Dec 14, 2011

Wearing My IHI Blue Shirt Every Day

I couldn’t look away. I didn’t know what it was or where it came from, but I couldn’t look away. Was it someone’s sandwich wrapper? Perhaps it was a sheet of paper that someone was too lazy to toss? Either way, I had no choice.

I was compelled to pick a piece of dirty, white paper off the Orlando International Airport floor and throw it away.

You might be wondering why. (Or, you might not be very impressed: “Way to go, man. You picked up a piece of paper and threw it away. Do you want a medal?”) But it’s not so much that I picked it up. It’s why I picked it up.

And the reason can be summed up in five words: I’m an IHI Blue Shirt.

If you’ve ever been to an IHI National Forum, you’ve seen us. Flocks of us. We leave Boston’s Logan Airport by the dozens in early December – all of us bright-eyed, curious, and excited. We come home six days later – all of us bleary-eyed, content, and exhausted. The long hours in between are draining and intense. Sore feet, blisters, and sleep deprivation are more the rule than the exception.

Yet after my first experience in the blue polo shirts last week, it’s something I can’t wait to do again.

Let’s back up and define an IHI Blue Shirt. Technically speaking, we’re IHI staff members (mostly from our headquarters in Cambridge, MA), that come down to the National Forum and help make the 5,000-attendee event a success. More specifically, we run registration, check rooms, greet attendees, manage shuttle buses, create signs, maintain the staff office, provide first aid, dispense conference materials, communicate important updates to hotel staff, comprise the human wall during keynote sessions, and perform any other necessary job.

In short, IHI Blue Shirts exist to do one thing: Delight our National Forum attendees. Lost on your way to your session? Right this way, ma’am. Wondering what time the exhibit hall is open? It’s 11 - 2, sir. I hope you enjoy it. Think we can do something better next year? That’s a great idea. Let me share that feedback at tonight’s staff debrief. (And rest assured that we do discuss it!)

But I learned it’s more than just the simple tasks and extra assistance. It’s more than helping attendees wheel their luggage from one end of the hotel to the other. It’s more than walking more than 10 miles every day. It’s more than the 5 a.m. wakeups, countless paper cuts, and long stares at the gorgeous Florida sun (and glistening pools) through large hotel windows.

What is being an IHI Blue Shirt really all about? Simply put, it’s about going out of your way to help others. And the biggest life lesson I took away from my first week wearing an IHI Blue Shirt was that there’s no reason to ever take it off.

Even when the event ended at 5 p.m. on Wednesday, I wanted to help. I wanted to help clean up. I wanted to help people find the hotel lobby. I wanted to pick dirty pieces of paper off airport floors.

And in a moment of clarity (in between the hours of exhaustion), I realized that even though the experience lasts only one week each year, I should always “wear” my IHI Blue Shirt under my clothes. Why wouldn’t I hold doors, greet people with a smile, or point people in the right direction? Why wouldn’t I go out of my way to help others?

Come to think of it, what if we all wore our “Blue Shirts” every day? People would smile more. People would say “thank you” more. People would connect more. And maybe, just maybe, the world would be a better place.

I do, however, know one thing for sure: The floor of the Orlando International Airport would be cleaner.

- Mike Briddon, Managing Editor, IHI Open School

Nov 28, 2011

Tackling Quality Improvement Projects At Georgetown University

As the Community Manager of the IHI Open School, I have the joy of periodically visiting our Chapters to get to know them, hear about the exciting work they’re doing and, help with the challenges they face. This November, it was a pleasure to travel to Georgetown University for my first site visit.

What stood out most about the visit was the passion and energy this Chapter is putting toward its quality improvement projects.

Chapter founder, Dr. Daniel Alyeshmerni, a hospital resident, and Chapter leaders, James Cervantes and Mark Fischer, (both health systems administration students) are guiding many of the Chapter’s 70 students on eight different interprofessional projects at Georgetown University Hospital (GUH).
IHI Open School Chapter at GU working group members: Cervantes, Horak, Alyeshmerni, Fisher and O’Mally

The group, which comprises students from medicine, nursing, health administration, and pharmacy, is working on these projects that began approximately 8 months ago:

- Central Line Associated Blood Stream Infections (CLABSI)
- Inpatient Handoff Communication
- Venous Thromboembolism (VTE) Prophylaxis
- Discharge
- Inpatient-Outpatient Handoffs
- Interdisciplinary Rounds
- End-of-residency Handoff Communication
- Hand washing

Just getting started can be a challenge, but the students at Georgetown have been both resourceful and creative. One of the project teams utilized the IHI Open School’s
Mentor Matching Tool to identify mentor hospitals with similar demographics and low rates of CLABSI. After identifying New York Beth Israel and Swedish Medical Center as mentor institutions, the Georgetown team hosted regular conference calls with them to learn from what they were doing. From there, the CLABSI team went to hospital leadership, who recommended ideal units to pilot the project. And after initial success, they are now rolling these out to other units at GUH.

The eight projects are in various stages – some are just getting off the ground, others are already collecting data – but each one has the same goal: to improve care for patients in the hospital. (Note: Georgetown is serving as one of 20 test sites in the IHI Open School Quality Improvement Practicum.
Click here to learn more.)

And, I was delighted to learn, the QI projects are only one initiative within this vibrant Chapter. Faculty advisors Bernard Horak, Professor of Health Systems Administration, and Dr. Eileen Moore, Assistant Dean for Community Education and Advocacy, along with other faculty members are committed to making this improvement work real and permanent. The group is also striving to:

- Engage more students in their Chapter
- Secure funding for Chapter events and activities
- Integrate QI in curriculum

Georgetown University recognized IHI with a certificate of appreciation for their educational contributions! (From left to right: Fischer, Horak, Cervantes, Perlo, Alyeshmerni and Moore).

Thank you, IHI Open School Chapter at Georgetown, for an excellent first site visit. After a day with your group, I am absolutely inspired by our community of healthcare professionals and can’t wait for the next site visit!

- Jessica Perlo, IHI Open School Community Manager

Nov 22, 2011

The Unique Path of a Clinical Nurse Leader

There are numerous pathways to becoming a Clinical Nurse Leader. The program lends itself to a diverse group of students, as there are no restrictions on the required undergraduate degree – as long as certain prerequisites are met. That being said, I thought it might be interesting to highlight the members of the cohort with whom I’m studying at the University of New Hampshire.

They truly are amazing individuals, striving through one of the most difficult programs and periods of their lives together because they hope to make a difference in the nursing profession.

What other nursing classroom in New Hampshire could you sit in and glance to your left at a thirty-year-old mother chatting about her 2- and 4-year old children; to your right and see a middle-aged man with a military crew cut fiddling with a tape-recorder; and straight ahead at a fresh-out-of-undergraduate woman color coordinating her notes? Add another 19 students ranging in age from 22 to 42, covering fields of study from archeology, to graphic design, to acupuncture, who all realized at some point along the way they wanted to switch gears and become a nurse.

Reaching the halfway point of this accelerated program has proven to be a test in survival skills. No one individual would have been at this point if not for the one sitting next to him or her; it’s been a real team effort. Anyone in this group would vouch for a sense of cohesion that has never been experienced. We’ve become almost like a family and are not competitive with each other, but, instead, genuinely supportive. This sort of respect and encouragement is the epitome of the CNLs role: empowering one another, transferring knowledge, continually communicating and collaborating.

But unfortunately, continual judgment is passed on this group of CNLs and other programs like this, for the program offers the opportunity to receive a master’s degree in nursing without going through a previous nursing curriculum, nor earning a previous nursing degree. Some veteran nurses are shocked to hear this. Others may even be insulted.

What we hope to prove collectively is not only ourselves as capable of the challenge and worthy of the profession, but also that this track offers a priceless combination of mind power, innovation, and knowledge. If you compile a group of type-A, self-competitive, driven people and put them in an accelerated year-round program, the outcomes can be truly amazing and innovative. Generation of ideas is incredible. Professors are often struggling to get through lectures due to the amount of questions and discussions that are held.

