QI Field Trip: The UNH IHI Open School Chapter Comes to Cambridge

By Jessica Hatch, Nursing Student, IHI Open School Chapter Leader, University of New Hampshire

Is your chapter in the Boston area? Have you considered taking advantage of touring the IHI offices and meeting the Open School staff?

If you haven’t, then you should! If you did not know about the opportunity, then start inquiring! And if you are thoroughly disappointed that you are geographically unable to visit, I honestly cannot blame you.

What I can do is offer you an inside scoop on the environment of IHI: engrained in the values of quality improvement and innovation, the offices are the epitome of an unforgettably original and exciting organizational culture.

The IHI offices are housed in the high rises of the Charles Hotel in the heart of Cambridge, overlooking the locally beloved Charles River. Immediately upon exiting the elevators, guests and employees alike are greeted with a motivating segment of the IHI’s mission statement displayed in large font above the reception area. The open floor plan invites group collaboration with only the slightest segmentation of task forces, by either low dividers or glass frames. Each task force is encouraged to gather centrally at their shared tables throughout the day, again showing how highly teamwork is valued in the organization.

Interesting and colorful progress boards are found throughout the hallways, offering information on upcoming goals, previous achievements, and often a comical comment for a good laugh or two. One wall is strictly dedicated to displaying the history behind IHI, like a timeline, reminding all whom explore the building of the hard work and underlying values that have allowed this organization to continually improve and flourish. 

Have I mentioned the numerous quotes strategically strewn throughout the office space? Not only were they visually pleasing, but they were thought provoking and encouraging. As students, we all looked around and could envision ourselves working in such an amazing space. Or perhaps it was the idea that one’s organizational culture could be genuinely represented in the design of their workplace. If we are to proclaim the ideas of interdisciplinary collaboration, transfer of knowledge, empowerment of staff, and evidence-based best practice, what better place to start than to immerse yourself daily in a floor plan that is supportive of just that?

Without going on and on much more about how the beliefs, values, and aspirations of IHI were evident in each staff member as well, I will share the takeaways that a number of fellow peers shared after our tour:

“Inspiring to see quality improvement in action at such a large scale…great opportunity and encouraged us to use IHI resources now and in the future”

            -Katie

“I found all of the quotes on the walls inspiring as well as the enthusiasm of our tour guide and the people with whom we stopped and spoke with along the way. It showed that they are not just people sitting behind desks pushing out tutorials for the front lines. They are passionate about their work, live their mission and vision, and truly care about making hospitals and ambulatory care settings a safer, better environment.”

            -Dawn

“At first I was confused as to why we were taking a tour through an office building — aren't they all the same? But I soon learned that there is value in seeing and understanding how IHI employees work.  The atmosphere within the office seems to mirror the philosophies of the organization. Meeting with the IHI Open School team was also a very useful conversation. I didn't realize how new the concept is and how much it is still evolving. I felt that the meeting was beneficial on both sides (I hope it was!) since the Open School course work focuses on quality improvement just as the CNL does.”

            -Beth

“They were extremely kind and do amazing work. I thoroughly enjoyed it.”

            -Jackie

“The tour encouraged future use of IHI resources when no longer a student — IHI is a life-long valuable resource.”

            -Stephanie

“Their enthusiasm for their work was infectious. Our cohort got so much out of this visit and we are excited about bringing IHI resources into our future practice.”

            -Kristin

“IHI is a community of innovative, forward thinkers and it was exciting to see and have hope for the future of health care!”

            -Rachel

“I appreciated the folks at their desk that took a minute to tell us what their job entailed. The personalization brought it to life … I’m interested in staying connected and motivated to complete the QI process through IHI.”

            -Sarah

“I loved that their work environment matches their philosophy. The workplace truly would inspire collaborative teamwork, creative thinking, and inspired innovations. Everyone was incredibly friendly, open, and approachable. We felt so welcome; it was great to have the open discussion at the end too to learn more about IHI, and it was awesome to see the IHI team genuinely interested in our feedback”

            -Justin

“I greatly appreciated the open management structure. It was nice to see a more horizontal leadership approach outside of the textbook. From my view, openness facilitates the creative process.”

            -Anthony

Introducing The Conversation Project

What if every citizen’s end-of-live wishes could be expressed and respected in a way that was simple and transformative? Would you have the conversation about your views on a “good death” if you knew it would bring peace, security, and calm to your loved ones?

We are all mortal, yet as a society we have been painfully slow in recognizing and acknowledging how many of the people we love are not dying in a manner of their choosing: in comfort, among people who care about them, and engaged in what matters most for as long as possible.

