IHI Open School Blog - University of Michigan Chapter

Martin Luther King Jr. Day: Socioculturalism in Medicine

2011-01-25T15:06:00.000-08:00

When you are born with yellow skin and black hair into a multicolored country, socioculturalism is a daily reality. Although my parents label me as an ABC (American Born Chinese) with amusement, unbeknownst to them, every day is a continuous combination of integration, negotiation, and assessment of how my decisions and actions define who I am. For example, if I choose Peking duck over sirloin steak for dinner, does that make me more Chinese? Where did this preference for a northern Chinese delicacy even stem from? My parents are from Shanghai, so my preferred protein should really be freshwater shrimp. Of the dance styles that I enjoy the most, my decision is straddled between Chinese and hip hop. When I’m seeking symptomatic relief from colds, I instinctually reach for Acetaminophen, Ibuprofen, and Phenylephrine. But, for sore throat relief specifically, my first line treatment of choice is Nin Jiom herbal lozenges and syrup. Asian Americans are predisposed to specific cancers and there is an overwhelming prevalence of Hepatitis B in the Asian American community. Because my diet is probably closer to the average American diet, what disease risk factors and predispositions do I actually have?

As illustrated above, I am socioculturally stochastic. Even the best statisticians would not be able to make any sense of this variability and extract a reliable pattern to predict my future actions. While I have never felt intimately tied to my ancestral culture, my physical appearance is a daily reminder that there is no escaping it. Despite my inability to lean one way or the other, whether I like it or not, I am American, Asian, and Chinese. Although I have traveled extensively around the world and have lived in several microcultures within the US, it wasn’t until I traveled to Ghana that I began to understand the significance and potential consequences of my blended identities within a broader context....

Go to the IHI Open School Blog to read the full post!

Morning Report: 3rd Annual Patient Safety and Quality Leadership Institute

2011-01-24T06:00:00.001-08:00

Last week, I had the privilege of participating in AMSA’s third annual Patient Safety and Quality Leadership Institute at Thomas Jefferson University in Philadelphia. Nearly 40 participants from various backgrounds converged to learn about and discuss issues surrounding patient safety. The diversity of the students ranged in years from pre-meds to residents, but also in fields from nursing through pharmacy, and of course medicine. Our host was Dr. David Nash, the Dean of the Jefferson School of Population Health, and a preeminent expert in outcomes management, medical staff development and quality-of-care improvement. Over the intensive course of three days, senior leaders of hospital systems and experts in patient safety exchanged ideas with our group on two main domains: how to structure undergraduate medical curriculum to incorporate patient safety and quality into training, and how to implement our own ideas for projects into hospital systems. Though the days were packed with lectures, discussions, and project work-shopping, the evenings were left open for socialization with my fellow students. I walked away from the weekend feeling a sense of re-invigoration, purpose and the belief that the future of medicine without considerations for patient safety and quality is a future that cannot exist at all. I’ll briefly expound on three of my takeaways for the weekend:

Patient safety is here to stay: perhaps I’m singing to the choir as the readers of this blog most likely have similar beliefs, but to those of you who may have stumbled here accidentally, the patient safety movement is here to stay. With the work laid out by various organizations such as IHI, and leaders like Don Berwick at CMS, there is no longer the feeling that patient safety is a fad. Hospitals and hospital systems are taking a careful eye to their own operations and taking legitimate issue with these topics. The leadership at these institutions, whether they are early adopters or late-comers, will inevitably arrive at the conclusion that if they will survive as organizations, they must prioritize quality initiatives, lest punishment by government or third-party insurers. This changing environment will allow ample opportunity for any student of medicine or related fields to access leadership for traction in his or her own project.

Grass-roots AND top-down: as Dr. David Longnecker, the Director of Health Affairs for the Association of American Colleges Medical Colleges illustrated, the movement to incorporate patient safety into medical school and residency will no longer be a matter of “if,” but of “when.” Pervasive throughout the governing bodies of GME is the impetus of change; curricular activities will have some form of training requirement for residency related to patient safety. At the University of Pennsylvania, Dr. Jennifer Myers told our institute about a specialized patient-safety longitudinal track for interested residents. Elite programs around the country, as well as the world, have adopted such a model for resident education. But this may not be enough. While curricular changes in residency may indeed force some perspectives to widen, there is an on-going need for medical schools at the undergraduate level to continue on in this mold. Models of patient safety should be integrated into medical schools throughout the country, not merely as an hour-long “special topics” lecture, but an extended module incorporating didactics and projects for practice. The essential inter-disciplinary nature of patient safety necessitates that these models should not be learned in isolation, but shared with colleagues throughout the patient care realm (i.e. nursing, public health, pharmacy).

Take action: the best way to get involved is to... surprise! Get involved! This can range from having coffee chats with your classmates to joining your local IHI chapter to implementing your own projects at your hospital. All of the participants at this leadership institute came in with project ideas that we hoped could benefit from the exchange of ideas that this forum affords us. Having experts working with us one-on-one to define and refine our project scope and implementation plan was invaluable. Even more impressive was the ability to view the range of patient safety improvement projects around the country; the enthusiasm was palpable to say the least, with 40 minds humming away offering suggestions to each other.

I cannot express enough gratitude to Dr. Nash for enabling and providing us with such a fantastic weekend of programming. The slides for the various presenters are open to the public, should one feel like perusing through the excellent material. Future leaders of healthcare, take note: patient safety is inextricably linked to the success of your institution, start learning and practicing today!

Slides from presenters:

http://www.amsa.org/AMSA/Homepage/EducationCareerDevelopment/AMSAAcademy/PSQLI.aspx

AMSA Patient Safety Webinar:

http://www.amsa.org/AMSA/Libraries/Initiative_Docs/AMSApatientsafetywebinar.sflb.ashx

Dealing with Culture Shock: The Aviation and Health Care Industries

2010-12-05T23:40:00.000-08:00

One of my favorite things to do is travel. Traveling provides me with an unmatched exhilarating sense of adventure. Whenever I casually walk down an unknown bustling street, my sense are overloaded with new sights and smells. This kind of excitement is unbelievably addicting. My mind just races with comments. What is that brilliant green dress she’s wearing made of? Can you really eat that? Whoa, where did all of those chickens come from? Did those kids just point and laugh at me? Is his cell phone really that tiny? Why is everyone so tall?

Do I ever experience culture shock? Sure. Every new environment will take some time to adjust to, but the challenges of getting around and living outside of my comfortable apartment in Michigan is all part of the fun of traveling.

What about the culture shock of transitioning from one industry of work into another? The University of Michigan IHI Open School Chapter’s Monthly Speaker Series guest, Gary Sculli, probably does not have many positive feelings associated with his move from the airline industry into health care. Gary Sculli is currently a Program Manager at the National Center for Patient Safety in Ann Arbor, MI. He has both extensive experience as an airline pilot and is a registered nurse.

As Sculli starkly contrasted the two industries, it was clear that the airline industry and health care were two very different beasts. While it may have been difficult for me to adjust to taking cold showers while I was in Ghana, “traumatic” would be the word I’d choose to describe a move into health care from the airline industry. Here are some differences at a quick glance.

Airlines	Health Care
Team training	Hierarchical barriers
Human Factor awareness	Human Factors NOT emphasized
Standardization	Varying degrees of standardization
Checklists discipline	Expectation to complete outside functions
Formalized recurrent training	Haphazard recurrent training
FAA mandated performance checking	Absence of mandatory performance checking

Not only are there differences in work environment between the two fields, but health care is associated with higher error rates—rates that make up the harrowing statistic of up to 98,000 deaths a year due to medical errors, published in the IOM Report, To Err is Human in 1999. A recent study evaluating quality improvement in health care’s progress since the publication of To Err is Human reports the sobering fact that not much has changed. Just as many people become victims of medical error today. While a lot of improvements have been made, we still have a long way to go. According to the Joint Commission, at the root of many of the errors we see in health care are communication and organizational culture. So, what health care needs is a cultural transformation. With the likes of Gary Sculli, we are well on our way on the journey towards safer health care.