We may not step on the floor at the end of the program with the perceived equivalent clinical experience of other masters prepared nurses, but our life experiences and academics will guide us as we continue to learn and grow throughout our careers.

- Jessica Hatch, Nursing Student, University of New Hampshire

To hear more about Jessica and the clinical nurse leader role, see her first post here.

Nov 15, 2011

IHI Open School San Antonio Chapter shines in photo campaign

This fall, the IHI Open School launched a photo campaign to promote empathy, compassion, and patient- and family-centered care. We asked students, residents, faculty, and health professionals to put themselves in the shoes of a patient for one day and take a picture.

As you can see from the colorful collage here, the response was wonderful.
One chapter, the IHI Open School San Antonio Chapter, took center stage. Turning it into a Chapter activity, the members visited a local health care facility and snapped dozens of colorful pictures.

We asked them a Chapter leader Jessica Schwartz, a health care administration student at Trinity University, a few questions about the experience:

Why did you get involved in the photo campaign?
One of our faculty advisors called my attention to this photo campaign and I’m so glad that she did! The concept of asking future healthcare professionals to stop what they’re doing and force themselves to see healthcare from a different perspective is such a valuable opportunity. This process of viewing something familiar from a different vantage point can be quite educational, but also brings us back to what’s important: patient care.

Where did you go to take the pictures?
The Center for the Intrepid in Fort Sam Houston, Texas. Recurrent images of the patient’s perspective are generally in civilian hospitals and portray something negative. We decided to show something different. San Antonio has a large military population and unprecedented capabilities to not only treat them, but bring them to a level of physical and emotional strength thought to be impossible given these injuries.

Center for the Intrepid is an outpatient rehabilitation facility for soldiers who are active duty or veterans. This nationally recognized Armed Forces Rehabilitation Center was donated by more than 600,000 Americans. It offers state-of-the-art facilities for amputees and burn victims. Members of IHI Open School San Antonio were graciously welcomed into this incredible place to capture the miracles that occur there on a daily basis. The pictures that we have submitted include their “clinical, research, and administrative space, a gait lab, a computer assisted rehabilitation environment, a pool, an indoor running track, a two-story climbing wall, and a prosthetic fabrication lab” (CFI brochure).

Who knew the patient’s perspective could be so inspiring?

What were you looking for when you took the pictures?
I tried to capture a day in the life of a patient at Center for the Intrepid. This includes rehab facilities and prosthetics of all kinds in a military setting. I hoped to relay frustration, confusion, and loss, coupled with inspiration, perseverance, and strength.

What was the best picture you took? Why?
Sorry, but I have two! No. 6 and No. 11. (Both are below.)

Picture No. 6 is a detailed aerial view of many of the physical therapy exercises with natural light shining in on the beautiful facilities. It is evident here that you really have to put in work to improve.

Picture No. 11 is a simple image, but very impactful. Two prosthetic legs are seemingly crossed and casually leaning against the table, as if they were already attached to a human being. The running shoes send a powerful message to me. These are not ordinary walking shoes; it is clear that this person was/will be a competitive runner and/or is training for a physical challenge. This describes the majority of patients who come into CFI. They have been physically and mentally strong, focused, and competitive and they will do anything to return to that elite level. Of course there are running shoes already attached to prosthetics.

What lessons did you learn from participating?
I am thankful for this opportunity to further appreciate not only the patient perspective, but also the wounded soldier perspective and road to recovery. In addition to the outstanding capabilities of this facility, I was reminded how important the patient-provider relationship is for a full recovery. Both the patient and the providers (physicians, trainers, etc.) give over 100% every day to yield the best possible result. I walked out of there with a new view of patient care and a new perspective on life.

Nov 4, 2011

IHI Announces Winner of David Calkins Memorial Scholarship

Chi Chu, a second year medical student at UMass Medical School, won this year's David Calkins Memorial Scholarship, good for a free seat at the National Forum and up to $1,000 for travel, lodging, and expenses.

Here is his winning esssay:

For years, St. Anne’s free clinic has opened every Tuesday evening to provide free medical care to communities in and around Worcester, Massachusetts. St. Anne’s is the busiest free clinic in the area, often seeing over 80 patients in one night. Frequently, searching for medications is the most time consuming step in patient care. Because medications are almost all donations, they are notoriously difficult to track, and there is little in the way of record keeping for what comes in. Thus, searching for medications that may not be in stock takes up a significant amount of time per patient, forcing them to wait and occupying a volunteer who could be caring for others.

I am working on a process improvement project to eliminate waste in the medication management process using Lean methodologies. The goal is to decrease the total time spent managing drugs by 50% in 3 months. This includes time spent logging the incoming donated medications, searching for medications, and counting medications to dispense to patients.

Currently, I am collaborating with the clinic coordinators and volunteer “regulars.” These are the people who are most familiar with the clinic’s processes, and who show other volunteers what to do when they come for the first time. Therefore, they are in a prime position to help map out current state processes and implement tests of change.

The primary outcome measures include average time spent logging donations, searching for medications, and dispensing medications. We also plan to track volunteer ratings of the ease of finding and dispensing drugs. These balancing measures will check that changes are not making the process too complicated, which is particularly important given the week-to-week turnover of most volunteers.

So far, the medications have been sorted into bins according to the class of each medication. We have also nearly finished entering the in-stock medication quantities into an electronic spreadsheet. Because the medications are shared with other local free clinics, we are collaborating with coordinators of the other clinics to keep the spreadsheet updated. This real-time inventory will help drive decisions going forward.

Our focus is on designing an efficient, robust, and sustainable process for determining if we have a certain medication, finding it, and then dispensing the correct amount. Change ideas we are considering include prepackaging commonly dispensed quantities of certain drugs (which would reduce patient waiting time and avoid recounting) and using visual management principles (to allow easier identification of drugs that need restocking). In short, we have many ideas – we now need to put them to trial. We plan to pilot small tests of change, targeting the most frequently dispensed medications according to our data. In this manner, we hope to get actionable feedback each week regarding what worked and what did not, such that we can determine how to proceed in the next week. Ultimately, we hope to instill a culture of continuous quality improvement that persists through changes in leadership, allowing St. Anne’s to provide ever better care for all future patients.

Editor's note: Click here for more on the David Calkins Memorial Scholarship.

Nov 3, 2011

Lessons from the Dana Farber Cancer Institute

I consider myself lucky. My experiences as a patient are limited and predictable. My sister, on the other hand, suffers from a combination of chronic conditions. Midnight trips to the ED due to extreme pain occur regularly – often times accompanied by needless harm.

About a week ago, my sister was admitted to the ED, doubled-over in excruciating pain. The medical staff called for a CT scan. As a nurse was administering an IV for contrast solution, my sister explained that the needle was not in a vein. Unfortunately, the nurse did not heed this plea. After administering the scan, two things happened:
1) The scan showed nothing
2) Ashlee’s arm ballooned to three-times its normal size, stiff with contrast that never made it into her veins

Despite the success stories and leaders of patient-centered care I learn about IHI, my sister’s experiences leave me in limbo – somewhere between skeptical and cynical – regarding the state of care.

This limbo changed last week.

I joined 20 IHI team members on October 27 on a site visit to the Dana Farber Cancer Institute. We had the unique opportunity to dive into the patient experience without bearing the burden of being a patient.

Aside from the familiar name, I was completely unfamiliar with what Dana Farber offers to patients. But it quickly became apparent that Dana Farber did something special. Our destination, the Yawkey Building, stood out as the new building on the block. Instead of the cold, industrial design of its neighbors, the Yawkey building welcomes with a glass facade, cut with naturally-colored, wood trim. The design feels like it could hold an art institute, and in a way, it does (more on this later).