Many Americans assume these conversations should and will take place between doctors and patients, but doctors are often uncomfortable and untrained in initiating these end-of-life discussions, so wishes are never expressed and words are never spoken. The Conversation Project fills a void by bringing these important conversations from the hospital bedside to the kitchen table, so patients’ choices drive the decisions rather than medical finances.

Our mission is to provide individuals, communities and society at large with the knowledge, wisdom and grace needed to have what can be a painful conversation. The Conversation Project is your forum for sharing stories, a coordinated messaging and communications effort, a social marketing campaign, and a web home base for conversation starters. It’s where you will find guides to help you ensure your end-of-life wishes are respected. 

We are not interested in a temporary change, but rather a full cultural shift that will enable us to remove the stigma and uncomfortable nature of the topic, enabling us to have the conversation within our own families but also, collectively, across cultures, workplace communities and neighborhoods.

Our goal is to help people of all ages engage loved ones, care providers, clergy, and others. Rather than promote a ‘desired’ action, the Conversation Project plays the role of catalyst and advocate for families and circles having these conversations. Those who have had The Conversation report the benefits far exceed any preconceived expectations. We know this is hard, but we also know the number of people who want to have these discussions will continue to grow.

We ask you to join us by having The Conversation with your loved ones. We promise never to steer your decisions, only to support and encourage your discussions.

To learn more, follow @convoproject on Twitter. The Conversation Project website will launch in June.

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

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.

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: http://www.apha.org/NR/rdonlyres/47FDA17C-1B25-43D1-8E40-2CE17B0E8326/0/PerformImprovePubHInformsheet.pdf

Or visit the official website: http://www.sph.umn.edu/programs/certificate/piph/index.asp

- Becky Ng, Public Health student, Emory University

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

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

Student Teams at the Forum

The IHI Open School team cares about maximizing the value you take away from the National Forum. This year we've incorporated student teams -- a new team-based approach, exclusively for IHI Open School attendees--into our programs. The student teams concept is our answer to a simple question: What are the habits of the world's best conference goers? How do the seasoned veterans leverage a few days' meeting into the knowledge, networking, and inspiration to fuel a year's worth of success in improving health care? It must take more than coffee.

The response has been terrific and we have 10 teams coming to the Forum! Each team is formed of 4-6 students and residents with a mix of professional and demographic factors. We'd like to thank all of you who will be participating in this unique experience. The student teams received their team assignments last week and were asked to develop their team's learning mission by making a comment at the end of this blog post. You'll be able to see what other teams are working on and hopefully find opportunities to collaborate while at the Forum. We've collected a set of best practices from other conference goers below.

How to optimize your IHI National Forum experience:

1. Active learning. With so much packed into three days, it's easy to miss a key insight in the blur of PowerPoints and plenaries. The best technique, we learned, is to think up questions well before the end of a talk. Keeping questions in mind throughout the conference, continuously searching for answers, and reflecting on daily lessons are key best practices of active learners.
   
2. Networking for collaboration. The knowledge to be gained at the Forum is world class, but it's called a meeting because that's what you're supposed to do! To make the most out of your experience, you'll want to be sure to meet the right people. You may find it difficult to find colleagues who share your interests in health care improvement at your school or institution, but student teams are designed to provide an immediate addition to your network of colleagues with common interests, and to provide a starting point for connecting with people you want to meet.
   
3. Connecting to core values. What makes the IHI National Forum so valuable is that improving health care is not just a specialty, it's a movement. Along with a list of great ideas and a stack of business cards, you leave with a sense of joy and excitement about the mission of improving health care that will carry you through the challenges of the year. The IHI Open School hopes that with the help of the student teams you will be going home at the end of the Forum energized and inspired. We hope that the Forum will be as much about learning what's new as rediscovering the core values that sparked your passions in the first place.

To our student teams: We're excited to see the results you come up with while at the Forum. Now's your chance to share your team's mission with the rest of the IHI Open School Community! Please share your team's mission in the comments section below.

See you in Orlando!

--Daniel Henderson

Student Events at the 22nd Annual IHI National Forum

The 22nd Annual National Forum on Quality Improvement in Healthcare is only a few weeks away! The IHI Open School team wants to make sure that you get the most out of your Forum experience that you possibly can. Read on to learn about the great student-focused events that will be taking place.