Being flexible and keeping an open mind are two important items to pack when traveling to ensure a positive experience. Gary Sculli surely did not forget to pack these on his move. He took the lemons he found in health care and made lemonade by applying effective communication and leadership strategies practiced in the airline industry to health care in order to make health care more effective and reliable. In his discussion, Sculli outlined the concept of crew resource management as a team building effort to not just strive towards eliminating error, but more importantly, how to manage error when it does occur. He also discussed different leadership styles, being a dictator or facilitator, and the health care consequences associated with each. What else is needed to make health care more reliable? Sculli illustrated the need to redesign health care to support “situational awareness,” being able to perceive, comprehend, project, make decisions, and perform actions on variation in one’s environment. Check out the University of Michigan IHI Open School website for more information on topics discussed at the Monthly Speaker Series event.

The application of many of these airline tools have been able to make some great changes in health care. With the use of checklists, many hospitals have been able to effectively standardize procedures and eliminate hospital acquired infections. Through communication training among the staff of the operating room, physicians have been shown to be more adept at soliciting feedback and taking appropriate actions, while nurses and other members of the OR team have moved away from the “hinting and hoping” strategy of declaring an error to providing feedback in a direct, concise, and specific manner.

Perhaps what I love most about traveling is that once you move past the initial jolt of shock that the differences of a new location can give you, people are really all the same. I’ve learned so much from the cultures and people I have interacted with on my travels and have adopted some of these practices into my daily life. Personally, these adopted practices have made my life better. Is health care really so different from the airline industry? They are both fields that include teams of individuals performing highly specialized skills with extreme risk and small margins of acceptable error. With the help of inspiring leaders like Gary Sculli, health care is adopting the best practices from other industries. If we keep moving in this direction, I’m sure the next culture shock health care will give is one of success that we can all be proud of.

News Flash!

2010-12-01T21:24:00.000-08:00

U-M hospitals win award for being one of the nation's safest by Leapfrog! Click here to read more!

Gut Check: University of Michigan's Medical Error Disclosure Program

2010-11-26T14:36:00.000-08:00

We're all familiar with the story of George Washington and the cherry tree that gave rise to the famous line, "I cannot tell a lie, father, you know I cannot tell a lie!"

What motivated him to tell the truth? Was it some sort of rumbling gut feeling that told him that it was the right thing to do? Probably the same motivating forces that led the University of Michigan Health System (UMHS) to transition to a medical error disclosure program that is fully integrated with the hospital's quality improvement and patient safety efforts in 2001.

Unfortunately, our health care world today is one in which we don't follow George Washington's leadership. Medical malpractice is guided by a "deny and defend" approach. Insurers and counsels often urge secrecy, dispute fault, deflect responsibility, and make it as slow and expensive as possible for patients to continue the already unfavorable process. As a result of this approach, it's not uncommon for medical lawsuits to take five or more years to resolve. Information about the cause of injuries is also denied to patients and families for long periods of time, compensation is unavailable to those who most need it. Worst of all, there is little meaningful quality feedback for providers. Patients and providers are placed in adversarial positions, allowing fear to fester in between.

Turning the current, "deny and defend" approach to medical liability on its head, the current system at UMHS emphasizes full honesty and transparency between staff and patients and encourages the participation of risk management, regardless if a medical error is involved. At UMHS Medical errors are identified and collected by all staff, patients, and family members. Experienced risk managers with a clinical background investigate the claims, and care quality is evaluated. The system's three guiding principles are:

1. Compensate quickly and fairly when unreasonable medical care causes injury.

2. Defend medically reasonable care vigorously.

3. Reduce patient injuries (and therefore claims) by learning from patient's experiencesMost importantly, conclusions of the investigation are shared.

We were fortunate to have Rick Boothman, UMHS Chief Risk Officer, join the University of Michigan's IHI Open School for our first Monthly Speaker Series event of the year to discuss UMHS's medical error disclosure program. Boothman's presentation was focused on the underlying principles of quality improvement that help inform the disclosure program.

Boothman's extensive experience as a trial lawyer has given him a strong and almost intuitive sense about cases that he can almost accurately predict if he can win a case. But, he does what he refers to as a "gut check." Would he accept this kind of care for his own mother?

The undercurrent of quality improvement has led to some great results. As reported in the Annals of Internal Medicine in a paper written by Allen Kachalia et. al., with implementation of UMHS's disclosure-with-offer program, the average monthly rate of new claims decreased from 7.03 to 4.52 per 100,000 patient encounters. The average monthly rate of lawsuits decreased from 2.13 to 0.75 per 100,000 patient encounters. The median time from claim reporting to resolution decreased from 1.36 to 0.95 years. Average monthly cost rates decreased for total liability, patient compensation, and non-compensation-related legal costs.

A system that makes patients and physicians happier...and saves money at the same time? My gut is telling me that this is a system that we should take a look at.

Patient Centered Medical Home: An Anchor in the Ocean of Health Care?

2010-10-18T16:29:00.000-07:00

The health care system is a ruthless and turbulent ocean. For many patients, even a regular visit to the doctor can be quite unforgiving. With patient safety, effectiveness, patient-centeredness, efficiency, timeliness, and equity concerns, health care visits can feel like navigating the ocean on a flimsy fishing boat. Now that we are transitioning into the phase of implementing and executing health reform, we must push patient-centeredness to the forefront of all our efforts to inform us on how to improve the quality of our health care system.

For example, the concept of the medical home that many say will transform health care into a more coordinated and comprehensive system isn’t just implementing electronic medical records, restructuring care teams that group physicians, nurses, physician assistants and other allied health workers together, redefining scheduling, or figuring out how to pay for these new services. The medical home needs to be a patient-centered medical home—one that actively engages the patient’s needs and concerns. Our system’s struggles with achieving patient-centered care is most evident in how health care providers deliver bad news to patients...

Read the full post at the IHI Open School Blog

Lunch with Dr. Dean Gruner

2010-10-04T18:56:00.000-07:00

The IHI Open School is a great resource for learning from the leaders in the health care field. As the first educational event of the year, five IHI members had a causal lunch with Dr. Dean Gruner, the president and CEO of ThedaCare. He described the lean processes his Wisconsin-based health system put in place to dramatically improve patient care. We learned about the beginnings of the program, his leadership style, and his thoughts on quality improvement. It was a wonderful opportunity to get a personal look at how the initiatives IHI promotes work on the ground. At the end of the hour, we joined him in a larger lecture where he talked in more detail about the cultural changes associated with quality improvement.

Dr. Jack Billi, the Associate Vice President of Medical Affairs at UMHS, joined us for lunch to add his perspective on lean process. Dr. Billi will come to the Open School in October to lead a lean training session. Watch this space for more information about these sessions and more opportunities to meet leaders in our field!

Steve Brown
Ross School of Business

The Gift of Stories

2010-09-16T07:55:00.000-07:00

...My first year of medical school was defined by the time I spent in anatomy. I spent hours probing through various anatomical structure and yet I feel like I only scratched the surface in my pursuit of medical scholarship. But what I did larn during those hours in anatomy lab, as I slowly built an intimate rapport with my first patient, was the invaluable lesson of the joy and fulfillment gained through listening to the stories of every bump, kink, and scar. It is the magnetic draw for these patient narratives that led me to inevitably mature from the dangerous narratives of attempting surgical procedures on myself to attending medical school and working towards becoming a doctor. Your special gift, my first patient narrative, is one that will always stay with me as I continue to learn and never stop listening...