Patients and visitors can self park or valet (for the same fee!) in the underground garage. We made our way seven stories underground – the first few stories were full and when we found open spaces, they were reserved for patients and families. Nearly 100 feet underground, it became clear what sets Dana Farber apart. Patients are afforded the luxury of valet parking to avoid the garage – a nice touch when they clearly have more important things on their minds.

Yawkey’s main lobby and information center feels open and welcoming. Art hangs on the walls and from the ceiling. Dick Tonachel, a DFCI volunteer and one of our hosts, warmly greeted us and took us to our luncheon. Dr. Benz, the President of Dana Farber, welcomed us to Dana Farber. Then, in true patient-centered fashion, the leaders of the Dana Farber Patient and Family Advisor Council took over the meeting.

PFAC consults DFCI management to improve operations. As former patients, they provide a valuable end-user perspective. We learned that their input was sought out from the beginning. Initial blueprints were changed as the PFAC explained that certain plans could be improved for the patient experience. Including this perspective is so natural, but is not the industry norm.

Our group of 20 IHIers split into small groups of 5-6 members for the tour. Anne Tonachel – our tour guide, Dick’s wife, a DFCI volunteer, and a cancer survivor – led us through the institute.

A piece of art hung just outside the luncheon room. Anne explained that the building committee placed a high value on displaying art throughout the facility. This particular piece was titled The Souper Dress – a 60’s mod-style dress printed with a series of Campbell’s soup cans – an Andy Warhol original. The piece was donated to DFCI and is proudly displayed. We saw more art throughout our tour, some which was created by patients. It is all approved by a patient-filled committee.

(Starting with a Warhol was incredibly fitting. His fascination with Campbell’s Soup revolved around how egalitarian the soup was. The President of the United States and a minimum wage worker have the same Campbell’s experience. I think this sends a great message for the aspirations of our healthcare system.)

We continued on to the patient examination rooms. Anne pointed out that there were no cracks or seams in the room. The counter tops were one, continuous material. The examination table had no sections held together with seams. Places for germs to hide were minimized. Anne then pointed out the floor. No one noticed it at first. Instead of the standard, monochromatic tile, this tile included two perpendicular columns of color. Studies show that nauseous patients have an easier time when a simple floor pattern gives their eyes something to focus on.

This is when it hit me. DFCI pays incredible attention to detail. If there is something that can make the patient experience slightly easier, it is implemented. These small details add up to an experience that may be unmatched in health care. To drive this point home, Anne showed how every examination table in the building is stocked with the exact same items, in the exact same places, so a medic can handle an emergency on any floor.

The building team sought the eco-friendly Silver LEED certification. Aside from using as many renewable materials as possible, outdoor gardens collect rain water which helps minimize the energy consumption of the air conditioning system. DFCI thought of everything – and received Gold LEED certification.

Our final stop was a two story, indoor healing garden. Fresh plants are rotated monthly. Soft music plays. No food, drinks, or electronics are allowed. The calm of the room is soothing, giving patients a great place to reflect and mentally heal.

Going into this site visit, my mind was preoccupied with the upsetting patient story of my sister. But knowing how bad things can get and then seeing how incredible things can be had a profound impact on my spirit. It was a delight to see the Dana Farber Cancer Institute at work. We can all hope that this level of intentional quality will spread throughout our entire system.

- Alex Anderson, Executive Assistant at IHI

Oct 31, 2011

New Course Provides Refreshing Perspective on Care Delivery

Health care consumes one dollar out of every seven in the US economy, but it remains disappointing in terms of availability and quality of care. It is no surprise that it is central in media coverage and political debate.

Despite all the attention, little headway is made because of a powerful but false assumption: That whatever good is gained must be traded off for something else in return. The reasoning goes that more or better care must be more expensive, so we must chose between getting more or saving money. In other words, we cannot get more, but pay less.

This premise – and the resulting conclusions – is mistaken. In fact, it is possible to provide better care to more people at less per unit and total cost. Accomplishing this requires applying a more sophisticated approach to managing the delivery of care.

The newest course in the IHI Open School, “Achieving Breakthrough Quality, Access, and Affordability,” demonstrates how this more dependable, reliable approach works. By the completion of the course, students will come to understand that:

· The delivery of care is a far more complex undertaking than in years past because the contributions of many more people – spanning many more specialties and disciplines –have to be coordinated and integrated.

· The complexity of systems creates vulnerabilities that weren’t significant in simpler systems. Given the number of contributors involved and the strong interdependencies among their work, small aberrations – that might have had minimal effect – can gel to cause major harm.

· Certain behaviors, if avoided, and other behaviors, if embraced, both protect against these failures and also contribute to success.

As a result of these lessons, the best of both worlds is enjoyed: The full benefit of complexity is appreciated, diagnoses and treatments incorporate what is best known across multiple disciplines, AND the systems that harness all these contributions are reliable and responsive.

- The course is authored by Steven Spear, DBA, MS, MS, Senior Lecturer at the MIT Sloan School of Management, Senior Fellow at the Institute for Healthcare Improvement, and author of a number of influential articles on operational excellence in general and healthcare excellence, and author of the award winning book, The High Velocity Edge.

Oct 3, 2011

Wednesday is "One Day in the Life of a Patient"

The IHI Open School's photo campaign, "One Day in the Life of a Patient," is taking place this Wednesday, October 5.

All over the country -- and all over the world -- students and health care providers will pause and put themselves in a patient's shoes. The reason? To see the patient experience through a new set of eyes.

Many of the photos will be posted on the IHI Open School website and others will be used as part of a larger collage at IHI’s National Forum in Orlando in December.

In three easy steps:
1. Take a picture depicting the patient experience on October 5.
2. Write an email that includes your city/state/country and the time of day at which you took the photo.
3. Send the email to

Here's a video -- filled with pictures from the IHI staff -- to inspire you:

Sep 19, 2011

17 Days Until "One Day in the Life of a Patient"

Get your cameras ready for Wednesday, October 5!

This fall, to kick off the school year, the IHI Open School is launching a photo campaign to promote empathy, compassion, and patient- and family-centered care. Simply put, we want you to put yourself in the shoes of a patient for one day – Wednesday, October 5 – and take a picture. The images, which we hope to collect from around the world, can be sad, happy, funny, gross, ironic, silly, serious, or inspiring.

Many of the photos will be posted on the IHI Open School website and others will be used as part of a larger collage at IHI’s National Forum in Orlando in December.

In three easy steps:

1. Take a picture depicting the patient experience on October 5.

2. Write an email that includes your city/state/country and the time of day at which you took the photo.

3. Send the email to

To help get you in the spirit, we'll feature a new photo each day on our blog. Here is today's:

3:43 p.m. in Cambridge, MA, USA

Sep 12, 2011

Chapter Corner: Three Questions to Consider When Planning Quality Improvement Projects

Quality improvement projects benefit both students and organizations in a number of ways. Students have the opportunity to network and develop their improvement skills. Organizations, meanwhile, have the opportunity to meet enthusiastic students dedicated to improving healthcare, develop fresh ideas with student contributions, and guide and mentor the next generation of health professionals.

We just had our fall information session last week, and students have begun sending in their project applications. This is the first year the Atlanta chapter of the IHI Open School has embarked on establishing quality improvement opportunities for students.

Our goal is for students to gain real-world experience by participating in improvement projects, whether it is a snapshot or the various phases of a project. In addition to skills in quality improvement, some of these projects will also allow students to develop skills in patient safety, teamwork, leadership and patient-centered care.

Finding projects
Our group focused heavily on recruitment to gauge student project interest while simultaneously searching for project opportunities at various organizations. We wanted to ensure that there would be enough student interest to participate, but also wanted to ensure that project opportunities existed for student volunteers. I used contacts from informational interviews, previous internships, and professors to ask if their organizations might be interested in having students volunteer their time to quality improvement projects. If these contacts expressed interest, we then discussed the potential projects over a phone call.