3rd Annual IHI Open School Chapter Congress

December 6, 4:30 PM - 7:30 PM

The Chapter Congress provides Chapters with an opportunity to come together, share their successes and challenges, and generate ideas for the new year. Chapter members will be able to meet other leaders in the community, share best practices, and build new skill sets. At this free, pre-conference event, Kate Hilton and Matt Lewis of Leading Change at Harvard University will lead us through the Story of Us and Now, and will review public narratives. Please review the IHI Open School Public Narrative Guide. This will be a great opportunity to meet and interact with IHI Open School Chapters!

Student, Faculty, & IHI Faculty Reception
December 6, 7:00 PM - 9:00 PM
The Faculty and Student reception will provide an opportunity for students and IHI National Forum faculty to network. Meet other students and faculty members and have a chance to make lasting connections.

Graduate Medical Education Interest Group Meeting
December 7, 7:00 AM - 7:45 AM
The IHI Open School is receiving overwhelming interest from the GME community. How can we use the IHI Open School courses to teach residents about improvement? How can we structure an improvement project during a one month rotation? Meet us in the Student Lounge (Tampa) to meet others in this group.

NEW! Student Dine Arounds

December 7, 6:00 PM - 8:00 PM
Are you interested in creating a QI elective or course on your campus, strategic planning for your IHI Open School Chapter, or QI in the context of health reform? Discuss these topics over dinner with people who have similar interests. Sign up at the Forum and IHI will make a reservation for your group at a local restaurant.

IHI Open School Breakfast Session
December 8, 7:00 AM - 7:45 AM
Join the IHI Open School special interest breakfast session to hear from the Regional Chapter Leaders. In this interactive session, the Regional Chapter Leaders will lead a discussion about Chapter sustainability. Learn about successful Chapter fundraising, developing a Chapter constitution, Chapter leadership succession, and other sustainability issues that Chapters face.

Student Lounge
The Student Lounge is a place for students to meet during the Forum. Go to the student lounge (Tampa room) during breaks and lunch to meet up with other students and for the latest information.

NEW! Student Teams
For the first time, students have an opportunity to join student teams at the Forum. Student teams are interprofessional groups of 4-6 students with similar areas of interest who will meet up throughout the Forum. Check back for a blog post about the student teams in a few days!

Follow & Tweet with us at the Forum

Make the student and faculty presence known by tweeting with us at the Forum. Use the #IHI hashtag.

If you have any questions, please email the IHI Open School team.

Preparing for the Future

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

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

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

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

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

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

Swiffer Solutions for Health Care

Eva Luo “co-blogs” with guest contributor Curtis Chan, an analyst at Innosight, an innovation consulting firm in Watertown, MA co-founded by HBS professor and innovation expert Clay Christensen.



When I imagine a world without the Swiffer, I see it as a post-apocalyptic dustscape. Dead skin cells sublimate and overtake nitrogen as the most prevalent constituent of the atmosphere. People have acclimated to the ubiquity of filth, spills, and dirt: soil is no longer tracked into the house – your mom yells at you for adding a fresh coat to the carpet of mud. And, fully unbridled, wanton dust bunnies spawn like, well, bunnies.

Fortunately, Swiffer does exist. Launched by Proctor & Gamble (P&G) in 1999, the cleaning product had 75% market share of the quick-clean market, which totaled $750 million in revenue in 2005. (1) With the massive success of the product, have you ever stopped to think to yourself: “It’s a disposable towel. On a stick. Where the heck did Swiffer come from? And how in the heck did P&G dream it up?”

The answer, it seems, is by just looking. As revealed in The Innovator’s Guide to Growth, Swiffer was the product of an observational study conducted by P&G that followed consumers around their homes, looking around the house, observing behaviors, and generally hunting for clues as to what kinds of things consumers need to get done throughout the day. (2) The observed consumer needs and desires that the researchers observed helped inform P&G how to create and design innovative products or processes to help meet those needs and desires.

For fun, I’m going to take more than a few liberties with the details of an anecdote from the observational study here, but the message is faithful. This is how I would imagine an episode of the P&G study:

Two P&G researchers followed a nice, grandmotherly lady as she ambled about, showing them around her house. When she flung the doors of her closet open, the researchers noticed that a broom covered with dust stood in the corner. In another closet, a vacuum cleaner sat, unused and forlorn. The researchers nodded conspiratorially at each other as they jotted notes.

They all wandered into the kitchen. Jarring the researchers from their note-taking frenzy, the woman asked them, “Would you nice boys like some coffee?” The researchers agreed, blushing at being called “nice boys.” As the woman took a can of coffee grounds down from the pantry and opened it, the can slipped from her hands. She cried out as the can tumbled to the ground, strewing coffee grounds across the floor.