Delivered at the University of Michigan Medical School Anatomical Donations Memorial Service (Sept. 15, 2010)

Click here to read more on the IHI Open School Blog.

Preparing for the Future

2010-09-08T08:02:00.000-07:00

This summer, while I was traveling around Ghana conducting clinical quality and management research focusing specifically on the changes posting an OB/GYN specialist in district hospitals has on the hospital and the immediate community, my classmate Charlotte was busy administering a laparoscopic surgery training module to bring the technology of laparoscopy to Komfo Anokye Teaching Hospital in Kumasi, Ghana. Laparoscopic surgery, especially for gynecological surgeries, has been available to developed countries for at least 20 years, but this minimally invasive form of surgery has yet to become standard practice in Ghana. The benefits of laparoscopic surgery are many. It is cosmetically favored by patients and medically, reduces complications like hemorrhaging and has shorter recovery times. It is no exaggeration to say that Charlotte's work is ushering Ghana into a new surgical future that will bring a tremendous amount of public health benefit.

In 1910, Abraham Flexner's report titled, "Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching" ushered and shaped medical education into it's current form. The Flexner Report called for standardization of medical education that was rooted in sound and rigorous biomedical and clinical science challenging the American and Canadian medical education systems to train the highest quality of physicians. Flexner, not a physician himself, wrote a book-length report that was framed with the greater society in mind. He wrote, "The public interest is then paramount, and when public interest, professional ideals, and sound educational procedure concur in the recommendation of the same policy, the time is surely ripe for decisive action."

It has been 100 years since the publication of the Flexner Report and with 100 years of experience of modern medical education, we are due for some reflection on the alignment of the medical education system and the public interest. In an article published in Academic Medicine, Drs. Don Berwick and Jon Finkelstein write and discuss a, let's call it "Flexner Report 2.0", shaping a medical education system that will better prepare physicians to meet the needs of a today's world of health care. Read the article here.

In the article Berwick and Finkelstein outline new values that should complement the current emphasis on biomedical science we receive in medical school. These values include "patient-centeredness, transparency, and stewardship of limited societal resources for health care." There is no time in the current curriculum to add on training in these new skills, many educators would argue. Berwick and Finkelstein also review the innovative programs, including the IHI Open School, that attempt to provide medical students and residents with a foundation in these new skills, as well as outlining a new frame of reference for medical curriculum change that will incorporate these invaluable skills. I certainly can't reproduce Berwick and Finkelstein's eloquence, so I will leave the explanation of the fine details to the article. Definitely a must-read!

In the 100 years since the publication of the Flexner Report, the medical education system has trained millions of physicians who have dramatically transformed health care. It was this cohort of physicians that popularized laparoscopic surgery! Looking just at performance outcomes, we have made incredible gains in both the length and quality of life for our patients. However, there is much more we can do. If we adopt Berwick and Finkelstein's recommendations, we will be poised to create a new physician workforce adept at navigating and continually improving the complexities of health care to consistently meet patient needs. We all need to collectively reflect on and brainstorm innovative interventions to fold the skills of systems thinking into our current medical education system. If we can develop the technology of laparoscopic surgery, I'm confident that we too can succeed in reinventing ourselves to better treat our patients with the tools of quality improvement. In 100 years, the world will surely look very different. I'm imagining a modern metropolis not unlike the life of the Jetsons. But, what will medicine look like? What kinds of public health accomplishments can we celebrate in the next 100 years? Let's work together to reshape medical education so that we will have plenty to celebrate in the future!

What do you think of the Berwick and Finkelstein paper? Leave a comment!

Read more posts on the IHI Open School Blog

Project Fives Alive: Two Days of Energizing Inspiration

2010-08-16T14:47:00.001-07:00

Karni QI Team

In typical last-minute Eva fashion, two years ago, I decided to defer from medical school for a year to work at the Institute for Healthcare Improvement (IHI). IHI can be best described as a fast-paced social change organization that operates like a cross between a think tank and consulting firm that focuses on improving the delivery of health care through spreading systems redesign tools and interventions all around the world, including Ghana. As much as possible, IHI practices what it preaches. In addition to encouraging health care systems and health care professionals to employ the model of improvement to make the delivery of health care more efficient, reliable, and effective, all of IHI’s own work is continuously evaluated for improvement. After living and breathing quality improvement for a year, the transition to medical school, where the focus sometimes felt like mindless memorization of volumes of facts, was difficult.

My main motivation for coming to Ghana this summer to work on clinical quality and management research was to return to the field of quality improvement of health care. For the most part, my research has been very fulfilling as I have delved into answering the questions: what kinds of improvements can be made at the level of a district hospital to improve maternal health and how can those improvements be made? Since data is the backbone and currency of quality improvement, sometimes answering my objective questions has been frustrating because I continuously run into underdeveloped data and information systems. On the days that I felt particularly beat by data available to me, I’d wonder how IHI functions in Ghana.

Lambussie QI Meeting

IHI has three developing countries programs: Ghana, South Africa, and Malawi. In Ghana, Project Fives Alive, a partnership with the National Catholic Health Service (NCHS) and Ghana Health Service (GHS) is working towards reducing under five mortality through quality improvement. While I was working at IHI, the CEO, Don Berwick, made a short visit to Ghana and collected the most inspiring stories. Thanks to Nana Twum-Danso, Project Fives Alive director and Ernest Kanyoke, Project Fives Alive Project Officer, I had the opportunity to be inspired too.

Piina QI Team

Last week, I traveled to Wa in the upper west region of Ghana to join Project Fives Alive on two days of quality improvement (QI) meetings at various health centers and CHPS zones. It was a difficult journey up to Wa from Kumasi, but those troubles immediately melted away when I met Ernest. If it were possible to anthropomorphize quality improvement, Ernest would be the perfect model. He is brimming with energy and is whole-heartedly committed to quality improvement in his work and his everyday life. Upon arrival, when my hotel reservation was not processed correctly, Ernest immediately evaluated that this was due to a problem in hand-offs and he said he wished had time to help by first collecting data on how often this occurs. At the very least, seeing Ernest carry around a flip chart and colored markers conjured up feelings of comfort. IHI truly is flourishing in Ghana.

Lambussie Health Center

Because I arrived in Wa around 2:30AM and had to be up and ready for site visits at 7AM, Thursday’s meetings were tough. Immediately after Ernest’s more than deserved introduction of myself to the QI teams, I’d invariably fall asleep. I am still so ashamed that in response to the amazing work that these health centers are doing to reduce neonatal deaths, all I could give them was an inattentive, silent, sleeping Eva. Thankfully, even while sleeping, I think my brain was still alert and I gathered some truly remarkable accounts of the QI work being done by midlevel providers (midwives, community health nurses, and local support staff) to drastically improve the processes that can reduce neonatal mortality.

Samoa QI Team

For example, in Samoa, the two CHPS Zones have greatly improved their skilled delivery rate by making small changes to make delivering at a health center attractive for mothers. These changes include offering traditional porridge to the women after delivery. This small change does not just represent a inventive adaptation of traditional practices, but also sends the message that the health care staff cares about the well-being of the mother and that the health centers are welcome institutions. In Karni, the QI team discussed the progress of their intervention to reach out to women and develop a pregnancy plan to increase their skilled delivery rates, which are at a laudable 90+% and a very effective mosquito net distribution program that has reduced their rates of malaria admissions.