Here are a few of the questions we kept in mind during the project planning process:

1. How can we develop and maintain good relationships with participating organizations?
If we maintain good relationships with these organizations, we might find additional project opportunities in the future within and outside of the organization. To maintain these relationships, we plan on touching base with project supervisors every so often throughout the project. And since this is our first year, we have limited the number of IHI Open School projects so we can focus on successful completion of these few projects.

2. What if we get a smaller applicant pool than we expect?
We wanted enough student interest so that each project would be able to find a number of students from various disciplines that would be a good fit for the organization. We emailed faculty/department advisors and our student government association to forward on our IHI Open School information to students. And since medical students are difficult to recruit due to their incredibly busy schedules, we contacted dual degree MD/MPH students that are in their MPH year, where the schedule is more flexible. Our final applicant pool is still yet to be seen.

3. How can we encourage students to share experience and knowledge with other students? While we want students to develop various skills, we also want them to share their project work and knowledge with other fellow students. We hope that this will create a culture of teaching others, developing leaders, and building relationships. We'll be setting up Open School meetings for students to share what they've learned.

It will be interesting to see how these projects progress over the course of the year. If anyone has any comments or suggestions, we would love to hear them!

- Becky Ng, Public Health student, Emory University

Sep 7, 2011

2011 Costs of Care Essay Contest

Do you have a story about a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a medical test or treatment might cost? How about a time you figured out a way to save money while still delivering high-value care?

As part of our second annual essay contest, Costs of Care, a nonprofit group based in Boston, is offering $4000 in prizes for anecdotes like these that illustrate the importance of cost-awareness in medicine. Judges will include former White House Budget Director Peter Orzsag, former United States Surgeon General C. Everett Koop, Governor Jennifer Granholm, women’s health and cancer research advocate Dr. Susan Love, and Harvard University Provost Dr. Alan Garber.

The mission of Costs of Care is to expand the national discourse on the role of care providers in controlling healthcare costs. The stories we receive as part of our second annual essay contest will provide everyday examples from across the nation that illustrate the power patients and care providers have to curb costs at a grassroots level.

Submissions should be no longer than 750 words and are due by November 15th. More details are available at Email submissions to

You can also read about our winning essays from last year here.

Aug 29, 2011

University of Minnesota Strives to Improve QI in Public Health

Quality improvement (QI) in public health is still not well defined, as there is often confusion about how the tools, techniques, and methodologies fit together.

Just a few of the challenges:
  • Specific programs, such as emergency preparedness, are more likely to utilize QI methods than others.
  • The IHI QI models are transferrable to the public health sector, but the governmental nature of public health departments are not typically found in other organizations, and can be an added challenge.
  • The National Board of Public Health Examiners, the Public Health Accreditation Board, and the Council on Education for Public Health have voiced concerns about the need to provide more educational opportunities in performance improvement to working public health professionals.

Despite these obstacles, QI strategies will play a vital role in improving outcomes, especially as demands on the U.S. public health system continue to increase. In an effort to address these concerns, the University of Minnesota's School of Public Health is launching its certificate program for public health performance improvement.

The program, which is launching this fall, is designed to prepare public health professionals for successful leadership and implementation of quality improvement initiatives within their respective organizations. To become certified, a student must earn a minimum of 12 credits during five terms, which can be taken in person or online. Students will have the opportunity to apply their knowledge by leading an improvement team within their organization.

It's my hope that other universities across the country will also take steps to create quality and performance improvement certifications and concentrations to give students and working professionals the skills to implement successful improvement initiatives.
For more information on Minnesota's certificate, view this PDF:

Or visit the official website:

- Becky Ng, Public Health student, Emory University

    Aug 23, 2011

    From the Vineyard to the Bedside: A Clinical Nurse Leader's Journey

    Clinical Nurse Leader is the first professional designation added to the American Nurses Association in the last 35 years. So, what is it?

    In an effort to begin blogging about becoming a Clinical Nurse Leader (CNL), I should first share a tidbit about who I am. My name is Jessica Hatch. I am 24 years old, and I am not yet a CNL but on the progressive pathway toward this exciting designation.

    Upon graduating from the University of New Hampshire - having obtained a B.S. in Nutritional Sciences with a minor in Healthcare Management and Policy - I dabbled for a number of years in viticulture and enology (aka grape growing and winemaking) in New England. Since the owner of the winery is a retired ER physician, his wife is a visiting nurse, and I was a student of nutrition, none of us had strayed too far from our respective health care fields. (What occurs in the wine cellar is biochemistry at its best; we had just extended our scientific knowledge into another interesting area of study.) As much as I enjoyed the wine world, I realized my true passion was to work with patients and that winemaking would instead become a hobby.

    Nursing was always in the back of my mind, but I had never committed to the idea. Then I came across the Direct Entry Masters Program at UNH, which allows students of all undergraduate fields to become a Registered Nurse, and earn their CNL certification, in just two (very accelerated) years. The role was new to me, having only heard of it from an acquaintance studying in the program. But as I learned about the program, it was clear I could finally combine many aspects of my diverse educational background while growing into a prominent and needed leadership position as a nurse.

    The hope is that, collectively, CNLs can guide all other professions to alter the path our stubborn healthcare system continues to follow. The role of the CNL is not to put innovative ideas that have never been considered into play, but instead to place a higher value on the key patient-care components that are often overlooked. A re-evaluation of pre-existing ideas that date back to Florence Nightingale and assigning more appropriate value to these ideas is a reoccurring theme throughout the literature that demands one thing: viewing the patient as a whole.

    This will be accomplished through a redesigning of the system, incorporating the expertise of all disciplines to form a strong collaborative team that the CNL will guide. From pharmacists to school systems, social workers to surgeons, the CNL will empower all members of the team to transfer knowledge, constructively debate, collectively plan, and deliver care representative of the patient's values and goals. The hope is that ideal patient care is delivered.

    It is important to note that the CNL works with other nurses, including Clinical Nurse Specialists, reports to the same nurse manager, involves all other disciplines to coordinate care, but at the same time, takes a leadership role.

    This is what sets the CNL apart.

    Through a strategically designed education and practice curriculum, the CNL is well prepared upon graduation to assume this role. (I believe a few years of work experience are also necessary.) Other staff members have been spread so thin that the CNL will be able to oversee direct patient-care, which should be the main concern. Still, the CNL will be sure to delegate appropriately and distribute equal loads across the partnership so there truly is a team effort in working with the patient. This is key to the success of the CNL, as it is clear other disciplines have become worn out due to overload. Furthermore, the CNL will reduce fragmented care, which results in errors - system errors, not staff errors.

    I hope my introduction was interesting and helpful. In future posts, I will begin to shed more light on the role of the Clinical Nurse Leader. Stories from students, examples of practicing CNLs, and much more is on the way.

    In the meantime, feel free to share your comments and questions!

    - Jessica Hatch, Nursing Student, University of New Hampshire

    Aug 15, 2011

    Why I'm Becoming a Doctor

    "Son, I shot her in the face."

    Most people probably can't pinpoint the moment they chose their career. I can, though. It was the moment - in a quiet, sunny courtyard on a July - that I heard an old man utter those seven words to me. He probably didn't realize it, but it changed my life forever.

    Let me start at the beginning.

    My personal statement for my American Medical College Application Service (AMCAS) application was adequate. It talked about passion for medical school in three dimensions - academics, research, and service. I had a nice story about a personal experience with mental illness in my family, examples of my dedication to service work in the community free clinic, and a short but detailed description of my basic science research in neurosciences. All in all, I think it was pretty good. And more importantly, it served its purpose!

    But not much of that was the real reason I was coming to medical school. I had the experiences that truly defined my interest in the profession, but I was too young to understand their impact on me. I now realize that the real reason I am studying/pursuing a career in medicine is because patients are people. How did I come to this realization?