Instantly, she grabbed a paper towel and attacked the mess, muttering to herself as she crouched on the floor. When she stood again, the researchers were staring at her, befuddled. “What?” she asked, the look of puzzlement on their faces engendering a puzzlement of her own. “You didn’t use the broom,” one researcher remarked. “Or the vacuum cleaner,” the other chimed in.

With a sigh, the lady vented her frustration –the broom wouldn’t do a good-enough job and would leave coffee grounds on the floor, and the vacuum cleaner was heavy, cumbersome, needed to be plugged in, and was just overkill for the small mishap.

The researchers nodded and wrote. Then, flipping their notebooks closed, they smiled and glanced at each other again with that same conspiratorial look, the gleam of excited insight shining from their eyes.

P&G took the findings from their observational research and created the Swiffer, a dispensable electrostatic cloth fixed on the end of a long handle, which got the job done of cleaning up small spills just right. By employing an observational approach – in the natural setting of consumption – the researchers were able to see what the old lady would never have been able to tell them in a survey or a focus group; they were able to notice products around the home that went unused and were able to watch actual behaviors during real-time events. Based on real environments and behaviors, researchers can ask more informed questions to garner more useful, reality-based consumer responses. Indeed, by employing observational research, P&G was able to understand their customers and precisely what they needed and wanted to get done in the day.

Are there health care Swiffer stories? Can observational research help us better understand our patients and what they both need and want in order to achieve better health and experience better health care? The answer, it seems, is yes.



One such example is Project HEALTH, a non-profit organization located in Boston, MA that seeks to break the link between poverty and poor health outcomes. The story of Project HEALTH’s birth is a story of observational research, just like the Swiffer story. Dr. Barry Zuckerman, Chief of Pediatrics at Boston Medical Center and Co-Founder of Project HEALTH often tells this story:

A six-year-old boy who suffered from uncontrolled asthma arrives at the Boston Medical Center for care. Despite receiving daily oral doses of corticosteroids, a common asthma prevention medication, he was absent from school once or twice every six weeks. As a result, his mom was forced to miss work in order to take care of him and bring him to the hospital for care. The boy has insurance, so access is not the problem. He is also seeking care at Boston Medical Center, a reputable teaching hospital, so neither is quality of care the cause for his frequent visits to the hospital. Why then is asthma a major disruption in his life and the life of his family?

On a visit to the young boy’s home, the visiting nurse discovered asthma triggers: mold due to a leaky water pipe and wall-to-wall carpeting harboring dust mites. Thus, each step of improvement the young boy tried to make was inevitably countered by his poor living conditions. Dr. Zuckerman often says, “I can provide the most updated form of medical care for low income families, but they would still get sick.” Upon discovery of the asthma triggers in the young boy’s home, negotiations with the landlord led to replacement of the leaky pipe, clean-up of the mold, and removal of the carpet. Within six weeks, the young boy had stopped corticosteroid asthma treatment and was attending school regularly. (3)

Rebecca Onie, Co-Founder of Project HEALTH adds another layer to Dr. Zuckerman’s observational research. Onie notes that several physicians understand this connection between poverty and poor health outcomes but are “frustrated because the clinical interventions that they can do in 18 minutes are not enough to change the health of their patients.” Furthermore, physicians are often unaware of what they can do to help address these psychosocial issues. This physician and caregiver inaction is a systems design problem.

Combining these two parts of observational research has led to a health care Swiffer: an innovative new care model that meets the patients’ needs called Project HEALTH. This is the logic: The hospital is the site where health care is delivered—and with just a minor stretch is also a convenient site where psychosocial interventions can be introduced to better and more comprehensively improve the health of kids and their families. The systems redesign answer is a crew of motivated college students stationed in the hospital. If doctors feel their patients need assistance obtaining housing, have food insecurities, or can benefit from utilities bills discount programs, doctors can now refer patients to Project HEALTH volunteers who work with patients to obtain those resources right there in the hospital.

A simple solution that has achieved great positive change, Project HEALTH now has locations in New York, Providence, Chicago, Baltimore, and Washington D.C. Project HEALTH was also just recognized by Michelle Obama at Time’s 100 Most Influential People Awards Gala. This year, 600 Project HEALTH volunteers will dedicate 100,000 hours to connect over 15,000 low-income children and adults with the resources they need to be healthy. (4)

How could health care improve if observational research was more commonly used? Are there Swiffer-like solutions for every health care problem?

Following the model of observational research itself: Let’s look and see.