Karni QI Meeting

What impressed me the most was not the outstanding results and outcomes that these health centers can celebrate, but the dynamics of the QI meeting itself. The health center staff have no formal training in statistics, yet after just a few learning sessions, are very data driven. Midwives and community health nurses take turns contributing to and facilitating the QI meeting to discuss and evaluate the rates of first trimester registrants for prenatal care and improving postnatal care follow-up visits. During the meeting, their various registers (the raw data), are always open right in front of them and they reference the data throughout the meeting. The connection between data and the individual patient success narratives they are experiencing is strong and solid. I can’t say that even providers in the US have made this connection. The foundations of QI have been laid for these teams and with that, I believe that they can take on any health care delivery challenge.

Exuberant Ernest Working His Magic

All of this progress, however, could not have been possible without the skillful facilitation of the project officers. The project officers not only have a deep understanding of the individual process and quality measures and interventions that each health center is undertaking, but are also experts at managing relationships. Project Fives Alive is a partnership with the NCHS and GHS are extremely important agencies to work with for the success of its work. The project officer has mobilized and empowered all of the necessary stakeholders to participate in the shared goal of reducing under five mortality. A representative from the GHS district health office traveled with us and was present at every QI meeting. All levels of staff were asked to open their registers and discuss and interpret the data. And then together, the QI team would set aims and deadlines to meet before the next QI meeting. My own research experience has proven that this is no easy task. Building confidence and a positive attitude among the providers is on an entirely higher level. The hospitals that I visited were still struggling with just making sure all of the necessary stakeholders that would work together to improve maternal mortality were all available on the same day at the same time to just discuss maternal deaths. These project officers, like Ernest, have just the right combination of encouragement and persistence to have led the QI teams to where they are now.

Run-chart at Piina

The four sites that I visited were extremely resource deprived in comparison to the district hospitals that I have spent most of my time working with—most of the health centers do not have electricity! Yet, despite these resource challenges, look how far a statement like, “let’s take a look at the data” can go. The run charts and meeting minutes posted on the wall is really the only technology I saw that these facilities were using to achieve their results. It’s phenomenal. The next waves of the project are to expand and replicate the work being done in the northern regions to the rest of Ghana. This kind of exposure to QI has so much potential that I know whenever I have the opportunity to return to Ghana, the health care delivery system in Ghana will be positively unrecognizable.

The Fearless Issah

My site visits and time spent with the Project Fives Alive team was the perfect burst of inspiration that I needed as I begin to undertake my last small project before I have to return to Michigan. Perhaps it was Issah’s adroit driving skills that powered us through sometimes as much as 300km of dirt roads to reach these communities, but after just two days with Ernest (and his highly marketable energy if only extractable) and the community QI teams, I’m excited for my own project with the confidence that QI works successfully in resource-poor settings like Ghana. With more opportunities for these community teams to share, evaluate, and celebrate their work and even greater individual engagement with data, the results that Project Fives Alive will produce I think will exceed the already achieved success. Three cheers for Project Fives Alive!

Thank you again to Nana Twum-Danso and Ernest Kanyoke for this amazing opportunity to join you all for two days. I look forward to following Project Fives Alive as it continues to grow and spread.

For more information about IHI and Project Fives Alive, here are some relevant links:
Project Fives Alive Website
Fives Alive Project Description
On the Ground Account When IHI's Jane Visited Ghana

For more blog posts about my summer in Ghana, visit "Eva Ghana Wild"

Costs of Care: Cost containment and unfinished business

2010-05-05T19:11:00.000-07:00

Costs of Care: Cost containment and unfinished business

Healthcare reform's unfinished business

2010-05-05T16:25:00.000-07:00

While the contentious healthcare reform bill enables access to health insurance for 32 million Americans, what about costs and efficient healthcare delivery?

The often-heard criticism of the 10-year, 1 trillion healthcare reform plan is that it simply does not do enough to rein in the cost of treatments. According to a government report released in February this year, healthcare spending grew to a record of 17.3 % of the GDP in 2009, $ 134 billion more than 2008, marking the largest one-year jump in its share of the economy since the government started keeping such records half a century ago.

The question then is, how does ObamaCare plan to deal with the American view of more care is better care? Given that the new healthcare overhaul requires the government to now pick up more of the healthcare tab, can we cope with that? Moreover, how do we convince patients and providers that new procedures, tests, drugs or devices that might save or improve lives really are not always necessary or worth the exorbitant prices?

A stark example of the inefficiency in the system was brought to bear in a recent study published in JAMA about the rise in unnecessary back surgeries. Despite the growing evidence that it does not really work well for patients and increases the likelihood of life threatening conditions like heart attacks, strokes and pneumonia,complex back surgeries have increased 15-fold between 2002 and 2007. In essence, more complex procedures mean higher payments for surgeons. The misaligned financial incentives, the paucity of patient education about less invasive treatment options and the trying-anything-and-everything mentality in medical practice even if we’re not sure it works are all part of the problem.

And it’s not just more back surgeries. More CT scans pose a problem too. A recent study demonstrated the significant overuse of such scans, projecting that 15,000 people die in a given year due to the radiation received from CT scans. Caesarean births have become more common, with little benefit to babies and significant burden to mothers. Men who would never have died from prostate cancer have been treated for it and left incontinent or impotent. Cardiac stenting and bypasses, with all their side effects, have become popular partly because people think they reduce heart attacks.

Overall, the consensus is that culture change is needed to move away from wasteful spending to more efficient healthcare. They include new making doctors more sensitive to costs of care, establishing new payment methods for doctors, more comparative- effectiveness research and penalizing hospitals for inefficiency. The hope is that the Patient-Oriented Outcomes Research institute established by the healthcare Bill, charged with setting the national agenda for the comparative- effectiveness studies, as well as providing more money and disseminating results, will bring some order into the chaos of practicing medicine. The hope is that it's studies will have an impact on healthcare delivery.

Shooting for "Sensemaking" in Health Care

2010-04-27T20:17:00.000-07:00

Despite my lackluster sports careers in tennis and Ultimate Frisbee, I am a huge sports enthusiast. In college, I was introduced to basketball. My hometown team, the Miami Heat had fought their way to the 2006 NBA Finals. Like any good fan, my eyes were glued to the TV every game against the Dallas Mavericks. I gasped at every missed shot, held my breath during every free throw shot, and cheered for every point scored. The Miami Heat's journey to the championship was epic and I have been enamored with them ever since....

...As much as I love the Miami Heat and have faith in Wade's athletic prowress, I am not hopeful about tonight's game. Using Weick's own words, the Miami Heat are not a high reliability organization, an organization that operates under very trying conditions all the time and still manages to have fewer than their fair share of accidents, but should be...

Click here to read the full post on the IHI Open School Blog

An Evening of Thanks

2010-04-21T18:50:00.001-07:00

I have a little over a month left of my first of year of medical school...an unbelievable fact. One of the highlights of my year has been the Family Centered Experience program. I have written about the program in previous posts here and here. Closing up our year, all first year med students were asked to work in small groups and create an interpretive project using untraditional media to express our understanding of what we have learned from our patient volunteers. Tonight, all of our interpretive projects were on display and we spent the evening with our classmates and patient volunteers experiencing the reinterpretation of the struggles and triumphs of a life with illness...

Go to the IHI Open School Blog to read the full post!

This is the Clinic that Will and Charlie Built...

2010-03-22T06:22:00.000-07:00

I have officially become a groupie of the quality improvement in health care movement. Books sitting on my nightstand include: Pauline Chen's Final Exam, Super Crunchers by Ian Ayres, and How to Change the World by David Bornstein. I squealed like I had just sighted Brad Pitt when Atul Gawande's latest book, The Checklist Manifesto arrived at my door. Instead of simply saying that I need to clean my apartment, I specifically think that I need to "5S" my kitchen and desk. In order to stay fit and get rid of the belly fat I've grown since starting medical school, I am now in PDSA cycle 3 for a 30 minute exercise routine that I can reliably perform every day. The latest sign that I am a quality improvement junkie is my weekend pilgrimage to Mayo Clinic in Rochester, Minnesota.