    The summer before my junior year in college, I had the opportunity to work as a Patient Safety Aide (PSA) in a local hospital. For those of you who don't know, a PSA is wonderful thing. We exist to serve. Our technical description is essentially to replace restraints. My unit was filled with rather sick geriatric patients, and as you may know, they sometimes get confused and try to get out of bed, take out their IVs, and generally cause a fuss. Instead of using restraints, the hospital put aspiring students in various units to move from bed to bed, check on patients, keep them company, and occasionally play some games with them. I also spent a lot of my time with the nurses, and I really was eager to help (when I wasn't reading novels, anyway - I think that was a Harry Potter summer for me). I would help clean up rooms, get things that nurses needed, and I wasn't really aware of much going on around me. You may think that I really got to connect with the patients, because I was spending so much time with them, but this is entirely untrue. Unfortunately, most of the patients weren't too communicative, and many of them were rather confused about where they were.

    All in all, it was a very pleasant atmosphere and a nice summer. But it didn't particularly make me want to go into medicine. Actually, what I saw was pretty discouraging. Patients looked like bags of meat with all kinds of tubes sticking in them. Really, that's what I saw - near lifeless sacks of flesh that seemed to be entities of suffering far more than of living.

    One sunny, July day, I engaged myself in one of our additional duties. Some thoughtful clinician had realized that patients don't really like to be cooped up in their rooms all day. I gathered the patient up into a wheelchair to take them outside.

    It was a gorgeous day outside, the kind of sunny day that just feels great in scrubs that you've only been in for a couple of hours. I wheeled the patient to the garden and breathed in deeply, enjoying the flowers and bathing in the relaxation of the moment. It was just me and this garden, and it was rather peaceful. "This was a pretty good summer," I thought. "This'll look great on my med school app and I can probably write about some meaningful experience I basically make up about how I saw a doctor really connect with a patient and ... what was that noise?"

    The patient had started talking. It wasn't too clear, and I had to walk around in front of the wheelchair and kneel down. I got a better look at him. He looked like he was 80, beaten badly from the inside out, with the bruises showing through his skin, but I knew he was in his early 60s. And he was talking to me.

    "Sir? I can't really understand you."

    A little coughing. The coughing had actually gotten quite a bit better, it seemed like.

    "I was in the war."

    "Sir? The war?"

    "I was about your age. I was with my boys ... a little girl was walking up to us. It was disgusting there. She was maybe 6 years old. She was pretty. So pretty. Beautiful face. Adorable. She was one of them, wearing rags and looking tired and confused, but she was a beautiful little girl."

    "Sir? A girl?"

    What was this guy going on about? Maybe I should be worried - maybe he is becoming delirious or something. Maybe this is why they have me here, for when this happens and he starts to think he is back in the war, what if he tries to stand up and fight me or something. He probably thinks I'm the enemy!

    "Son, I shot her in the face."

    "... Excuse me?"

    "She was carrying a grenade. They had sent her to us with a live grenade. I shot her in the face to save my men. She was so beautiful ... "

    That is when it happened. Patients became people. That was the moment, crystal clear in front of my eyes to this day and forever. This man looked like hell and lived with incredible amounts of suffering, but he did not live the life I saw. He lived a life of profound regret for that one moment in his life that happened when he was as old as I was. He possessed a profound clarity despite the chocking fog of his illness, and he was not delirious or demented. And he was a person.

    I think I told that story in an interview at my medical school, with a student. I don't know why I started to tell it, because I really didn't think it was a good story to tell at an interview. I told that story, and I barely understood it or its impact on me. Three years later, with some more maturity and a bit more experience with patients, the meaning of that story is only beginning to set in. Those suffering patients in that hospital were not sickened, lifeless, unanimated meat. They were human beings in the most deep and spiritual sense of the word, and they lived those ultimately human experiences. Love. Pain. Regret. The question of whether or not they did the right thing.

    I would be lucky to be that human, ever. And that is the real reason why I want to be a doctor. Because patients are people.

    - Lakshman Swamy, MD/MBA Candidate, 2013, Boonshoft School of Medicine at Wright State University

    Aug 5, 2011

    Chapter Corner: The Importance of Sharing Knowledge

    By itself, content is limiting. While the information from a book is useful, there is no incentive or opportunity to offer an opinion and receive a response. It is simply a one-way flow of information. It's the people we meet and speak to that hold the real knowledge. As social creatures, others' work and life experiences will resonate more with us when we ask questions and have the opportunity to respond directly, whether it is in person or through email. I know all of these things because I learned them firsthand.

    I asked a colleague of mine if they knew anyone working with process improvement in healthcare, and they put me in contact with two professors at Emory University's School of Medicine. From these connections, I was put in touch with a director at a nearby hospital's center for clinical performance improvement, as well as the Chief Quality Officers at two other hospitals. I've learned a tremendous amount from my conversations with them.

    My conversations with these people were the true driving force that sparked my interest in quality improvement in healthcare, and I try to drop a line to say "hi" every few weeks or months. I'm even working with the director at the clinical performance improvement center to establish a quality improvement project for the Atlanta IHI Open School students. It's experiences like these where I find value in establishing new relationships, especially with those so willing to give back to students.

    Here are some other ideas on sharing knowledge:

    • Take advantage of others' knowledge by talking to fellow students, teachers, leaders - anyone you can make time for (and can make time for you).
    • Search on LinkedIn for professionals in the area who are involved in healthcare improvement (after all, wasn't LinkedIn made for networking?).
    • Email leaders from other schools in your region, or across the country. See what others are doing and network to share ideas.
    • Read the "Chapter Accomplishments" on the IHI Open School website and find ideas that interest you and your group.
    • Contact schools to learn more about their methodologies and challenges to accomplishing their goals. (It's been my group's experience that IHI Open School chapter leaders are extremely receptive to sharing ideas.)
    • Talk to others to share knowledge and to generate opportunities. People generally love to talk about themselves, and would be more than happy to meet or speak about their experiences (probably more willing to do so than you might think).
    • Talk to professors and coworkers, and ask them about what they do and how they got there. Ask if they know others in quality or process improvement, and see if you could set up a time to chat with them for 15 minutes. This could lead to new partnerships with your chapter, quality improvement projects, mentorships, additional IHI Open School exposure, among other advantages. Once you've developed those relationships, maintain them by following up throughout the year.

    I reached out to one of my public health professors to ask about her work in quality improvement and told her about my involvement with the IHI Open School. After some meetings and phone calls, we eventually established two quality and process improvement team projects for IHI students to be involved in, and we hope to find the right students to make these initiatives a success! It's my hope that I'll be able to give back the same way that these professionals did for me.

    I've found it invaluable to have these discussions with others, and I encourage other chapters to do the same. It sounds simple, but it can be tough work to find and maintain these relationships. We will always have something new to learn from each other.

    - Becky Ng, Public Health student, Emory University

    Aug 2, 2011

    Another Health Care Workshop? Five Reasons Why SQLA is Worth Experiencing

    It's been almost six weeks since I left the IHI Open School Student Quality Leadership Academy (SQLA). Admittedly, I volunteered to put together a blog post weeks ago, but my hectic schedule as an outgoing student (classes, work, research projects, job interviews, networking, and summer visitors) kept stealing my attention.

    As an emerging health professional, I have availed myself of numerous free networking events and educational seminars (and food). Eventually, after attending so many that fixated on the need for change in health care, I became jaded about how much these events actually contribute to inspiring innovation. But when I heard of SQLA, knowing IHI's great reputation for visionary leadership in health care improvement, I couldn't shake the feeling that this program was going to be different from the rest. Since attending, I have felt inspired to share my experiences with prospective attendees and, in the process, encourage you to apply for next year's Academy.

