Behavioral Health Integration Capacity Assessment Tool – Institute for Healthcare Improvement – 2014
“The purpose of the Behavioral Health Integration Capacity Assessment (BHICA) is to assist behavioral health organizations in evaluating their ability to implement integrated care. The BHICA enables behavioral health organizations to evaluate their processes related to three approaches to integrated care: coordinate care, co-locate care, or build primary care capacity in-house. It also allows organizations to assess their existing operational and cultural infrastructure to support greater integration. The BHICA was developed by IHI and the Lewin Group under a contract from the CMS Medicare-Medicaid Coordination Office.”Read Full Post | Make a Comment ( Comments Off on Behavioral Health Integration Capacity Assessment Tool – Institute for Healthcare Improvement – 2014 )
High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs – Institute for Healthcare Improvement – 6 December 2013
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013.Read Full Post | Make a Comment ( Comments Off on High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs – Institute for Healthcare Improvement – 6 December 2013 )
A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost – IHI – 13 December 2012
Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.
“This white paper provides a menu of suggested measures for the three dimensions of the Triple Aim. The menu is based on a combination of the analytic frameworks presented in the paper and the practical experience of the organizations participating in the IHI Triple Aim prototyping initiative. The suggested measures are accompanied by data sources and examples. The paper also describes how the measures might be used along with increasingly specific, cascading process and outcome measures for particular projects to create a learning system to achieve the Triple Aim.”Read Full Post | Make a Comment ( Comments Off on A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost – IHI – 13 December 2012 )
IHI Innovation Series white paper by Resar R, Griffin FA, Haraden C, Nolan TW.
“In 2001, the Institute for Healthcare Improvement (IHI) developed the “bundle” concept in the context of an IHI and Voluntary Hospital Association (VHA) joint initiative — Idealized Design of the Intensive Care Unit (IDICU) — involving 13 hospitals focused on improving critical care. The goal of the initiative was to improve critical care processes to the highest levels of reliability, which would result in vastly improved outcomes. The theory was that enhancing teamwork and communication in multidisciplinary teams would create the necessary conditions for safe and reliable care in the ICU. We focused on areas with potential for great harm and high cost, and where the evidence base was strong.
While there were many changes the teams in the initiative worked toward implementing, care of patients on ventilators and those who had central lines became a strong focus, as it satisfied all of our criteria: the evidence for the clinical changes was robust, and there was little or no controversy concerning their efficacy. Further, teams would need to find new and better ways to work together to produce reliable change and superior patient outcomes. We found that by using a “bundle” — a small set of evidence-based interventions for a defined patient population and care setting — the improvements in patient outcomes exceeded expectations of both teams and faculty.
Thus began an innovative approach to improving care: the use of bundles. This white paper describes the history, theory of change, design concepts, and outcomes associated with the development and use of bundles over the past decade. We reflect on what we have learned and make suggestions for further research and implementation of the bundle approach to improving care.”Read Full Post | Make a Comment ( Comments Off on Using Care Bundles to Improve Health Care Quality – Institute for Healthcare Improvement – 2012 )
Respectful Management of Serious Clinical Adverse Events 2nd ed – Institute for Healthcare Improvement – 2011
Conway J, Federico F, Stewart K, Campbell MJ. Respectful Management of Serious Clinical Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011.
“This white paper introduces an overall approach and tools designed to support two processes: the proactive preparation of a plan for managing serious clinical adverse events, and the reactive emergency response of an organization that has no such plan.
Every day, clinical adverse events occur within our health care system, causing physical and psychological harm to one or more patients, their families, staff (including medical staff), the community, and the organization. In the crisis that often emerges, what differentiates organizations, positively or negatively, is their culture of safety, the role of the board of trustees and executive leadership, advanced planning for such an event, the balanced prioritization of the needs of the patient and family, staff, and organization, and how actions immediately and over time bring empathy, support, resolution, learning, and improvement. The risks of not responding to these adverse events in a timely and effective manner are significant, and include loss of trust, absence of healing, no learning and improvement, the sending of mixed messages about what is really important to the organization, increased likelihood of regulatory action or lawsuits, and challenges by the media.”
