An institute for health professionals that promotes continuous improvement in the medical field. The goal: recognize ways to analyze your surroundings, determine what needs to be changed, and be empowered enough to act on these opportunities for improvement.
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...
...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?....
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?
....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?...
...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...
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.
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!