    Upon reflecting on the lectures and activities from the SQLA weekend, there are five reasons why I would recommend taking part in SQLA to all students in any field of health care (I personally am a clinical social worker and MPH candidate in Health Policy & Management):

    1. Exposure to Diverse Perspectives: At our table alone, we had two international students, a nursing undergraduate, a physician, several advanced med students, a Masters-level nurse, and a public health social worker (yours truly), representing great diversity in geography, race/ethnicity, age, and education. Each member contributed thoughtful examples and insight from his or her actual experiences, covering an even broader spectrum of sub-specializations (mine is behavioral health). This rich confluence of experiences was very enlightening, introducing me to the perspectives of professionals in other health care areas with whom I have literally never interacted, and may not have for much longer if not for SQLA. For too long there has been an unfortunate dearth of cross-disciplinary collaboration among our segregated health schools, and SQLA breaks down these barriers.

    2. Unbeatable Expertise: All of the weekend's presenters were seasoned veterans of health care leadership and innovation. Each one holds or has held very senior positions in national policy advising and/or academic medical centers. This year's presenters were predominantly current or past leaders from Beth Israel Deaconess Medical Center in Boston - one of the most respected, innovative health care organizations in New England. The only one without at least 20 years of professional health care experience was Dr. John Halamka, who is merely the youngest chief officer in the history of BIDC, had served as a key health information technology (HIT) advisor to the Obama Administration, and was recently contracted by Japan to assist development of a new HIT system across their Northern region following this year's devastating earthquake and tsunami. To say his knowledge and perspective are expansive is a serious understatement, and each presenter was of equally strong caliber.

    3. Gaining Essential Management Skills: Take a walk in the woods to build rapport with your opponents and identify shared values. Use interest-based negotiation methods to manage and overcome conflicts. Implement "double-loop learning" to learn from and prevent future conflict situations. Carefully choose when to identify people instead of numbers when quantifying problems. Learn how leadership vision and operations management can foster an environment that minimizes conflict. The "Transition Curve" framework offers a method for managers to conceptualize and facilitate change processes with minimal staff resistance. Before embarking on a difficult conversation, ask those involved about their understanding of a situation, and let this guide your approach and language. These are just several of many examples to evidence that SQLA actually covers concrete management techniques that any of us can apply to improve our team's performance, morale, and ability to adopt innovations.

    4. Assessing Personal Strengths and Needs: Through exposure to new management concepts, personal anecdotes from presenters, and group and individual exercises, the weekend at the Leadership Academy gave me the time and tools I needed to identify where I may struggle and succeed as a new manager in the health care industry. This self-understanding will be handy for upcoming job interviews, and also in identifying positions where I'm most likely to succeed.

    5. Having Fun! Of course, after days full of challenging sessions, self-evaluation, and passionate presentations on health innovation, we were able to unwind. Harvard Square (and the rest of nearby downtown Boston!) offers a plentiful assortment of interesting activities and quality spots to pass the time with good people and entertainment. This year featured a public dance party in front of Cambridge City Hall, which closed down the largest roadway through town and featured thousands of locals partaking in a good old fashioned outdoor celebration. After three years in the same social and professional circles, networking, story-swapping, and joke-telling with 100 new, equally passionate students was rejuvenating. The city offers an eventful, lively locale for this gathering, which is pivotal because our work, no matter how valuable or urgent, cannot become our entire life. So once the lessons have been learned, there is much-deserved time to get out and play! So come early, stay late, and enjoy the marvelous landscape, history, culture and nightlife of Boston. Good things should come to those who wait (and bravely work on the daunting challenge of health care improvement)!

    - Sandy Cohen, MSW, Boston University School of Public Health

    Jul 21, 2011

    Chapter Corner: Happy Hour in Atlanta!

    This is the newest installment in a series of posts written by chapter leaders and members. The goal, simply, is to share best practices and creative ideas with other chapters around the globe.

    I love happy hours. But I love them even more when they are an excuse to spread the word about the IHI Open School.

    My group, the Atlanta IHI Open School Chapter, is made up of students from Emory University and the Georgia Institute of Technology. We kicked off recruitment for 2011 on July 7th with an IHI Open School information session. We followed this up with a happy hour the following Saturday.

    Why did we do a happy hour? We think social events like these build solidarity between group members from different schools. These are opportunities for our current and prospective members to meet other students outside of our particular programs. Events like the happy hour will help develop friendships and create an added incentive to participate in IHI Open School activities throughout the school year. We had a turnout of about 10 at our happy hour session, despite the pouring rain. The vice president of Health Students Taking Action Together (HealthSTAT) was also in attendance, and she and our president have discussed plans of co-sponsoring events throughout the year.

    Even better, our summer information session turnout was great with over 20 attendees, including a handful of healthcare professionals. At our meeting we included snacks and distributed a fact sheet that summarized the IHI Open School, our goals for the year, and proposed upcoming events.

    Here are three questions - and answers - we think might be helpful for other Chapters:

    What did we include in our information session agenda?
    1. A Denver Health patient safety video
    2. Introductions around the room
    3. Small groups to briefly share any personal stories of patient harm or unjust culture
    4. A short presentation made by our chapter president describing what IHI is, the Open School, and what we've done so far
    5. An overview of what we have planned for the year, including:
    - Monthly "lunch and learns"
    - IHI modules to be integrated into school curriculum
    - Upcoming quality improvement projects
    6. Don Berwick's Introduction to Open School video
    7. A survey asking about interest in events and involvement

    Why start recruitment in the summer?
    We want students to start thinking about the IHI Open School and talk to their friends about it. We feel the interest-we just have to get the word out! We also want students to start preparing for any quality projects they might be interested in by taking the IHI quality modules as early as possible to prepare.

    How did we advertise our event?
    We asked our schools and departments to forward our event email and flyer to the current and incoming class, as well as posted flyers around schools. We also emailed any connections we had with faculty and professionals to pass on the word to any interested individuals.

    We're trying to foster a supportive environment where we can build relationships and share ideas. Social events like the happy hour can help facilitate this, in addition to our group meetings and learning events. What are your thoughts?

    - Becky Ng, Public Health student, Emory University

    Jul 11, 2011

    Chapter Corner: Five Rules of (Student) Engagement

    This is the first in a new series of posts written by chapter leaders. The goal, simply, is to share best practices and creative ideas with other chapters around the globe.

    One of the biggest challenges that we face as a group at UMass (in Worcester, MA) is encouraging people to come to our events and classes. The topics and the speakers may be fantastic, but the audience consists of only about 10 students. It is difficult to engage students in anything outside of the board exams even if the material will be important in their careers. We worked hard to increase student interest and attendance at events this past year. Things did not always work out for us, but the following are some of the strategies that we used to bring students in:

    1. Make it personal for the students. Take a story that will really hit home and organize a speaker or a class around that one story. For example, we had a death at UMass Medical Center on the telemetry floor. The story was all over the local news broadcasts and many students were discussing the case, especially saying that they were embarrassed to represent UMass. We took a different spin and invited the physician who was working to solve the problem to come and speak. He talked about what UMass was doing to prevent future incidents of alert fatigue and really excited the students to get involved in solving the problems instead of gossiping about them.

    2. Early preparation is critical! We had one event that had great speakers and a really interesting topic, but we had the worst luck getting a room. The day before the event a room finally opens up, and we emailed out to all of the students with the room assignment. The morning of the event room reservations calls us and switches the room. So we email again saying, "Last minute room change!!" Later that day, mere hours before our event, we get switched to yet another room. So we send out another room change email, but at this point, it is just about time to get started. In the end, we had fewer than 10 students in attendance. Lesson learned? Get all your ducks in a line quickly and early so you can accurately advertise long before the event.