… continues on the site
Federico F, Conway J. Planning for a clinical crisis: Next steps. Healthcare Executive. 2011 Nov/Dec;26(6):74-76.
“The response to the 2010 Institute for Healthcare Improvement white paper titled has been remarkable, as detailed below.
This article presents a summary of the learning gained since the Institute for Healthcare Improvement white paper, Respectful Management of Serious Clinical Adverse Events, was first published in 2010. The challenges remaining for clinical crisis planning along with comments on four areas of crisis management that are receiving the greatest attention are also discussed.”Read Full Post | Make a Comment ( Comments Off on Respectful Management of Serious Clinical Adverse Events 2nd ed – Institute for Healthcare Improvement – 2011 )
Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs – Institute for Healthcare Improvement – May 2011
Craig C, Eby D, Whittington J. Care Coordination Model: Better Care at Lower Cost for People with Multiple Health and Social Needs. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011.
“People with multiple health and social needs are high consumers of health care services, and thus drivers of high health care costs. The elevated cost of care in this population offers a tremendous opportunity to understand the individuals and their priorities and needs, and to craft a service delivery plan that meets their needs more effectively at a significantly lower cost.
This white paper outlines methods and opportunities to better coordinate care for people with multiple health and social needs, and reviews ways that organizations have allocated resources to better meet the range of needs in this population. There is special emphasis on the experience of care coordination with populations of people experiencing homelessness.
The framework relies on a methodical approach to delivering coordination services, not just health interventions, to improve health outcomes while ensuring efficient access to the health care system and other needed supports. The role of strong partnerships between health care and community organizations is highlighted and innovative test ideas are included.”Read Full Post | Make a Comment ( None so far )
Authors: Roger K. Resar, Frances A. Griffin, Andrea Kabcenell, Catherine Bones IHI
Within the US and around the world, hospital executives are facing increasing pressure to reduce operating costs and improve quality of care. Hospitals that fare best will be those that become efficient operators and reduce waste in their clinical care. Efforts are underway in many places to reduce waste, improve efficiency, and maintain quality. In December 2009, the Health Foundation in the United Kingdom commissioned the Institute for Healthcare Improvement (IHI) to design and test a tool for identifying clinical waste within the hospital inpatient setting. Through review of existing literature, conversations with experts, and direct input from hospitals engaged in testing, IHI developed the Hospital Inpatient Waste Identification Tool. The Waste Identification Tool was designed to identify clinical and operational waste from the perspective of frontline clinical staff, with the aim of informing strategic decision making for the hospital.” … continues
Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care – IHI White Paper – 2011
Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care – IHI White Paper – 2011
Balik B, Conway J, Zipperer L, Watson J. Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011.
“In response to growing interest from the hospital community in better understanding and improving the experience of patients and their families during hospitalization, the Institute for Healthcare Improvement (IHI) conducted an in-depth review of the research, studied exemplar organizations, and interviewed experts in the field. Our aim was to identify the primary and secondary drivers of exceptional patient and family inpatient hospital experience (defined as care that is patient centered, safe, effective, timely, efficient, and equitable), as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey’s “willingness to recommend” the hospital.
The project identified five primary drivers of exceptional patient and family inpatient hospital experience of care: leadership; staff hearts and minds; respectful partnership; reliable care; and evidence-based care.”Read Full Post | Make a Comment ( None so far )
The Pursuit of Genuine Partnerships with Patients and Family Members: The Challenge and Opportunity for Executive Leaders – IHI – 2010
The Pursuit of Genuine Partnerships with Patients and Family Members: The Challenge and Opportunity for Executive Leaders – Jane Taylor, Patricia Rutherford Frontiers of Health Services Management 2010 26:4: 3-14
“Summary • Empowering patients to control their own healthcare experiences, sharing decisions with patients and family members, being open and transparent, and anticipating patient needs create fresh partnerships between healthcare professionals and patients. The “new rules” the Institute of Medicine (IOM) defined in its 2001 report Crossing the Quality Chasm provide guidance for leading a cultural transformation in which clinic and hospital staff truly partner with patients and their family members. The resulting experiences inspire patients to say, “They give me exactly the care I want and need, exactly where and how I want and need it” (Berwick 2009). Improved health outcomes and patients who control their own hospital stays are simple concepts that are difficult to execute. Some may view these new relationships as disruptive to clinical decision making; others may see no need to change the way they’ve always done things.