This past weekend the AMSA Chapter at Mayo Clinic hosted a Patient Safety and Quality Care Conference at Mayo Clinic. The Mayo Clinic has not only been one of President Obama's shining examples of high quality care at low costs since he began his health reform push early last year, but has also consistently popped up during my experience at IHI as a health system that has truly embraced the IOM aim of patient-centeredness. Even though I'm buried underneath the dorsal columns of my central nervous system sequence, this was an opportunity I could not miss...

Click here to read the full blog post on the IHI Open School Blog.

"What Do I Need to Know for My Clerkships?": A Look at the Lucian Leape Institute Report on Medical Education

2010-03-15T09:31:00.000-07:00

In the world of medical school, spring is a time of transitions. First year medical students are returning from spring break and gearing up for the last stretch of class before summer. Second year medical students are getting ready to buckle down and study for the USMLE Step 1 board exam (good luck to all!). Third year students are on their last clerkship rotations before becoming fourth year medical students. And fourth year medical students are holding their breath as Match Day approaches (this Thursday!). Like any time of transition there are a lot of questions about the future floating around. One of the most honest and interesting questions I have heard recently was from a second year student to a resident, "What do I need to know for my third year clerkships?"

This may sound like a strange question to those outside of the world of medicine. The third year of medical school should be a logical progression from the second year, right? Not exactly. Most medical schools in the United States are structured so that the first two years are spent predominantly in lecture. The first year covers the normal physiology, anatomy, and biochemistry of the body systems and the second year delves into pathology and pathophysiology. These years are marked by long hours in class and little, if any, patient interaction. With at most a two week gap after the USMLE Step 1 exam, third year medical students are then thrown into the hospital wards to learn how to apply the basic sciences into the practice of patient care. Are these new third year medical students ready to care for patients?

The Lucian Leape Institute of the National Patient Safety Foundation says, "no." Just last week, the Lucian Leape Institute released its first of a series of reports on patient safety. The first report, titled: “Unmet Needs: Teaching Physicians to Provide Safe Patient Care,” finds that U.S. medical schools are not adequately teaching students how to provide safe patient care. Click here to read the report....

Read the full post on the IHI Open School Blog

Understanding the Incomplete Medical Diagnosis

2010-02-15T17:09:00.000-08:00

names and some details have been changed to maintain and protect privacy

If multiple sclerosis was an anatomy review item, I can just imagine Dr. Zeller pointing at the spinal cord and asking me, “Eva, what is the clinical presentation of multiple sclerosis?” After overcoming the anxiety of being “pimped,” my response would probably include symptoms such as: muscle weakness, difficulty in moving, difficulty with balance, visual problems, fatigue, and pain. Before meeting my patient volunteer, Casey, that’s how I characterized multiple sclerosis. The mental image in my head also included a wheelchair. This snapshot of multiple sclerosis is the medical mold that physicians give to their patients upon diagnosis, which I used to think was complete and scientifically correct.

After almost six months with Casey, I now understand that this sort of medical mold is incomplete. This medical mold is analogous to giving an unknowing sculptor a headless cast of Michaelangelo’s David and telling him that this represented Michaelangelo’s complete masterpiece. What was missing in the medical mold of multiple sclerosis (MS)?

What was missing was Casey...

Click here to read the full post on the IHI Open School Blog!

Being Honest: Ducking Out from Under the Table

2010-02-15T17:05:00.000-08:00

My adorable dog, May, has her flaws. Her bark and temper are infamous in our neighborhood. If the toy is not made of rubber, it will become an unrecognizable ball of mush within days. However, when it comes to going out to do her business, May almost never has accidents. On those rare occasions she has does have an accident, she hides under the dining room table instead of running to greet us when we arrive home.

We understand why these accidents happen. Analogous to most medical errors, May's accident is a systems error. These accidents only occur when we leave the house for a long period of time without allowing her to go out before we leave. May was not being negligent or purposefully filthy; the system she lives in simply does not allow her to successfully avoid these accidents...

...Medical malpractice is one of the few bipartisan goals of the current health reform battle. However, how to reform this messy process that is hard on all participants (physicians, hospitals, patients and families, and insurers) emotionally and financially is not as clear. Focusing on how to minimize costly lawsuits through caps on financial damages awarded to patients further complicates the fundamental courtesies that should occur when a mistake happens: acknowledgement, understanding, acceptance, and forgiveness...

Click here to read the full post on the IHI Open School Blog.

Too many drugs?

2010-02-03T11:52:00.000-08:00

Ever wondered about the contents in your medicine cabinet? Or the forces that got you on those prescription medications in the first place?

This NPR editorial does a great job bringing to light how Merck’s Fosamax for ostopenia, a condition deemed treatable by this drug, got into the cabinets of million women across America. And how the marketing of the pill changed the definition of bone disease and sought women to seek unnecessary treatment.

This pharmaceuticalisation phenomenon, meaning the pharma companies quest to turn every research endeavor into a blockbuster drug highlights the manipulative role of drug companies in deciding what constitutes the definition of a disease just so they can market a drug to cure it.

Set against the backdrop of the controversial evolution of ostopenia as a disease, we read about how pharma companies are vying to get the FDA to sign off on a prescription pill for jet lag! Do we really need a pill for jet lag? Or worse yet, should we let the pharmaceutical industry decide which drugs fit what therapies? With spiraling healthcare costs are we going to let pharmaceutical companies hold the reigns?

More importantly, can we draw the line between treatment, research and development for the greater good versus drugs that are downright redundant?

Practicing medicine by numbers

2010-02-03T11:48:00.000-08:00

In a system of upside down incentives – a fee-for-service payment model that results in doctors doing too much – more tests, more procedures and more treatments, left almost entirely up to a doctors “informed intuition”.

Intuition indeed is necessary in medicine, explains Jerome Groopman, in How Doctors Think, but can lead doctors astray. Numbers on the other hand can help resolve quality variation by data-driven methods.

After years of knowing the benefits of beta-blocker prescriptions, safety checklists and so called ‘evidence based practices’, what keeps doctors from doing what they know? Can we afford to rely on the variability of their good judgment and intuition? Why are quality managing practices like lean and Six Sigma facing so much resistance in the practice of healthcare?

Quite simply put, because we trust our doctors to do what is best for us. Hospitals and physicians that provide less than top-quality care are rarely punished. There is that, and how we pay for healthcare. Volume care is compensated, irrespective of the added value for patients.

In the midst of the country’s struggle to health reform (or lack thereof),this article offers a refreshing look at what can be done right. Brendt James – the champion of the ‘Intermountain way’ challenges doctors to continuously test and tweak protocols, set clinical goals, track patient outcomes and deliver quality care at low costs – offers reason for optimism.

Hiding In Plain Sight: A Lesson in Human Factors Engineering

2009-11-19T17:40:00.000-08:00

Dr. John Gosbee was our featured guest speaker this past Monday at our November Open School meeting. John is a Human Factors Engineering (HFE) and Healthcare Specialist who lectures frequently in the UM community for students and healthcare professionals and also has his own HFE healthcare consulting company with his wife. His interactive talk was an engaging introduction to a field very relevant to healthcare improvement. John gave us a brief history of HFE, including its birth as early as 1950 in the aviation field. As with the LEAN and other automotive engineering philosophies we have to wonder why it has taken so long for this insight to reach healthcare?

John’s talk challenged us to look at the poorly designed features ubiquitous in our daily lives, literally “hiding in plain sight”. I deal with poorly designed features everyday without thinking too much about them: from the frustratingly enigmatic knobs on my own stove that confuse me every time I try fry an egg, to features of my car that keep me guessing each time I attempt to use them, like how I usually pop open my trunk and gas tank at least 5 times when I attempt to open the hood of my car (even Toyota isn’t perfect!)

