May 2015 Jӧnkӧping, Sweden The Doctor and the Sheriff Inspiring a New Generation of Health Care Improvers Maureen Bisognano President and CEO The IHI Triple Aim “The secret of the care of the patient is in caring for the patient.” -Francis Peabody Toolkit to Care 1. Curiosity The Doctor The Human Cost of Preterm Births Infant mortality rate for preterm births before 32 weeks of pregnancy is 70 times greater than the infant mortality rate for infants born between weeks 37 and 41. Johnson, Steven Ross. "Mothers' Helpers: Providers, Insurers Use Home Visits to Reduce Infant Mortality." Modern Healthcare. Modern Healthcare. Crain Communications, Inc. Web. 16 Mar. 2015. <http://www.modernhealthcare.com/article/20150314/MAGAZINE/303149941> The Financial Cost of Preterm Births Average medical cost for a baby from birth through first year of Life Healthy, full-term baby from birth through the first year $5,085 Premature and/or low-birth weight baby (less than 37 weeks gestation and/or less than 2.5 kg) $55,393 Johnson, Steven Ross. "Mothers' Helpers: Providers, Insurers Use Home Visits to Reduce Infant Mortality." Modern Healthcare. Modern Healthcare. Crain Communications, Inc. Web. 16 Mar. 2015. <http://www.modernhealthcare.com/article/20150314/MAGAZINE/303149941> 10 95 63rd 1 12 12 53rd 6th 21 39th 52 22 9 8 32605 23rd 34th 39 13th 18 28 12 75th 18 e 40 72 23rd 103 18 wth o rn 29 ore esh Lak 81 32641 81 125 University Ha 25 33 1 12 24th 48 41st 94ton llis Wi 20 82 R h er Arc ky oc nt oi P 75 32667 47 63rd This map shows the distribution of 2,760 Medicaid Births. Census Blockgroups with less than 5 Medicaid Births are not labeled. 6 36 1 35 2 - 35 7 33 8 - 33 2 32 3 30 9 - 32 8 3 30 - 29 4 27 9 - 29 8 4 - - - 27 9 25 0 23 6 22 1 24 5 23 0 Mobile Outreach Clinic Stops - 22 5 20 6 - 20 1 19 2 - 19 6 17 7 - 17 2 16 3 - 16 7 - - 14 14 8 - 13 2 13 3 10 4 11 9 10 11 8 3 89 - 90 - 74 75 - 59 60 - 45 46 31 17 -1 6 30 Color Legend: Approximate Number of Medicaid Births per Square Mile 0 32608 37 69 18 32 16th 20th Mai n 64 5 32611 26 27 Depot 4th 15 141 24 27th 32601 44 45 8th 2nd 286 32607 15 15th 91st 6 22 32603 2nd 11 33 74th 5 berr y 55 th 10 New 8th 30 20 16th 6th 43rd 98th 5 11 23rd 23 8 64 108 13 W ald o 31st 22 11th §¨¦ 26 44 33 57 75 32606 38 32609 132 15th 19 43rd Millhopper 26 63rd 26 5 32653 39th 23rd 43rd G GA A II N NE ES SV V II L LL LE E ,, F FL L :: M ME ED D II C CA A II D D B B II R RT TH H D DE EN NS S II T TY Y A AN ND D C CO OU UN NT T B BY Y C CE EN NS SU US S B BL LO OC CK KG GR RO OU UP P (( 2 20 00 07 7 -- 2 20 00 09 9 )) The Doctor and the Sheriff Density of Child Maltreatment (2005-2008) Density of Domestic Violence Homeless Children Previous Address (2010) Low Density High Density Mobile Outreach Clinic Mission - Provide a clinical education to health students (undergraduate and graduate) - Promote a culture of service - Provide health care access to the medically underserved in our community Health Outreach Quality Improvement (HOQI) Program Created in Fall 2012 for undergraduate pre- professional students at UF Unique volunteering opportunity for students Hands-on learning experiences at clinic - Provide service that paid employees provide in our health science center clinics - Key role in coordinating care and services for patients outside of clinic visit Weekly commitment of 3-4 hours in clinic alternating with care coordination Mobile Outreach Clinic Student Reflections How to do local needs assessments and communicate results How clinicians can screen, diagnose, and help/hurt victims of Intimate Partner Violence (IPV) How to do diagnostics in a low resource environment Local food insecurity; “food deserts” Mobile Outreach Clinic Student Reflections Understanding literacy among our patients Transportation barriers for rural Alachua County and parts of greater Gainesville Awareness of how to find local resources for special populations Broad cultural sensitivity and humility, not race/ethnicity alone, but social and environmental disparities as well The Importance of Curiosity IQ – Intelligence Quotient processing complex data sets and having the mental capacity to problem solve at speed EQ – Emotional Quotient the ability to perceive, control and explain emotions; risk-taking, creating resilience and empathy CQ – Curiosity Quotient inquisitive, open to new experiences, finding novelty exciting Chamorro-Premuzic T. “Curiosity Is as Important as Intelligence.” Harvard Business Review. Aug 27, 