Executives are called to lead a cultural transformation—that is, to shape the views, perspectives, and behaviors of the individuals throughout their organization to achieve patient- and family-centered care. This article uses Kouzes and Posner’s (2007) leadership framework to outline how executive leaders might embrace this challenge and accomplish profound change. We support this idea with examples from our practice at the Institute for Healthcare Improvement.”Read Full Post | Make a Comment ( None so far )
Conway J, Federico F, Stewart K, Campbell MJ. Respectful Management of Serious Clinical Adverse Events. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2010.
“This white paper introduces an overall approach and tools designed to support two processes: the proactive preparation of a plan for managing serious clinical adverse events, and the reactive emergency response of an organization that has no such plan.”
…continues on the siteRead Full Post | Make a Comment ( None so far )
Options for Large-scale Spread of Simple, High-impact Interventions – September 2010
This report was prepared by the USAID Health Care Improvement Project (HCI), implemented by University Research Co., LLC (URC), for review by the United States Agency for International Development (USAID) and by request of the World Health Organization (WHO) Patient Safety Programme and the Harvard School of Public Health. It was authored by M. Rashad Massoud (URC), Katlyn L. Donohue (URC), and C. Joseph McCannon (Institute for Healthcare Improvement).
“This paper outlines what we know to be effective in the adoption and spread of high-impact interventions.”
Recommended citation: Massoud MR, Donohue KL, and McCannon CJ. 2010. Options for Large-scale Spread of Simple, high-impact Interventions. Technical Report. Published by the USAID Health Care Improvement Project. Bethesda, MD: University Research Co. LLC (URC).Read Full Post | Make a Comment ( None so far )
Patient- and Family-Centered Care Organizational Self-Assessment Tool – Institute for Healthcare Improvement (US)
Patient- and Family-Centered Care Organizational Self-Assessment Tool – Institute for Healthcare Improvement (US)
“This self-assessment tool allows organizations to understand the range and breadth of elements under patient- and family-centered care and to assess where they are against the leading edge of practice. Use this self-assessment tool to assess how your organization is performing in relation to specific components of patient- and family-centered care, or as a basis for conversations about patient centeredness in the organization.”
Login (free) required in order to access the download of the tool.Read Full Post | Make a Comment ( None so far )
Reducing Costs Through the Appropriate Use of Specialty Services. IHI Innovation Series white paper – 2010
Baker N, Whittington JW, Resar RK, Griffin FA, Nolan KM. Reducing Costs Through the Appropriate Use of Specialty Services. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2010.
[Free] login required to download the white paper.
“This white paper describes efforts by the Institute for Healthcare Improvement (IHI) to find ways to reduce overuse, with a focus on specialty services, by identifying the most promising change ideas from case examples and the literature, and by incorporating improvement methodology to implement these changes. The resulting framework is a theory of the elements needed to reduce costs through the appropriate use of specialty services, focused primarily on changing professional practice culture by engaging physicians in developing and implementing practice standards that will work best in local circumstances.”
…continuesRead Full Post | Make a Comment ( None so far )
Improvement Map Launch Approaching … US Institute for Healthcare Improvement
“With the official launch of the IHI Improvement Map on September 15 , improvers all over the world will have access to a new, interactive, web-based tool that distills the best clinical and managerial information available to help hospitals provide exceptional care. IHI has assembled an array of exciting programs – including our new membership program, Passport – to help hospitals implement key processes in the Improvement Map.”Read Full Post | Make a Comment ( None so far )
Raising Joy in the Health Care Workforce
Thursday, July 9, from 2:00 – 3:00 PM Eastern Time (US) – event can be downloaded afterwards from the Archive
Joanne Watson, IHI Fellow and Consultant Endocrinologist, NHS
Katie Bell, Partner and Lead, Gallup-Healthways Well-Being Index
“There’s nothing optional about a health care workforce that’s capable and empowered to deliver optimal care to patients. Staff members who are engaged in their jobs, have opportunities for growth and development, and feel respected by trusted colleagues and higher ups alike, go out of their way to implement best practices and, in the process, help their organizations earn reputations for best places to work.