Although initially amusing, as John next discussed the context of healthcare, these seemingly idiosyncratic details quickly became terrifying. For instance, the design features of many IV medications and solutions commonly lead to fatal errors by nursing staff or pharmacists who misread the practically identical packages/labels.

The first exercise is pictured below- students were told to hold their breath and were handed epipens (fake ones without needles) and we were challenged to determine how to administer the drug before letting out our breath. Nearly six students were required to attempt what should be a simple task in light of the pressure of an emergency situation when an individual is going into anaphylactic shock! Personally, I misread the overwhelmingly detailed instructions and would have injected myself with epinephrine had it been a real needle...

The exercise reinforced the point that in healthcare, the more small things that build up requiring workarounds due to impractical design, the less we become able to compensate. Catastrophes result in the form of medical errors. While there are of course lessons to be learned by the engineers who design programs and tools used in healthcare to be user friendly and simple, there is a great deal of value for healthcare professionals to learn to spot these hazards. Developing an acute awareness of the design of tools utilized in the healthcare industry and an intentional mindfulness that workarounds are inefficient may alleviate further complications.

Apparently it's quite rare for a hospital or health system to employ an individual with the role of "human factors engineer" to watch out for threats posed by problematic design features. Therefore, knowing that small adjustments can lead to large, statistically significant improvements it seems crucial that we, as healthcare professionals, attempt to adopt similar mindsets.

As John explained, poor designs can be reported--for instance, the example of the insulin "pen" that he presented was one that was reported to the FDA because the numbers were reverseable depending on how the user held the pen. If US regulatory agencies receive feedback about patient safety threats it is feasible that they will be amended-at least moreso than if never reported! Relevant stakeholders are not limited to frontline caregivers; pharmacy, billing, purchasing and nursing departments all have something to gain by maintaining a critical eye to the design features of the electronic ordering systems, medical devices and other tools commonly used.

That's continuous quality improvement at its best.

A Grey's Take on To Err is Human

2009-11-09T22:49:00.000-08:00

Hi, my name is Eva and I watch Grey’s Anatomy.

I started about three years ago with the hotly anticipated Season 2 Finale and have been addicted ever since. I have tried to stop and had hoped that a change in environment (back in school and no TV) would stop this unhealthy habit. But, I have been unsuccessful. In fact, I believe I have reached a new level of addiction.

At the end of every episode I watch, I have been able to extract a lesson to justify my time spent following the lives of the characters at Seattle Grace Hospital. I tell myself that these lessons learned will help me become a better doctor…

...But, do I feel safer or sense the improvements made whenever I interact with the health care system? As this episode of Grey's Anatomy demonstrates, tangible and measurable progress is probably still not yet within our grasp.

Once we get there, this episode should be rewritten. Seattle Grace will be a shining example of the transformation of the culture of medicine. All of the characters would not be individual heroes searching for glory, but would support each other in order to deliver better care for their patients. The Chief and hospital leadership would not bury mistakes like Mrs. Becker's death, but would take the time to identify root causes of the error and fix the system. And every single person would critically evaluate and make improvements to the complex work processes of delivering health care...

Click here to read the full post!

An Economics Lesson: Local Solutions

2009-10-28T15:55:00.000-07:00

Because I now have less time to read things that don't look like textbooks and lecture notes, I've become a frequent podcast listener. Some of my favorite podcasts are This American Life, NPR's Fresh Air, IHI's podcast, and The 10th Wonder. I have about an eight minute walk to class, so a week of walking takes me through about two hour long podcasts!

After listening to two phenomenal This American Life podcasts coproduced by NPR's Planet Money team about the rising cost of health care, I've started listening to NPR's Planet Money podcast. One of the most recent NPR Planet Money podcasts is a short interview with Elinor Ostrom, the first woman to win the Nobel Prize for economics. The podcast describes her Nobel Prize winning work: qualifying the concept of The Tragedy of the Commons...

...Here's where the "IHI bells" began to ring in my head! Reforming or transforming health care probably operates on the same principle...

See the IHI Open School Blog for the full post!

Transforming Leadership: From Individual Patients to the Community

2009-10-25T22:22:00.000-07:00

...About two weeks ago, I flew out to LA to take refuge from the Michigan cold. LA was unseasonably chilly, so I didn't quite get the sun and warmth that I had hoped for, but I got something better.

I attended the annual Asian Pacific Americans Medical Student Association (APAMSA) National Conference and spent my three days in LA meeting other medical school students and listening to inspiring lectures and workshops. The majority of the sessions focused specifically on health issues in the Asian American population. These include the incidence of Hepatitis B, the large number of uninsured in the Korean American community, the incidence of lung cancer, health awareness and education, and cultural competency.

California has a very large and diverse Asian population. I visited the Monterey Park/Freemont/Arcadia area on my last day in LA and could have sworn I was abroad! Because of this large Asian population, Asian American specific health issues are very apparent in California and there have been several great stories of progress. We had the privilege of hearing from Assemblywoman Fiona Ma of the San Francisco area and Assemblymember Mike Eng of the Los Angeles area describe the great strides that California has made in making the Hepatitis B issue a city-wide awareness and screening campaign (Hep B Free). We also heard from Dr. Jimmy Hara, Community Benefit Lead Physician for Kaiser Permanente Southern California, Dr. Arthur Chen, Medical Director of Alameda Alliance, Captain Cynthia Macri, M.D., Special Assistant of Diversity to the Chief of Naval Operations in the US Navy, and Dr. Paul Song, Director of Clinical Quality Improvement for Vantage Oncology who have all expanded their medical careers to address large scale efforts and discussions on how to better deliver health care, increase access, and shape national health policy. To top off this list of inspiring speakers and the many not mentioned here, our conference closed with talks from Dr. Sammy Lee, the first Asian American to win an Olympic gold medal for the US and Dr. Eliza Lo Chin, president-elect of the American Medical Women's Association.

Since most of these speakers hailed from California and have done such admirable work in the state of California, I felt a little discouraged at first. My hometown in South Florida's greatest health issues are geriatric and centered around ensuring that our seniors are able to live quality lives and obtain the health care that they need easily. My second home in Boston has nearly achieved universal health care access through its individual mandate, but now struggles to iron out the financial details of managing and continuing this initiative. And my new home in Ann Arbor? Unemployment is everywhere. I have yet to gain a better understanding of the health issues in Michigan, but my guess is that access is one of the top five concerns. With significantly smaller Asian communities in these three locales, how am I supposed to take the inspiring and encouraging words from the APAMSA conference and transform them into action locally?....

See the IHI Open School Blog to read the full post!

Breaking News! Medical Students Shadowing Nurses

2009-09-25T07:42:00.001-07:00

I just received this message from one of our Deans of Medical Education. Even though I have my first anatomy practical today, perhaps this is a sign that despite all of that, today will be a wonderful day!

Subject: New Required Educational Experience - Nurse Shadowing in M1 Year

Date: Sep 25, 2009 9:52 am

Message:

Dear M1 Class:

This year we are offering you a new required educational experience to complete during your M1 Year. You will each spend one half-day shadowing a nurse in the UM Health System.

Today’s health care delivery system challenges all health care professionals to provide care that is patient-centered, efficient, effective, safe, and timely. To meet this challenge, collaboration among members of health care teams (including, but certainly not limited to, physician and nurses) is vital. In at attempt to educate medical students on the role of nurses in the health care team as well as to foster open communication and teamwork between health professionals, this shadowing program – created originally by medical students – was run as a pilot last academic year. We hope that you enjoy the program as much as students last year did, and take something away that you can use for the rest of your careers as physicians.

