Patient-Centered Care in Rwanda

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

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

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

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

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

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

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!