Join WIHI host, Madge Kaplan, and experts Joanne Watson and Katie Bell, for a lively discussion of new research findings and new strategies being deployed to build stronger connections between clinical outcomes, patient-centered care, and engaged frontline employees. Come listen, share your knowledge, and ask questions on IHI’s brand new audio “talk show” – the first of its kind devoted to capturing the best ideas for reforming the health care system through system redesign.
WIHI is a new free audio/web broadcast from the Institute for Healthcare Improvement that combines the best of improvement ideas with global experts, a seasoned host, and hundreds of engaged participants. The 60-minute program is offered live every other week and by download whenever it’s convenient for you to listen. Produced and hosted by Madge Kaplan, WIHI is your opportunity to meet up with colleagues who want to improve patient care and shape a true health reform agenda.”
Increasing Efficiency and Enhancing Value in Health Care: Ways to Achieve Savings in Operating Costs per Year – IHI – Jun 2009
Martin LA, Neumann CW, Mountford J, Bisognano M, Nolan TW. Increasing Efficiency and Enhancing Value in Health Care: Ways to Achieve Savings in Operating Costs per Year. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2009.
“Until recently, the rationale for health care providers to undertake quality improvement (QI) initiatives rested largely on “doing the right thing”; any financial benefit resulting from QI efforts was regarded as an attractive side effect. However, changes in the current economic environment and mounting evidence that better care can come at lower cost provide additional motivation. Thus far, the Institute for Healthcare Improvement (IHI) has focused efforts to make the business case for improving quality on trying to identify the “dark green dollars” (i.e., actual savings on the bottom line, as opposed to theoretical cost savings that cannot be tracked to the bottom line, or “light green dollars”) resulting from QI projects. This method has proved very challenging; although hospitals often claim cost savings from such projects, it is rarely (if ever) possible to track the savings to a specific budget line item.
A new approach to the business case is the systematic identification and elimination of waste, while maintaining or improving quality. Here, the aim is primarily financial; any positive impact on quality, while desired, is secondary. IHI’s new way of thinking about “dark green dollars” is to express the improvement aim in terms of waste reduction—that is, to identify inefficiencies in the system and remove them, rather than separating out, or not addressing, the cost of a quality improvement project and the potential savings it generates. This paper proposes a set of steps health care organizations can undertake to systematically identify and eliminate inefficiencies to create a portfolio of work leading to a 1 percent to 3 percent savings in operating costs per year. Methods for developing a balanced portfolio of projects and for calculating and tracking cost savings are also described.”Read Full Post | Make a Comment ( None so far )
“This Second Edition of the IHI Global Trigger Tool for Measuring Adverse Events white paper contains no substantive changes to the overall methodology or process for review. Clarifications have been made to some text and trigger definitions. Experienced reviewers will note that there are changes to the list of triggers. ”
“Traditional efforts to detect adverse events have focused on voluntary reporting and tracking of errors. However, public health researchers have established that only 10 to 20 percent of errors are ever reported and, of those, 90 to 95 percent cause no harm to patients. Hospitals need a more effective way to identify events that do cause harm to patients in order to quantify the degree and severity of harm, and to select and test changes to reduce harm.
The IHI Global Trigger Tool for Measuring Adverse Events provides an easy-to-use method for accurately identifying adverse events (harm) and measuring the rate of adverse events over time. Tracking adverse events over time is a useful way to tell if changes being made are improving the safety of the care processes. The Trigger Tool methodology includes a retrospective review of a random sample of patient records using “triggers” (or clues) to identify possible adverse events. Many hospitals have used this tool to identify adverse events, to measure the level of harm from each adverse event, and to identify areas for improvement in their organizations. It is important to note, however, that the IHI Global Trigger Tool is not meant to identify every single adverse event in a patient record. The recommended time limitation for review and the random selection of records are designed to produce a sampling approach that is sufficient for the design of safety work in the hospital.”… continues on the websiteRead Full Post | Make a Comment ( None so far )
Griffin FA, Resar RK. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2009. May 2009
This Second Edition of the IHI Global Trigger Tool for Measuring Adverse Events white paper contains no substantive changes to the overall methodology or process for review. Clarifications have been made to some text and trigger definitions. Experienced reviewers will note that there are changes to the list of triggers. Changes to the triggers in the Second Edition will not affect data for organizations that have been using the prior version of the IHI Global Trigger Tool.Read Full Post | Make a Comment ( None so far )
Reducing Average Length of Stay on Mechanical Ventilation Using Bundles and Mobility
University of Rochester Medical Center
Rochester, New York, USA
The team from University of Rochester Medical Center is a participant in IHI’s Improving Outcomes for High-Risk and Critically Ill Patients Learning and Innovation Community.