2014. Toolkit to Care 1. Curiosity 2. Improvement Skills IHI Open School Online Resources • • • • • • • • Improvement Stories Tools Publications Case Studies Video Interviews Audio Clips Posterboards Weekly Newsletter Building Your Own Skills Learn how to improve in your daily work Move from “fix and forget” to “see, solve, and share” Learn to ask “what matters to you?” Hewitt TA, Chreim S. BMJ Qual Saf Published Online First: [10 Mar 2015] doi: 10.1136/bmjqs-2014-003279 Toolkit to Care 1. Curiosity 2. Improvement Skills 3. Teamwork Saskatoon: Admission-Discharge Ratio This is knowledge that would be wasted otherwise This Approach was developed by Dawn Calder and John Ash “Forecast model to predict surges in health care demand.” Saskatoon Health Quality Council Blog. Available at: http://blog.hqc.sk.ca/2015/04/07/forecast-model-topredict-surges-in-health-care-demand/ Improving With Your Team Using huddles to: Innovate Spread Exnovate Innovation Where are care models and processes broken? Where do we need new thinking? Innovation labs, design processes Harvesting Spread Where do we see variation in performance? How can we reliably spread to ensure that we can provide the best care to every patient, where they are? Transparent data Curiosity Spread Model Exnovation How do we stop what doesn’t work anymore? How will we eliminate wasteful practices and processes? It takes courage! IHI Leadership Alliance Radical Design Principles Design systems that expect and embrace change Change the balance of power Cultivate joy in work Make it easy Move knowledge, not people Cooperate and collaborate Assume abundance Return the money Berwick DM, Feeley D, Loehrer S. Change From the Inside Out: Health Care Leaders Taking the Helm. JAMA. Published online March 26, 2015. doi:10.1001/jama.2015.2830. Primary Children’s Hospital Salt Lake City, Utah Toolkit to Care 1. Curiosity 2. Improvement Skills 3. Teamwork 4. Taking Care of Yourself 100 Million Healthier Lives Who We Are 100 Million Healthier Lives is an unprecedented collaboration of change agents pursuing an unprecedented result: 100 Million People Living Healthier Lives by 2020 “Fit to play, fit to learn” St Ninians Primary School Stirling Scotland Ms Elaine Wyllie [email protected] •Our School friend ....81 •He has his own castle and estate •Hosts Famous Five nurture days •2 chess clubs + individuals • Storytelling, poetry, recitation penny whistle 33 I wonder? (Test 1) • Could the children run round the field a few times each day to get fit? • Took 1 class on 1 day out to run round the field a few times to see what would happen? • Many ‘couldn’t run the length of themselves.’ • Almost all of the children could only manage scout’s pace. It was true – they were not fit. How the Daily Mile Works • Children go out in almost all weathers • Context driven time chosen by the teacher • Easy to fit in to the day -fifteen minute turnaround max -no need to change into Exercise kit -no training for teachers – it is simple -it’s FREE! • regularly refreshed – e.g. links to national sporting events and to the curriculum • Integrated with policy educational activities (IDL) many links made Measurement • Each child / class plans their own approach to the Daily Mile and tracks their own performance. • measurement and goals vary and are suggested by the children and the class teacher. • Qualitative feedback from pupils, teachers and parents. Aim: To create an opportunity to get children fitter by running a mile everyday at St Ninians School, Stirling in Scotland by June 2012 Changes A P S D A P S D Cycle 2e:All classes participating including nursery Cycle 2d:Test the daily mile with Nursery class Cycle 2c: Test the daily mile including all classes Cycle 2b Test the daily mile with 4 classes Cycle 2a:Test the Daily mile with 2 classes new classes start at a Scout Pace Process Change: To introduce the Daily Mile ALL other classes Essence of the Change Keep people well Keep people whole Support health and well-being Make it easy When needed, best care in hospital Ask, “What makes a good day?” Caring at the End of Life “What’s a good day for you?” https://www.youtube.com/watch?v=Dnnu43ZtoA&list=UUAAMqu8sJ3ULFGI9FIC0jyA&index=1 Toolkit to Care 1. Curiosity 2. Improvement Skills 3. Teamwork 4. Taking Care of Yourself Tack! Maureen Bisognano President and CEO Institute for Healthcare Improvement 20 University Road, 7th Floor Cambridge, MA [email protected]
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