The Doctor and the Sheriff

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>
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This map shows the distribution of 2,760 Medicaid Births.
Census Blockgroups with less than 5 Medicaid Births are not labeled.
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Mobile Outreach Clinic Stops
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Color Legend: Approximate Number of Medicaid Births per Square Mile
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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
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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
wylliee48s@stirling.gov.uk
•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
mbisognano@ihi.org