This year's Institute for Healthcare Improvement Forum covered a range of topics, including quality improvement, health equity, population heath, patient safety, joy in work, and telemedicine.
More than 5,000 healthcare professionals convened virtually this week for the Institute for Healthcare Improvement's IHI Forum 2020.
The Boston-based organization's annual forum is the largest healthcare improvement event held in the country and draws educational session presenters and keynote speakers from around the world. This year's event covered a range of topics, including quality improvement, health equity, population heath, patient safety, joy in work, and telemedicine.
HealthLeaders attended several educational sessions, which included the following three big ideas.
1. Ensuring successful adoption of quality improvement initiatives
Chris Hayes, MD, MSc, MEd, a former IHI fellow and chief medical information officer at Trillium Health Partners in Mississauga, Ontario, Canada, presented an educational session on strategies to ensure that quality improvement improves joy in work.
Hayes' presentation included six primary factors for highly adoptable quality improvement initiatives.
1. End-user participation: End-user staff such as physicians should be involved in the initiative.
2. Alignment and planning: The initiative should be aligned with the organization's or healthcare team's goals, and the launch of the initiative should be planned effectively.
3. Resource availability: The required resources for the initiative such as equipment and personnel should be known and made available.
4. Workload: The cognitive, physical, and time workload should be defined and manageable.
5. Complexity: The initiative should not be overly complex.
6. Efficacy: There should be evidence and belief that the initiative will achieve the intended outcomes.
"In the assessment of projects, we get people to say where they are in these six factors for their project or the planning of the project. Then we give them tools to measure workload and to reduce workload and complexity," Hayes said.
He said one of his favorite assessment tools for quality improvement initiative adoptability is the NASA Task Load Index.
"This is a subjective workload assessment tool. For example, you ask people: How mentally demanding was the task? How rushed or hurried were you? How successful were you in completing the task? How hard did you have to work to accomplish the level of performance? And how insecure, discouraged, irritated, distressed, or annoyed were you? If people rank very high on the last question, the initiative is not going to work, or at least it is not going to work for very long because it is too demanding on people," Hayes said.
2. Launching quality improvement initiatives
Christine Southey, MSc, an IHI improvement adviser and faculty member as well as principal at SoutheyC Consulting in Toronto, Ontario, Canada, was part of a three-member panel that conducted an educational session on quality improvement concepts, methods, and tools. She said a crucial first step for any healthcare quality improvement initiative is engaging members of the organization as well as patients and their families.
"When we have done some of our quality improvement work with long-term care facilities around COVID-19, one of the common themes is to talk with the staff. You need to find out what is important to them, to find out what troubles they are experiencing, and to find out what they are concerned about. That effort not only helps you get a sense of the key focus of your quality improvement but also helps lay the groundwork for engaging people in whatever quality improvement initiative you pursue in the weeks and months to follow," she said.
This first step familiarizes quality improvement leaders with the day-to-day operations of an organization as well as the patients that the organization serves, Southey said. "You not only connect with staff members on a one-on-one level but also get very valuable information about what it is really like to work within the organization. You also want to talk with patients and family members, which gives you a good sense of what it is like to receive care or to support someone who is receiving care."
This foundational work generates gains in the long run, she said. "As you start moving to improvement initiatives, you can go back and show people how their concerns informed the work that is moving forward. You invite people to be a part of the work; and as you start spreading ideas, you have laid the groundwork to be able to engage with people so that they know how they might be able to be involved."
3. Caring for caregivers in a crisis
Jesse McCall, MBA, a director and improvement adviser at IHI and Arpan Waghray, MD, CMO of the Well Being Trust in Oakland, California, led an educational session on joy in the workforce. Their session featured "psychological personal protective equipment" during a crisis for individual healthcare professionals and team leaders.
Individual psychological PPE:
1. Take a day off to create space between work and home life
2. Avoid unnecessary publicity and media coverage of the crisis
3. Get mental health support during and after the crisis
4. Seize on opportunities to show gratitude
5. Recast negative experiences in a positive light
Team leader role in psychological PPE:
1. Limit the length of shifts or time in the workplace
2. Design clear roles and leadership responsibilities
3. Train managers to be aware of risk factors and to monitor for signs of stress
4. Make peer support services available to frontline staff
5. Pair workers together in a buddy system
Leaders can limit the length of shifts or time in the workplace by establishing "float teams" through cross training so that staff members with appropriate licensure, skills, and experience can help in stressed medical units during a crisis, McCall said.
"Moving staff around creates organizational capacity and increases caregiver resources when they are needed most. … To support float teams, leaders should have a set of questions to gauge how the float teams are doing in mixed roles. The people who are doing the work are the ones who are really going to know how the float teams are functioning. Leaders also should ask patients about the staff that is rotating into a unit."
Waghray said healthcare leaders need to use several skills and methods in times of crisis.
- Tolerance for uncertainty is one of the more important skills.
- During a crisis, leaders should recognize that their role evolves over time. In the early days of the coronavirus pandemic, it was important for leaders to be visible, to offer transparent communication, and to project calm and empathy. As the pandemic advanced, other roles became significant such as addressing anger and frustration among healthcare workers while continuing to provide hope.
- For leaders, communication during a crisis is essential such as establishing formalized listening sessions and intentional leadership rounds.
- Being vulnerable as a leader is an important skill. It helps to exhibit humility, curiosity, inclusion, and genuine empathy.
- A practical action leaders can take is to ask about what is going well—leaders can try to overcome the negativity bias that can run rampant during a crisis.
- In healthcare, seeking help is often seen as a sign of weakness, so leaders should try to normalize help-seeking behavior.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
There are six primary factors that impact the adoption of quality improvement initiatives such as end-user participation and resource availability.
To help ensure success, the first step in quality improvement initiatives should be engaging frontline staff as well as patients and their families.
During a crisis, healthcare organizations should provide "psychological personal protective equipment" for individual staff members and team leaders.