    3. Get creative with your advertising. This example doesn't come from our IHI Chapter, but one of the global health groups on campus sponsored an HIV/AIDS awareness event. To advertise, they gave out small goodie bags in class. These contained two condoms and enough M+M candies to represent a day's worth of antiretroviral medications. They also included a short written piece with some facts about HIV and an invitation to their event. Even if people didn't attend the event, they were exposed to the problem and the ideas they were promoting.

    4. Bring in the big guns! Include professors and administrators in the planning, and definitely send them an invitation. It adds legitimacy to events that you are organizing. We ran a panel event on interprofessional communication, and we had the dean of the school of nursing in attendance. She really encouraged nursing students to attend. We had great turnout from the school of nursing, especially relative to medical and graduate students.

    5. Schedule informal events around your class breaks. We started a series of "lunch and learn" events during the lunch breaks in our class schedules. These were short events, usually about 45 minutes, where students would pack a lunch and we would lead a discussion of a case study or recent article. The Open School web resources are fantastic for this sort of forum and attendance was good because people were sitting around campus anyways.

    These were some of the strategies that really helped us this year, but we still have a long way to go in engaging students in QI and patient safety. Sadly free food tends to be the best motivator, and we just don't have the budget to feed hungry grad students with every event.

    What have other people done at their chapters?

    - Aubrey Samost, medical student, University of Massachusetts

    Jun 30, 2011

    Lessons Learned from the IHI Open School Student Leadership Academy

    On June 24 and 25, many healthcare students and professionals converged on Harvard Square in Cambridge, MA, for a two-day forum on leadership. I think I speak for more than just myself when I say the weekend was fantastic -- both highly entertaining and educational. Our moderator for the weekend was Dr. James Reinertsen, the former CEO of CareGroup and current president of The Reinertsen Group. Over the two busy days of the conference, somehow his energy never flagged, and he was able to keep us energized and engaged. At the end of the weekend, Dr. Reinertsen left us with a parting message on life-long learning and how there are three equally important components of it:
    1. The continuous acquisition of knowledge

    2. Personal experiences

    3. Reflection on the first two parts

    So, just for you Dr. Reinertsen, these are my reflections on the incredible amount that I learned and the wonderful experience I had during those two days in Harvard Square:

    The easiest, but perhaps most complicated place to start is to ask, "What did I learn?" Through didactic sessions, I learned conflict management (I wasn't surprised to find that I'm an avoider) and how to take a walk in the woods (a negotiation technique, actually). Through the lectures and anecdotes from the invited speakers, I learned about how to lead through a crisis (like a massive computer system crash), how to lead without authority, and the benefit of a fancy job title. Through exercises, I learned how to effectively have awkward conversations (like dumping a guy or firing an employee) and how to assess the safety of a patient care unit by observing its teamwork. All of these skills I anticipate using throughout my career and life.

    While the lectures were useful and enlightening, I would be greatly remiss if I didn't discuss everything I learned from the other participants, the other students. We were assigned seating right from the start to force us to meet people we might not have interacted with otherwise. I ended up sitting with one other medical student, a psychology student, two nursing students, and three healthcare administration students. This medley of backgrounds and people's unique experiences made the discussion very lively. It was eye-opening to hear everyone's perspective on a problem because they could be so different from my own. Looking back, it makes me really appreciate a drawing that Dr. Barry Dorn (one of the speakers) made of a cone in a box which highlighted an important lesson: Where you are looking from greatly influences what you see.

    Needless to say, I learned a lot this past weekend, both from the speakers and from my peers. The lessons I learned are not found in textbooks or medical school lectures even though they are critical to our future work. I am extremely grateful that I had the opportunity to attend the Leadership Academy. The knowledge and experiences that I gained are definitely going to stick with me as I continue on my path toward becoming a physician.

    - Aubrey Samost, University of Massachusetts

    May 22, 2011

    Patient Safety in Iraq

    I recently visited the Iraqi region of Kurdistan, both working with the International Federation of Medical Students' Association and arranging an interprofessional patient safety symposium for nursing- and medical students.

    Iraqi Kurdistan is the northern region of Iraq with borders to Syria, Iran and Turkey. Given everything you hear in the media about Iraq and the war, I wasn't to sure what to expect, but what I did experience was a beautiful scenery, peaceful and friendly people and a well-functioning society.

    The region has several nursing and medical schools, all fairly new and with a very international approach. The regional Minister of Health (a doctor) have been wanting to focus more on patient-doctor communication as well as patient safety, and it was on his request that we prepared the symposium covering these two topics. It was held on the afternoon on the 24th of April at the Ministry of Health.

    We were not quite sure what issues the health professionals and students there had, so we started by asking some questions, and a lot of issues were raised. E.g: It is common to have consultations with up to 10 patients with the similar condition at the same time, not allowing much time to talk to the individual patient, hand hygiene, lack of guidelines, and a lack of educational resources, access to journals and evidence etc.

    Based on this we chose to focus on practical tools, that the participants could use there and then, and that is one of the beauties of the IHI Open School courses. We took them through Patient Safety 101, and also introduced the "Check a Box-Save a life" campaign, and it generated a lot of interest. Some of the comments we got after the symposium were "I never thought I could do anything about safety myself" and "Why have we never heard about this checklist?". In other words, just keep up the good work in your campuses, it actually makes a difference.

    - Jo Inge Myhre, medical student, University of Oslo

    Apr 23, 2011

    Hot Spot for Healthcare Improvement: Chicago

    On March 29, twenty-six enthusiastic students, faculty, and health care leaders from the Institute of Healthcare Improvement met at the Sofitel Chicago Water Tower to network and learn more about quality improvement. The event was sponsored by the IHI Open School and Aleta Belletete, a retired board member of the Institute of Healthcare Improvement who has thought about quality in another industry that gets a lot of attention, banking, serving as the Chief Quality Officer for Bank One.

    During the Institute of Healthcare Improvement Annual Forum in Orlando, Aleta was perusing the IHI Open School posters and stumbled upon our Chapter poster sandwiched in between several other Chicago-based chapters. She knew that one of the most valuable things to create change is to get them all in a room together and that is exactly what she did.

    Multiple institutions were represented and it was a lot of fun meeting other professionals excited about making health care safer, better, and more efficient. We were lucky enough to get some hands on instruction from quality improvement guru Bob Lloyd, Institute for Health Care Improvement Faculty and Executive Director of Performance Improvement, as well as Richard Scoville, who is also IHI Faculty. We learned about the IHI’s Model for Improvement and how to implement a Plan, Do, Study, Act (PDSA) cycle to achieve meaningful and lasting change. Attendees had the chance to interact with health professionals across the spectrum including: medical students, physicians, paramedics, administrators, pharmacy students, and residency program directors. This was really just a launching point to get the Chicago QI community connected and learning from one another.

    Much of the discussion focused on how to get Chapters started or sustain activity. Interestingly, our own Chapter, which is still very young, seemed to be in an advisory role, assisting other student leaders in finding mentors or thinking about activities. They key ingredients to a successful Chapter seemed to be the same: (1) committed students; (2) committed and capable faculty advisors; and (3) a shared vision around a specific activity the Chapter would sponsor. We are fortunate to have quality and safety as a major thread in our curriculum. Sustainability is also an issue with turnover of student leaders - one thing our Chapter is doing this year, is creating a "senior advisor" role for 4th year medical students who are coming out of their clinical clerkships to guide the preclinical students on the highest yield activities. Our own Chapter has been focusing on interprofessional collaboration with our health administration students and has started outreaching to pharmacy students as well. There was a lot of talent in the room and we look forward to future events!

    - Anthony Aspesi, MS1 and Vineet Arora, MD MAPP

    Apr 22, 2011

    IHI Open School Southeastern Regional Event

    My name is Dustin Cox and I am student at Clemson University studying Health Administration. The Clemson University Chapter is unique in that we are primarily undergraduate college students, and our group is a diverse mix of a variety of disciplines including health administration, engineering, architecture, business, nursing, and others. Our IHI Open School had elections a few weeks ago and I was elected President. Shortly after being elected, I was provided the opportunity to attend the Southeast Region IHI Open School Forum. Given that I have never attended any of these conferences before, I was anxious to see what was in store for a Southeastern Conference. To my surprise, there were over 350 people in attendance, including students and professionals alike!