Patients Take Center Stage in Gawande's Writing

It's been nearly three weeks since Atul Gawande's article, "The Cost Conundrum," was published in The New Yorker. But the buzz and excitement has not even begun to dwindle. On the contrary, my friends who never paid any attention to health care are now asking me questions like, "So, what's with the health care costs in the US?", "What is Obama talking about?", "Dartmouth Atlas? What is that?", "Is the US going to get universal health care?", "Can we fix the incentives to reduce waste?", "Is the overuse mainly a result of practices of defensive medicine?"...

To all of my friends who have asked me questions, thank you and keep them coming! As a very soon to be medical school student, I care a great deal about health care. While I understand everyone has their own passions, it has always surprised me by how little people cared about a system that everyone has had experience with. But, thanks to Atul Gawande, I now have an excuse to blabber on ad nauseam about health care to all!


Word Cloud from Atul Gawande's "Cost Conundrum" piece


Word Cloud from Atul Gawande's University of Chicago Pritzker School of Medicine Commencement Address

Why the sudden shift in interest? The facts that Atul Gawande is a eloquent and powerful writer, Obama has made Gawande's article mandatory reading for the White House, and that it's all over the news are important factors. However, for the first time, I think the health care reform agenda is being painted in a new light. Sure, insurance and coverage are still big topics; but there are new ideas being tossed around like quality, patient-centeredness, culture of medicine, and team work. Just take a look at the word clouds of Gawande's pieces!

Most importantly, patients are now a big part of what many see as the pathway to a better health care system. What do patients need and want? How can we as health care providers and engineers of the health care system provide better care for the patients? Since we are all going to be patients at some point in our lives, these arguments hit a very personal chord. Hopefully, as we continue to search for the best health reform plan, we can all dig deep and remember the true purpose of health care and let that notion guide us.

Thanks to Ben Tseng for sending me this piece in the Washington Post with the Gawande word clouds. These images are all too powerful!

Here is another great related Atul Gawande piece that focuses on quality: "The Bell Curve" published in The New Yorker.

Pay for Performance and A Glass Jar for Marbles

Throughout elementary school, middle school, and high school, the best term that would describe me would be, "teacher's pet." I was not trendy, funny, sporty, or rebellious. I was good at following the rules. And most importantly, I was recognized for following the rules both in a good way (by my teachers) and a bad way (by my classmates). I'm not entirely sure what motivated me to follow the rules, but thinking about my quest for good behavior through a "pay for performance" lens may provide some interesting insights.

"Pay for performance" or P4P is a hotly debated topic in health care. Many who see the perverse misalignment of incentives in the current "fee for service" or FFS payment schemes often suggest P4P as an alternative. P4P, as defined by Dr. Don Berwick, is "a contingent relationship, enforced, and implemented in an organizational hierarchy, in which supervisors judge the merit of the work of those below them in the hierarchy and, based on those judgments, give out variable and contingent financial rewards."

In the second grade, the P4P system looked like this: Each student had a glass jar sitting in the corner of his or her desk. Ms. Gabso always carried with her a handful of marbles. Whenever she saw us behaving well, she would drop a marble in our jars. Good behavior meant not talking when she was talking; sitting quietly with our hands folded at the start of each day and as we waited for dismissal; having all of our books ready whenever we switched between subjects; and raising our hand to speak in class. Once our jar was filled with marbles, we got the chance to open the treasure chest on Ms. Gabso's desk and pick out a trinket to take home with us.

In Ms. Gabso's class merit was good behavior and our rewards were marbles. That sounds simple and fair, right?

Well, not exactly. True to being a "teacher's pet" I probably racked up the greatest number of trips to the treasure chest. But, I don't think I was the best behaved student in class. Even though I was just a second grader, I quickly picked up on my fortunate advantages. Consider the following important factors in being awarded marbles:

1) Location in classroom: Ms. Gabso dropped marbles into our jars as she walked around the classroom. The path she walked most often was between her desk and the front of the classroom. I happened to sit right along this path. That means poor Tommy who sat in the back corner of the classroom would never get marbles unless his extraordinary good behavior caught Ms. Gabso's attention or she happened to walk by that corner of the classroom.

2) Material and appearance of the marbles: The marbles were identical and made of glass. Being slippery, they were not easy to maneuver in Ms. Gabso's hands. This made it difficult for her to accurately control the number of marbles awarded. Sometimes one marble became three marbles because two would slip out. Because all of the marbles looked exactly the same, once you accumulated a good number of marbles, mistakes of awarding too many marbles or too little marbles could not be easily corrected.

