Big Lessons: Chapters Share Learning from Event at the World's Largest Medical Center

Hi, y’all. I’m Rachel, a project coordinator at the IHI Open School. Some of you have probably seen my name at the bottom of emails or my smiling face at the IHI National Forum, but I’m still getting to know many of our students and Chapters. I got a great opportunity to do just that in my hometown of Houston late last year.

It was an experience that filled me with pride – and with help of Chapter Leader Joshua Liao, provided me with several lessons to share with new and experienced IHI Open School Chapter Leaders.

Early in the fall, I had the pleasure of working closely with Joshua, a third-year medical student and current IHI Open School Chapter Leader at the Baylor College of Medicine (BCM), to plan the first annual Houston IHI Open School Convention. The goal of the one-day convention at Texas Medical Center (the world’s largest medical center) was to use education and networking to expose attendees to important issues in patient safety and quality improvement.

The convention – a product of collaboration between IHI Open School Chapter leaders from BCM and the University of Texas Medical School at Houston – brought together student s and professionals from a wide array of educational institutions and hospitals from Houston and surrounding cities. It was inspiring and energizing, and surpassed all of the expectations we had set.

Following the convention, I asked Joshua to share details of the experience so that other Chapters could learn from them:

Who was involved in planning the event?
Early in the planning process, I took the lead in the overall vision for the event in terms of format, timing, content, and discussed these things with several other student leaders/officers before touching base with Rachel from the IHI Open School. Once that was broadly set, I moved forward with publicity with the help of a few other officers from the Baylor College of Medicine (BCM) Chapter –Jehan Alladina, Harman Kular – and Tyler Willliams , a medical student and IHI Open School Chapter Leader from UT-Houston Medical School. A number of other BCM and UT-Houston students – notably Varun Kumar, Jonathan Huang, and Mitchell George –helped with a number of pre-event and event-day responsibilities.

What topics did you include in your event agenda?
I chose two main topics - diagnostic error and safety culture - as the focuses for the event for three reasons: they are emerging, 'hot topic' issues in safety/quality, they are pertinent to the daily experience of health professions students, and we have a few of the nation’s leaders in these topics here in the medical center.

How did you select the speakers?
Given my desire to focus on safety culture and diagnostic error, Dr. Eric Thomas and Dr. Hardeep Singh were perfect choices. They are each leading researchers in these areas, respectively, and they are both very active in academic and educational roles within the UT-Houston and BCM communities.

How did you advertise the event?
I was admittedly ambitious with the scope of the event. I wanted to involve as many local Houston institutions as possible (whether they had IHI Open School Chapters or not), as well as a number of out-of-town chapters, knowing that regardless of eventual attendance, the effort and publicity from this kind of event would create important awareness and precedent for the future. As such, my team and I set out to advertise to all the hospitals and health professions schools (medical, physician assistant, pharmacy, nursing, etc.) in the medical center and also sent out invitations to other Chapters in surrounding cities. For local schools, we used paper flyers along with class-wide emails, and for hospitals we sent out invitation emails. For the Chapters and institutions further away, I drafted template letters that were sent to the appropriate deans, chiefs, and/or Chapter Leaders. We also set up a Facebook event to use social media to publicize the event and used eventbrite.com to set up an online invitation.

What was the biggest challenge you encountered during the planning process?
With the scope of this event, the biggest issue was date selection. Because everyone (speakers, student leaders, potential attendees) had increasingly busy schedules, choosing a date that worked for everyone proved to be a more difficult task that I originally imagined.

Is there anything that you learned about planning the event that other students would benefit from knowing?
Honestly, probably too many to count. But by way of overall lessons, I took away two big lessons from this event:

1. Don't be afraid to think big - While there's a time and place for smaller events, I think that if awareness and publicity of the Open School and safety/quality in general is a main goal, students shouldn't be afraid to think big (by inviting speakers, publicizing the a larger demographic, or selecting creative programming). As I learned, there are a lot of great secondary benefits to planning an event this way, even if the attendance doesn't reflect the number of invited students and professionals. From this event, I've already received several emails from people who've never heard of IHI wanting to join Chapters, and several leaders who weren't able to attend but mentioned they would love to be involved in something like this in the future. So in my case, thinking big created new connections and started new relationships that I couldn't have imagined beforehand.

2. Mind the details - For students who want to undertake planning a similar event, I would recommend that they do a large portion of groundwork before presenting or soliciting ideas from others. As mentioned before, in my experience, the planning process can stall in the early stages if student leaders wait on each other to get the ball rolling, which can be time consuming and very low yield. Whether the final agenda remains unchanged or not (in my experience it's actually a good sign if the agenda goes through multiple revisions!), having something concrete to present to other leaders and planners to discuss was immensely helpful. Because for better or worse, as one of the lead planners, the other leaders/organizers will be looking to you to fulfill that role to get the process started.

-Rachel Bissonnet, IHI Open School Project Coordinator

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

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

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.

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.

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.

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