    Upon arriving at the conference, I was amazed at such an energetic and exciting atmosphere. After hearing the opening remarks from the Southeastern directors, we were introduced to two professionals who would go on to give us a better understand of public narrative. The ability to share experiences and motivate others with the stories we told were the main focus of the afternoon. Everyone has a story of what brought them to where they are now, and where they would like to go in the future. When we left however, we were all able to tell that story in a way that influenced others in a positive light.

    I was able to take this experience back to Clemson with me and excite the other officers, that we are a part of a national movement to improve quality care. Not only was this Conference a good way for me to become more enthusiastic about healthcare improvement, but it was also a great way to network. Throughout the day, I was introduced to many local healthcare and IHI Open School Chapter leaders. I look forward to next year’s Southeastern conference and recommend this to any and everyone I come in contact with!

    - Dustin Cox, Healthcare Administration student at Clemson University

    Apr 21, 2011

    Kate Moores' experience at IHI Open School England Conference, 19th March 2011

    On Saturday 19th March, as part of my involvement with the Wales Student Chapter, I had the opportunity to attend the IHI Open School England Conference. The event was hosted by NHS Institute for Innovation and Improvement in association with Birmingham University Medical School.

    The conference was a fantastic opportunity to learn from different Chapters, and how they run workshops and other activities for their members, from across the UK, and also promote the excellent work that we are doing within the Wales Student Chapter, with regards to our membership and structure

    The day commenced with a welcome from Bernard Crump, Chief Executive for the NHS Institute for Innovation and Improvement, who was very pleased to see so many students engaging with healthcare quality improvement and patient safety.

    Sue Lister, a Senior Lecturer at Coventry University on Quality and Service Improvement in Healthcare, gave a presentation where she reiterated that quality and safety are not electives, and need to be integrated into our health professions training.

    She explained that no one goes into work looking to cause harm, but that it is the system that prevents us being able to do our job to the best of ability.

    Shannon Mills, Community Manager of the IHI Open School, gave a history of the IHI and the tremendous progress the Open School has achieved in just over 2 years where almost 300 Chapters have been established across the world.

    A keynote address was delivered by Helen Bevan (Chief of Service Transformation at the NHS Institute for Innovation and Improvement) who explained the fundamentals to becoming a change agent.

    I was very interested in her explanation of the different energies that inspire people to change, and become change agents, which is important because we want more people to become change agents within NHS Wales through the Wales Student Chapter.

    In this session delivered by students highlighting their involvement with their Chapters, I gave a presentation explaining my involvement with the Wales Student Chapter. Alongside this, an article I wrote about the Wales Student Chapter was then featured in the delegate packs.

    The main messages from the conference was the importance of faculty involvement when conducting improvement projects, but also the need for a committed group of students to ensure the good work of the Chapter is continued.

    If you’re interested in gaining leadership experience in the Wales Student Chapter, and shaping the future of quality improvement across Wales please contact Victoria Evans, Wales Student Chapter Coordinator:

    Apr 18, 2011

    Experience of a global health resident at the International Forum April 5-9th 2011

    My name is Narath Carlile. I’m a Global Health and Social Equity and Internal Medicine resident at the Brigham and Women’s Hospital in Boston. I had the chance to go to this year’s BMJ/IHI International Forum in Amsterdam, and I wanted to share with those of you who could not make it some reflections on the Forum, why you should go (if you can) and a little of what you can expect if you get to go.

    First off, I would say the forum is about connecting! Any of you who have experienced the IHI conferences in the United States know that these are collections of amazing, motivated people interested in improving things! It’s hard to imagine a place with more positive energy when you are there. The international forum is perhaps even more so, since there are people from all of the world here, interested in, studying, and doing improvement work. The diversity of the environments and challenges they are working to overcome is truly impressive.

    A typical day will start with you walking through the poster hall, coming across a poster from New Zealand where they have managed to reduce errors by 28% with a structured communication training program with such things as relaxation and increasing assertiveness. Dr Peter Lee (whose poster it is) is there and is very interested in you, and your residency/medical school program. How is it for you, what could be better? He gives you his contact information, you promise to email him, and he promises to send you more information and looks forward to keeping in touch. You grab your coffee and head over to the student/faculty morning session.

    The student/faculty sessions are a great resource for medical students, residents, and faculty. It’s our own space with sessions designed to inspire, touch on the basics, and share with us what is possible at any level of training. Here you join students, residents, and junior doctors from the Netherlands, Denmark, Norway, Sweden, Germany, Scotland, and the US. They are without fail, inspiring colleagues, who are traveling a similar road to you, in very different countries, and healthcare systems. They have all struggled with many of the same issues that you do, with how to positively interact with a system in which you see problems, how to inspire others and yourself to be better in a system that already demands so much of you. And you are often amazed by the creative solutions, and the dedication that you see in them.

    You’ve all started the week with an amazing session on the Fives Alive project in Ghana where they are making great strides in reducing morbidity and mortality in under 5 year olds, using simple change-packets and short PDSA cycles. During the next morning you “competed” against each other in the marshmallow challenge. Today however we are the envy of many of the attendees here, since we have a small intimate gathering with Dr Paul Batalden from Dartmouth, a very influential figure in QI, who has synthesized the core of QI teaching into a very easy to understand session. He’s very approachable and walks with you to the keynote session, and as you walk there you have the feeling of accompanying a rock star - he gets such warm greetings from all who pass.

    The keynote sessions are grand and inspiring, and today it is Jim Easton who discusses Improvement’s greatest challenge, from which I get that there are 3 generational challenges facing healthcare (cost, information technology, and the improvement movement), and that in order to improve we are going to have to address each of these, including improving improvement. “What we do is important, so doing it well is really important!”

    The events are very well produced, and keep you flowing, past the free coffee, tea and biscuits to your next session. Today you learn how to turn the world upside down through the creation of global learning network. During the session the idea of linking together those involved in local improvement emerges. This would allow lessons and particularly ideas that work in a local context to be shared with those who might benefit the most i.e. your neighboring hospital/clinic. Turns out the IHI has already been thinking of this and at the next forum you can expect to have a morning or afternoon session dedicated to regional Quality and Innovation Center discussion!

    The time for the session seems to short, but you are already on the move to your next - 4 fascinating discussions about the treatment of HIV and AIDS in resource poor settings, from Haiti, Mozambique and Uganda, each struggling with ways of extending and improving care in very challenging situations. The discussions after raise interesting questions many of which you have been thinking as you listen to the sessions (“why don’t we just ...”). Almost always, these are met with considered replies - those in the field, in these countries have very often thought of many of the armchair solutions we consider from afar, and have keen insights into why and why not they would work! Invaluable lessons from experience!

    Later in the day, you’ll play some serious games like the medical areas in Second Life, or the bio-feedback driven Air Medic One, watching one of your colleagues desperately try to relax in front of a “live studio audience” and almost succeeding! In the end you will see John Moore from
    MIT’s New Media Medicine present a session on some of the future tech of medicine, and you’ll be amazed at how much of it is centered on communicating more effectively, improving technology to allow more meaningful human to human interaction and less human to screen interactions.

    And with that, I have to encourage you all, as we sit in front of our screens to (as another attendee said) do “less talk, more walk.” I highly recommend that when the next forum comes, that you join your fellow students, residents and faculty. You will leave energized, committed, supported, and empowered with new knowledge, new ideas and new friends that will help sustain you in the challenges which lie ahead!

    - Narath Carlile, Global Health and Equity/Internal Medicine Resident, Brigham & Women's Hospital