3) Placement of marble jar: Glass jars in a second grade classroom is a recipe for accidents. However, our desks were grouped in clusters of six (a two by two square of desks flanked by one desk on opposite sides of the square). Those of us sitting in the square, had our jars grouped in the center. Again, because the marbles often slipped out of Ms. Gabso's hands, a few marbles to my friend Lauren on my right could also mean one or two marbles into my jar by mistake. This meant that my friends sitting on the ends always seemed to have less marbles than those of us in the center.

4) Good posture: Though she never said so, Ms. Gabso was a fan of good posture. Rather than just having your hands folded on your desk at the beginning and end of each day, if you also sat up straight, you were more likely to get noticed and be awarded with marbles.

5) First impressions: After the first few weeks of school, Ms. Gabso had identified a handful of best behaved students and throughout the year it was these students that continually were rewarded with marbles. Ms. Gabso is human after all. So, only consistent exceptional behavior as demonstrated since the beginning of the school year and dramatic improvements in behavior were noticed. If you fell somewhere in between, you were rewarded less frequently.

These five points mentioned have absolutely nothing to do with good behavior and are arbitrary and uncontrollable characteristics of this P4P system for good behavior. From Tommy in the back corner's point of view, Ms. Gabso's marble system was not fair. More troublesome is the attitude that the class developed: we only had to behave when Ms. Gabso was watching. This change in attitude was reflected in the fact that Ms. Gabso never needed to send any of her students to be disciplined by the assistant principle, but our electives instructors did.

Now, if the students were health care providers, the merit clinical performance, and the reward a financial bonus, what could you get in return? A P4P system that encouraged health care providers to only perform well on what was being measured and only when being evaluated. Does that sound like an improved and reliable system to you?

I will have to admit that my "teacher's pet" feathers have not completely been shed. Since Ms. Gabso was the only teacher to have such a P4P system in place, what continues to motivate me to follow the rules and always be on my best behavior? I think it must be the intrinsic satisfaction I must gain from following the rules and behaving well. For example, I don't need a bouquet of flowers after every dance performance to enjoy dancing and performing.

In health care, there is natural satisfaction gained from relieving pain, answering questions, working in a team, and helping those in need. Personally, I'd want my doctor to give me medical advice and the correct prescriptions not because he'll get an extra bonus at the end of the month, but because of the pride and joy he gains from caring for others.

Now, with that in mind, is P4P really a health reform panacea?

WIHI: The Blogosphere's Hospital CEO

Did y'all get a chance to tune into WIHI's discussion about hospital readmissions or the last broadcast about health IT? If you did, I'm sure you can't wait for the next installment of WIHI.

Join Madge Kaplan this THURSDAY for a discussion with Paul Levy, President and CEO of Beth Israel Deaconess Medical Center. Paul Levy with his blog "Running a Hospital" has become a true pioneer in health care. His blog entries are "must-reads" for any health care leader, administrator, or clinician interested in building cultures of improvement, safety, and transparency. Don't forget to register to listen here.

Just a reminder:
WIHI is an exciting new audio program from IHI. It’s free, it’s timely, it's interactive, and it’s designed to help dedicated legions of health care improvers worldwide keep up with some of the freshest and most robust thinking and strategies for improving patient care.

Each episode is 60 minutes and there's a new broadcast every other week. You can listen to WIHI live— via computer or telephone or both — or you can download an archived audio file for listening later (see the Technology tab for more information). All you need to do is register in advance.

The WIHI broadcasts will be hosted by IHI’s Madge Kaplan, who brings a wealth of experience to WIHI from her years reporting on health care for public radio. IHI’s Director of Communications since 2004, and the regular “voice” of the 100,000 Lives and 5 Million Lives Campaign conference calls, Madge is known for her ability to create a shared space for lively and enriching discussions.

Click here for more details about registering and listening in on WIHI.

Past WIHI broadcasts are archived and available for download here.

If you have been following these WIHI broadcasts, please let us know by leaving a comment!

Teach Us How to Let Go

In life, some skills are taught. They are passed down through parents, friends, and teachers. These include how to swim, ride a bike, multiplication, and even basic things like eating. And then there are some things that do not have a formal teaching process. We move through life reacting and observing to pick up these untaught skills. Building experience that will prepare us for the next time. One of these untaught skills is how to deal with the end of life.

It's a sensitive topic. The end of life means death is at the door, which carries with it for all involved a wide array of complex and oftentimes painful emotions. I'll admit that it has taken me at least 10x longer to blog about this topic compared to other posts I have written. In health care, the topic of end of life is very sticky.