The team’s overarching goal was to achieve a 20 percent reduction in length of stay across all adult intensive care units (ICUs) by:
* Achieving and sustaining a reduction in ventilator-associated pneumonia (VAP) to less than 1 VAP per 1,000 ventilator days before December 2009 by attaining greater than 95 percent compliance with daily sedation interruption and patient mobility
* Reducing complications from central lines by 90 percent before December 2009 by implementing the Central Line Insertion Bundle and a Central Line Maintenance Bundle, and mandating data collection on all ICUs to track compliance
… information continues on the websiteRead Full Post | Make a Comment ( None so far )
In the current climate of global economic change that influences how health care organizations set priorities and do their work, it is health care leaders and educators must act decisively for better health, better care, and better learning. The authors identify five strategies for addressing challenges and reshaping health care, and discuss competencies that offer a new bridge between health care operations and graduate medical education. Examples of new health professions education models to promote better care are also shared.Read Full Post | Make a Comment ( None so far )
In October 2008, the Institute for Healthcare Improvement (IHI) completed a 90-Day R&D Project to build on extensive work in the area of patient- and family-centered care. The focus of this project was to identify key drivers that have a positive affect on improving the inpatient care experience.
The materials posted here result from the work of the 90-day project:
1. IHI 90-Day R&D Project Summary Report: Improving the Experience of Inpatient Care
2. Driver Diagram for Improving the Inpatient Care Experience
3. Spreadsheet of Evidence from the Literature to Support the Drivers of the Inpatient Care Experience [see first tab in spreadsheet for explanation]
4. Selected Evidence to Support Primary Drivers of Improved Inpatient Experience of Care
5. Selected Core Readings: Improving the Patient Experience of Inpatient Care
Developed as part of the initiative, Transforming Care at the Bedside, a national program of the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement
The Healthcare Team Vitality Instrument (HTVI) measures team vitality with an emphasis on dimensions related to front-line staff empowerment and engagement, perception of a work environment supportive of safe and high quality patient care, effective communication, and team collaboration. The HTVI was initially developed to assess team vitality of nurses and other personnel working on inpatient medical-surgical units. The tool has been adapted based upon validation research.Read Full Post | Make a Comment ( None so far )
SBAR Training Scenarios and Competency Assessment – (Situation-Background-Assessment-Recommendation)
Institute for Healthcare Improvement (IHI) – US
Information from the Bronson Healthcare Group, Kalamazoo, Michigan, USA
These SBAR training scenarios, which reflect a range of clinical conditions and patient circumstances, are used in conjunction with other SBAR training materials to assess front-line staff competency in using the SBAR technique for communication.
Assessing the competency of front-line staff to use the SBAR technique is an important step in ensuring standardized communications in critical situations. Front-line staff are provided with one or more of the scenarios and asked to respond to the scenario with SBAR-based communication. The SBAR communications are assessed against the expected response and trained staff receive feedback of successful completion or suggested rehearsal resources and asked to repeat the exercise until competency is demonstrated.Read Full Post | Make a Comment ( None so far )
The IHI Improvement Map is an initiative to help hospitals make sense of countless requirements and focus on high-leverage changes to transform care. For details, download the Improvement Map overview.
The Improvement Map will cover the entire landscape of outstanding hospital care:
and now expanding the agenda with three new interventions:
- WHO Surgical Safety Checklist
- Prevent Catheter-Associated Urinary Tract Infections
- Link Quality and Financial Management: Strategies to Engage the Chief Financial Officer and Provide Value for Patients