We developed the following learning outcomes for the experience:

* Knowledge of what nurses bring to a health care team
* Ability to communicate effectively with a nurse
* Respect for the knowledge and skills of nurses
* Openness to learning about patient care from nurses

We will be asking you to complete a pre and a post-assessment of this experience. The post-assessment will serve as your documentation of completion of the required experience.

Sincerely,
Casey White, Ph.D., Assistant Dean for Medical Education

Little things like this that remind me why I decided to come to Michigan for med school! Do y'all have programs like this in your schools?

My First Patient

2009-09-08T20:33:00.000-07:00

....With this dangerous streak of curiosity in me, I was surprised to find myself, 17 years later, walking with trepidation down the corridor towards the anatomy labs. The ultimate chance to learn was finally here. But, my steps had lost their usual spring (not just because my scrubs were too big) and rather than looking straight ahead, the scuff marks on the ground began to "fascinate" me. I couldn't contain myself when I thought about finally peeling away the skin to see how all of the different parts of our body worked together. Anatomy has a tangible tie to the practice of medicine, much more than sitting in a lecture hall learning about protein structure. So, what was I waiting for?...

See the IHI Open School Blog for the full post!

Teaching Patient-Centeredness

2009-08-20T20:26:00.000-07:00

See the Original Post on the IHI Open School Blog

...After just a few weeks of medical school, I'm already worrying about losing my ability to empathize with others and my future patients. During our first lecture, our professors told us that they were going to teach us the language of medicine. Will learning the language of medicine prevent me from speaking normally? Will I be as careless as my scoliosis doctor when speaking to my future patients?

Fortunately, the University of Michigan has a component of our curriculum to prevent this from happening. The program is called the Family Centered Experience. The first year medical students are grouped into pairs and each pair is assigned a patient and family managing at least one chronic disease. This could be a mother suffering from breast cancer, a father managing diabetes, or a grandfather suffering from a neurodegenerative disease. Throughout the year, we will be visiting our families and attending clinic visits with them in order to learn from the patient and their family what illness means and how it impacts the individual and family...

Patient-Centered Care in Rwanda

2009-07-29T04:05:00.000-07:00

As part of the leadership team t the IHI Open School, University of Michigan Chapter, I had the opportunity during the past academic year to learn about the provision of patient-centered care. Although I was not expecting my IHI learnings to play a large influence in my summer internship in rural Rwanda, I've been quite surprised at how useful and applicable it has been.

This summer, I've been working in Rwanda with Access Project, an NGO that supports health centers in applying business and management skills to increase access to life-saving drugs and critical health services in their communities. For the past month, I've been working in a rural health center in the village of Ruhunda. I have been supporting the Titulaire, the nurse in charge of the health center, to improve efficiency and safety in several areas around the health center. I spent the first couple of weeks establishing strong, positive relationships with the staff while I observed their services. Afterwards, I begain a discussion with the Titulaire on what he, the staff, and the community believed to be the main obstacles in the provision of care at the center.

The main recommendation that I suggested focused on decreasing wait-time and improving patient flow at the health center. There were several reasons for this. First, the Titulaire mentioned that long wait time is a main complaint brought up in community discussions. In addition, my own observations at the Center confirmed that there was basically no system in place to deal with patient flow, or a process in place to ensure patients are seen on a "first come, first served" basis. The chaotic situation was what my friend Karen calls a "low hanging fruit," or an easy opportunity to make a significant and quick impact. Also, the health center is very understaffed, and this project could potentially produce much improvement with little or no additional burden on the already strained staff. And finally, and most importantly, this project improves patient safety, as there will now be a system to deal with illnesses and emergencies in a timely and efficient manner. To emphasize the severity of the situation that I observed, I was told by staff members that there are times when patients even decide to leave the health center instead of subjecting themselves to the long wait for care. This is a huge patient safety issue!

After conducting a baseline analysis for a few days, I discussed with the Titualaire my recommendations on how to improve on the current situation: I developed a simple numbering system to ensure that patients are seen on a first come, first served basis. The system also includes easily understood symbols to guide patients to the correct waiting areas, which is critical for communities with a significant illiterate population. I provided a simple template and trained him on how to create the staff task list on a weekly basis, instead of on a daily basis. This would allow the medical staff to be notified of their tasks in advance, and therefore provide them with enough preparation time in order to start seeing patients at exactly 8:00 am, when the health center opens. And finally, I discussed with the staff the results of my baseline analysis and the new system I devised with the support of the Titulaire, and asked for their input on potential problems. After a couple tweaks here and there, I'm excited to say that I've successfully implemented the new system and that I'm in the process of collecting data on how patient wait times have improved.

I feel extremely lucky to be working with Access Project, and organization that has given me the freedom to pursue this project and has encouraged and supported my work throughout my stay in Rwanda. My Access Project colleagues have provided invaluable support in helping me develop my ideas and also train the staff meembers during the practice "run through" of the new system. And because of my work in Ruhunda, I've been asked to travel to Gashora, where Access Project is building a model health center, in order to work with HR and patient flow issues. I'm so excited about this opportunity!

With that said, you may be asking how IHI has come into play during this time. IHI has provided me with the framework on how to successfully address an issue: the Model for Improvement. Being involved with the IHI Open School Chapter this past year and completing the IHI Open School online courses has also helped me develop an eye for recognizing opportunities for improvement and has trained me to be constantly aware of issues dealing with health care quality and safety. With this experience under my belt, I'm looking forward to rejoining my fellow IHI Open School colleagues in the fall, and having some great discussions about how they've been working towards improving patient safety and care this summer.

Leadership for Results

2009-06-04T18:27:00.000-07:00

The past two days I was fortunate to attend the IHI IMPACT (Improvement/Action) Network conference in Detroit. I was recruited by the IMPACT team to create a blog for the event so that IMPACT members (and Open School chapters) who were not present could review the materials presented by the numerous speakers.

I wanted to share the blog with you. Please feel free to comment on any of the pieces-the posts are organized in order of the speakers and panels that took place.

About the IHI IMPACT Network:
The IMPACT network is central to the strategy and concept of IHI and is a vehicle to drive change. It consists of leadership such as hospital executives and senior managers who are interested to drive system change and improvement. The program holds two meetings annually and as a “spread device”, IMPACT is about coming together and sharing knowledge locally, nationally and internationally. This week's event primarily included healthcare leaders from the Michigan community, IHI faculty and directors and other hospital CEOs from around the country.

I hope you are having a wonderful summer. Rubbing elbows with Donald Berwick and the IHI faculty has definitely gotten me very excited for our Open School activities to resume in September together!

IHI Meeting Overview - 4/7/09

2009-04-11T08:25:00.000-07:00

Many thanks to those of you who were able to attend the IHI Open School meeting on Tuesday night! We received very positive feedback regarding our guest speaker and the interesting discussion that followed. Here is an article passed along to us from Dr. Talsma regarding "Why 'Quality' Care is Dangerous" : http://online.wsj.com/article/SB123914878625199185.html

For those of you who indicated that you would like to be involved with future projects, I will be passing on your names and anticipated time commitments to the folks at UMHS. I will let you know what occurs in terms of the potential negotiation process that may occur. If anyone else is interested in being involved with some hands-on projects in the fall, we are working on determining the possibilities for extra-curricular involvement. Please send me your estimated time commitment per week for next fall, skills and/or interests and I will include these with my correspondence to the IPCE project administrators.

Thank you again for your support and attendance this year. We look forward to an exciting fall semester with enhanced participation and collaboration from a variety of health professions' schools!

