about individual patient's care. And that 50% of them have to be negative stories. Sure we're worried about finances, and we have a lot of underinsured patients. But we're a healthcare organization for heaven's sake. One of our board members is here and I'm going to make sure he knows about this."
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."
6. Debbie Robins, patient safety officer at 626-bed Shands Healthcare of the University of Florida in Gainsville and Jacksonville.
"Our environmental services staff is responsible for general cleaning, like mopping floors and emptying trash and visual aesthetics. But they're also responsible for 'terminal bed cleaning,' which is needed whenever we discharge a patient, and until that's done, the emergency department bottleneck can't be cleared. When someone suggested that there should be two types of environmental services teams, it would greatly improve patient flow. Several of us who attended that session looked at each other and said 'Why didn't we think of that?' "
7. Win Whitcomb, MD medical director of 659-bed Baystate Medical Center, Springfield, MA.
"I was impressed with Kaiser Permanente's demonstration of how they used video to capture patient experience with readmitted patients (revealing the circumstances that brought them back to the hospital, for use as a training tool for all providers on the team.) Use of video can tell a story that you can't get in any other way."
8. Susan Cissone, RN, clinical coordinator, 665-bed Abington Memorial Hospital, PA.
"Hospitals have to reach out to the communities to prevent emergency room visits. And one way, in an urban setting, might be something like the 'Adopt-A-Grandparent' program. Let's say you have a young, single mother whose child won't stop crying. She comes to the emergency department because she thinks that's her only choice. Adopt-a-Grandparent might give her another, and opens up horizons to see how people are doing different things."
9. Sue Garszczynski, quality manager at Watson Clinic, Lakeland, FL.
"We can make sure that patient satisfaction makes a great turnaround by improving the appointment times for physicians to see patients, starting with the way appointments are made."
10. Frederick Ryckman, MD, senior vice president of medical operations and professor of surgery at 523-bed Cincinnati Children's Hospital.
"One of the themes here was the near misses and precursor events, and to have a new appreciation of all this work being done to recognize those on multiple fronts. The old idea that there is a threshold (of mistakes and mishaps that happen in healthcare), and you can't get below that, is being dissolved."
There were more 'aha' moments expressed by others. But I'll write about those another time.