Health and medicine is conventionally about curing illnesses, fixing problems, and prolonging life. And many of us enter the field of health care for those very reasons. However, end of life care makes most health care providers uncomfortable because it throws a twist on a core belief: medicine allows people to live life to their fullest potential.

In a WBUR special titled: "Quality of Death: End of Life Care in America: Inside Out," Jim Conway, an IHI Senior Vice President and chair of Massachusetts' Committee on End of Life Care, said, most in health care believe that "doctors are not in the business of death, they are in the business of hope." If I am not feeling well, I do anything possible to feel better and reach out to medicine for help and hope. When I've caught a cold and have difficulty breathing through my stuffed nose, I take some pills to decongest my nose. If I'm experiencing lower back pain, I seek physical therapy to help realign my hips and spine. In these cases, the medical remedies are restoring or enhancing my ability to live my life to its fullest potential. As Dr. Jim Januzzi was quoted saying in the WBUR special, "The default is to do everything. Americans view medicine as a way to avoid deaths."

Medicine is a business of hope. That's what we've been trained to believe. George Annas, Boston University professor of health law, as quoted in the WBUR special explains, "The longer we live the less comfortable we are with dying; the more we fear it and the more we look to medicine to try to cure it." Jim Conway, counters this conventional notion by stating, "A respectful death is also a form of hope." In our fear of death, we place great effort in treating people during the final weeks and months of their lives. What we often don't realize is that in doing so, we are exposing these people to unnecessary pain and suffering.

When is the right time to stop aggressive treatment? When should palliative care begin? Palliative care aims to increase comfort while giving patients and their families the opportunity to explore treatment options beyond aggressive medical care. It also helps patients and their loved ones come to terms with the inevitability of death. Palliative care includes pain management and psychological care.

From a numbers perspective, palliative care makes sense. Studies have shown that while the majority of people would like to die a quick and painless death at home surrounded by family and loved ones, 80% in the US die in hospitals, sometimes hooked up to machines. Studies have also shown that when patients are started on palliative care at an earlier stage, they use less medical care and are more satisfied in their final months. A third of Medicare's annual budget is spent on the last year of life. That's about $144 billion. 70% of health care costs are for the elderly. Unfortunately, the amount of care received does not translate to better outcomes. Research has shown that greater intensity of care at the end of life is not better for these elderly patients, but is actually worse care.

Palliative care also makes sense through the lens of patient-centered care. Elderly patients in seeking aggressive treatment oftentimes bounce back and forth between hospitals, nursing facilities, or home. Many times, the treatments leave patients feeling confused, agitated, and sick. Studies have shown that when patients and their loved ones discuss end of life issues early on, the patients are more likely to have a comfortable death and their loved ones are less likely to suffer from prolonged grief and depression.

However, despite all of these rational reasons, I think it is still easier to talk about treatment options instead of palliative care and hospice options. Health care tends to attract type A overachieving personalities. So, how do you train future health care professionals to understand that palliative care does not mean you are giving up or that you are accepting failure? How do you let go? How do you make the transition from treatment to comfort? When is the right time to make that transition? It's not easy as a family member to watch loved ones pass, so I'm sure it is just as difficult for health care providers. I am no where near practicing medicine on my own, but I am already dreading the time where I'll have to initiate the palliative care conversation with my future patient and his/her family.

This complicated situation really should have a manual, but none exists. Since there is no manual, we must rely on experience. But, we can't wait till we start practicing independently to begin learning how to navigate these situations. Conversations about end-of-life care should be happening now while we are training. We need to experience it before we start running the show. End-of-life care should formally be included in our curriculum. A rotation in hospice or a nursing facility? We should all have the privilege to join a care team that is caring for an elderly patient nearing the end-of-life. At the very least, our professors and mentors should not hesitate to initiate discussions about end-of-life care with us. Only with this experience and support will we be able to deliver the care our patients truly want and deserve.

Help us build our experience. Prepare us for the next time.

Listen to the WBUR special titled: "Quality of Death: End of Life Care in America: Inside Out. In this documentary, special correspondent Rachel Gotbaum investigates end of life care in the US. What prevents many patients from having a dignified death? What kinds of challenges do patients, providers, family, and society face when dealing with end of life care? Click here to listen.

Talk Health IT with Dr. John Halamka and Dr. Brian Robson on WIHI

Did y'all get a chance to tune into WIHI's discussion about hospital readmissions with Dr. Amy Boutwell and Dr. Thomas Lee? If you did, I'm sure you can't wait for the next installment of WIHI.