Amy Silverstein and the IHI OS Team

Next IHI Meeting -- 4/7 at 7:00pm

2009-04-02T12:06:00.000-07:00

GENERAL IHI MEETING
TUESDAY, APRIL 7th. ~~6:30pm~~ 7:00pm*
Location: Room 1680, School of Public Health (same room as previous meeting)

*Please note the time change -- due to a scheduling conflict we pushed the meeting forward by 30 minutes. Room 1680 is the Community/Organ Room located behind the glass doors in the lobby of the SPH I building.

Fellow IHI Colleagues,
Mark your calendars for the next IHI Meeting on Tuesday, April 7th at 7:00 PM in Room 1680 of the School of Public Health.

Our guest speaker, Dr. AkkeNeel Talsma, will be joining us from the School of Nursing for the final general meeting of the academic year. She plans to have an engaging and interactive discussion on her research and experience concerning "Failure to Rescue." As always, please forward this information widely to other health professions' students who are interested in patient safety and quality improvement in healthcare!

We hope to see you there!

- The IHI Open School team.

IHI Open School Working Meeting

2009-03-15T07:38:00.000-07:00

IHI OPEN SCHOOL WORKING MEETING

TUESDAY, MARCH 17th. 6:30pm

Location: School of Public Health, Room 2690 (this room is approximately above the Organ Room/Community Room where our last meeting was held)

Please join us next week to coordinate some exciting projects that are in the works. The focus of this meeting is to prioritize and move forward on the initiatives, and to begin to make our active presence known at the UoM. This is not intended to be a "general" meeting and will be a "working" meeting, but we hope to see everyone there!

IHI Update

2009-03-03T05:07:00.000-08:00

Hi Everyone,

We’d like to update you on some IHI Open School happenings since our meeting last month. We are pursuing several exciting opportunities for active learning, on-site shadowing, and hands-on projects, as well as working to expand and improve our chapter of IHI OS. If you want to help us pursue any of these opportunities or take a leadership role in IHI OS, please contact me. Watch out for our next meeting at the end of this month.

—The IHI OS Team

1) We have been in touch with the leaders of the Idealized Patient Care Experience (IPCE) project at UMHS. This is essentially UMHS’s translation of the IOM’s Crossing the Quality Chasm. It sounds like there are opportunities for IHI OS learning and contribution. We'll be meeting with their team in the next week to discuss the details.

http://sitemaker.umich.edu/jbilli/files/ipce-workingdocument-06-24-08.pdf

2) We talked to Lee Green, a family physician and member of the Michigan Institute for Clinical and Health Research (MICHR). Their focus is on clinical and translational research; Dr. Green’s research centers on the theory behind changing physician/practitioner behavior, basically how to re-train/teach experts. MICHR seems to be connected with everything IHI-related in and around UoM, and Dr. Green believes students can be involved at any level that interests them, from attending meetings to improvement projects to theoretical research.

http://www.michr.umich.edu/about/

3) We talked to Marion Udow, a leader in the Center for Healthcare Research and Transformation. They are currently involved in two pilot projects for teaching both patients and physicians about appropriate use of imaging w/ back pain (basically don’t do it!) and about sticking with medical therapy rather than cath/angio in patients with stable angina.

http://www.chrt.org/projects/delivery.html

4) We're still working on gaining entree into the School of Nursing to find students and/or faculty who are interested in engaging in the group. PLEASE HELP US! If you have any contacts at the nursing school or other helpful ideas, contact Jonathan: jdunford@umich.edu

5) We have created this blog for general dissemination of information, and are beginning a webpage. Stay tuned!

Chapter Meeting

2009-02-03T22:10:00.000-08:00

This evening over 25 students, faculty, and health professionals attended the inaugural general meeting of the University of Michigan chapter of IHI. We had a great turnout from a wide variety of professions, including representatives from the medical school, dental school, school of public health, law school, and business school. During the meeting, we discussed what values were most important in providing health services to patients and how to address and reduce the incidence of medical mistakes. In addition, we listened to a couple clips from Don Berwick as he introduced the group to IHI (video) and described his requirements for a surgeon who would operate on his knee (transcript). Our next meeting will be in March - details to be announced soon. Hope to see you there!

Healthcare Blogs

2009-01-07T13:31:00.000-08:00

At this evening's IHI meeting, Jonathan showed how blogging can be used as a tool to stay up-to-date with developments in the health care domain. He created a file that you can use to import these blogs into Google Reader so you can read them at your convenience: google-reader-subscriptions.xml. The list of blogs is as follows:

Health-related

Health Affairs Blog – Health policy blog that contains critiques of the Obama/McCain health plans (http://www.healthaffairs.org/blog/index.php?feed=rss2)

Health Care Industry – Explains business concepts of healthcare
(http://feeds.feedburner.com/bnet/healthcare)

Health Care Renewal – Addresses threats to health care's core values (http://hcrenewal.blogspot.com/feeds/posts/default)

Health Management Rx – Comments on health management (of course) and patient care processes of the future. (http://feeds.feedburner.com/HealthManagementRx)

Medgadget – Source of new medical innovations/inventions (http://www.medgadget.com/atom.xml)

ScienceRoll – Written by a Hungarian med student who is interested in genetics and Web 2.0 (http://feeds.feedburner.com/Scienceroll)

The Health Care Blog – Conglomeration of numerous promoters of Health 2.0 (http://www.thehealthcareblog.com/the_health_care_blog/rss.xml)

WSJ.com: Health Blog – Up-to-date information about health-related news (http://feeds.wsjonline.com/wsj/health/feed)

Not health-related

Lifehacker – Contains tips and downloads for getting things done. (http://www.lifehacker.com/index.xml)

TED Blog – A best of the best blog. Their annual conference brings together the world's most fascinating thinkers and doers, who are challenged to give the talk of their lives. (http://tedblog.typepad.com/tedblog/atom.xml)

Welcome!

2009-01-01T05:51:00.000-08:00

Welcome to the IHI blog website. We have created this as a portal for those who are interested in learning more about the IHI movement and as a newsletter for those within the group. We hope to use it often to communicate with members, promote opportunities for improvement, and solicit participation in IHI activities. If you have any questions, comments, or suggestions for the group, please contact IHI-support@umich.edu.

IHI Open School Blog - University of Michigan Chapter

Martin Luther King Jr. Day: Socioculturalism in Medicine

Morning Report: 3rd Annual Patient Safety and Quality Leadership Institute

Dealing with Culture Shock: The Aviation and Health Care Industries

News Flash!

Gut Check: University of Michigan's Medical Error Disclosure Program

Patient Centered Medical Home: An Anchor in the Ocean of Health Care?

Lunch with Dr. Dean Gruner

The Gift of Stories

Preparing for the Future

Project Fives Alive: Two Days of Energizing Inspiration

Costs of Care: Cost containment and unfinished business

Healthcare reform's unfinished business

Shooting for "Sensemaking" in Health Care

An Evening of Thanks

This is the Clinic that Will and Charlie Built...

"What Do I Need to Know for My Clerkships?": A Look at the Lucian Leape Institute Report on Medical Education

Understanding the Incomplete Medical Diagnosis

*names and some details have been changed to maintain and protect privacy*

Being Honest: Ducking Out from Under the Table

Too many drugs?

Practicing medicine by numbers

Hiding In Plain Sight: A Lesson in Human Factors Engineering

A Grey's Take on To Err is Human

An Economics Lesson: Local Solutions

Transforming Leadership: From Individual Patients to the Community

Breaking News! Medical Students Shadowing Nurses

My First Patient

Teaching Patient-Centeredness

Patient-Centered Care in Rwanda

Leadership for Results

IHI Meeting Overview - 4/7/09

Next IHI Meeting -- 4/7 at 7:00pm

IHI Open School Working Meeting

IHI Update

Chapter Meeting

Healthcare Blogs

Welcome!

names and some details have been changed to maintain and protect privacy