Well, you need not wait any longer! Tune in TOMORROW with Madge Kaplan for a discussion on Health IT and electronic medical records (EMR) with Dr. John Halamka, Chief Information Officer of Beth Israel Deaconess Medical Center, and Dr. Brian Robson, Clinical Director for eHealth across NHS National Services Scotland, at 2PM. Don't forget to register here.

Just a reminder:
WIHI is an exciting new audio program from IHI. It’s free, it’s timely, it's interactive, and it’s designed to help dedicated legions of health care improvers worldwide keep up with some of the freshest and most robust thinking and strategies for improving patient care.

Each episode is 60 minutes and there's a new broadcast every other week. You can listen to WIHI live— via computer or telephone or both — or you can download an archived audio file for listening later (see the Technology tab for more information). All you need to do is register in advance.

The WIHI broadcasts will be hosted by IHI’s Madge Kaplan, who brings a wealth of experience to WIHI from her years reporting on health care for public radio. IHI’s Director of Communications since 2004, and the regular “voice” of the 100,000 Lives and 5 Million Lives Campaign conference calls, Madge is known for her ability to create a shared space for lively and enriching discussions.

Click here for more details about registering and listening in on WIHI.

Past WIHI broadcasts are archived and available for download here.

Health Reform: What Can YOU Do?

President Obama said X about health reform. Secretary Sebelius makes Y announcement about health reform. Senators Baucus and Grassley consider Z, A, B, and C in regards to cost-saving and health reform. Finally, physicians, employers, nurses, insurance payors, and many other stakeholders are sitting at the same table to discuss health reform. But, what can you do?

Join this free webinar hosted by The Commonwealth Fund and the Institute for Healthcare Improvement this Friday May 22nd, at 11AM to discuss how physicians and others can help create a health care system that offers high-quality, affordable care for all Americans while containing costs. Click here to register. Panelists will include:

Dr. Don Berwick, president and CEO of the IHI and professor in the Department of Health Policy and Management at the Harvard School of Public Health

Karen Davis, president of The Commonwealth Fund

Dr. Elliott Fisher,professor and associate director of Population Health and Policy at the Dartmouth Institute for Health Policy and Clinical Practice

The panelists will address quality improvement, integrated delivery, and payment reform as well as cost-saving measures that can help finance the coverage of the uninsured. Don't miss out and hope to see you on the webinar!

JAMA's "A Piece of My Mind"

What do toenails have to do with patient-centered care? Read last week's "A Piece of My Mind" column titled, "Beyond the Numbers," written by Dr. David Wu in JAMA here and share you thoughts on the blog!

WIHI: Exciting New Audio Program

How long is your morning commute to class or work? In high school, my commute was 45 minutes by car. My dad has always believed in never letting any time go to waste. So, rather than listen to my favorite music CD all the way through twice a day, my dad would urge me to listen to audio books.

The association of traveling and audio books has stuck. My commute now is a much more tolerable 20-25 minutes and I'm still listening to audio books and podcasts. Any of you listen to podcasts or audiobooks on your way to class or work? Plenty of novels and language books have audio formats. I've always wanted to listen to something health care related and now I finally have an answer...WIHI.

WIHI is an exciting new audio program from IHI. It’s free, it’s timely, and it’s designed to help dedicated legions of health care improvers worldwide keep up with some of the freshest and most robust thinking and strategies for improving patient care.

Each episode is 60 minutes and there's a new broadcast every other week. You can listen to WIHI live— via computer or telephone or both — or you can download an archived audio file for listening later (see the Technology tab for more information). All you need to do is register in advance.

The WIHI broadcasts will be hosted by IHI’s Madge Kaplan, who brings a wealth of experience to WIHI from her years reporting on health care for public radio. IHI’s Director of Communications since 2004, and the regular “voice” of the 100,000 Lives and 5 Million Lives Campaign conference calls, Madge is known for her ability to create a shared space for lively and enriching discussions.

The first broadcast is TODAY at 2PM and is titled, "Breaking the Cycle of Readmissions." Today's broadcast will feature Dr. Amy Boutwell of IHI and Dr. Thomas Lee from Partners Healthcare System and Partners Community HealthCare, Inc. in Boston. Dr. Lee is actively working on reinventing primary care in the U.S., a critical backbone to any efforts to reduce hospital admissions. He is also co-chair of the Committee for Performance Measures of the National Committee for Quality Assurance.

Click here for more details about registering and listening in on WIHI.

I know I'll be adding this to my list of things to listen to on my way to work!