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The Doctor and the Sheriff Inspiring a New Generation of Health Care Improvers
May 2015
Jӧnkӧping, Sweden
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>
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
The Financial Cost of Preterm Births
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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81
1832
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696
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8th
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34th
16th
6th
Mai
n
Archer
Wal
do
University
75th
23rd
24th
43rd
Newberry
15th
331
20th
Hawthorne
55th
2nd
Williston
91st
98th
121
27th
63rd
31st
41st
4th 11t
h
Lakeshore
Depot
2082Rocky Point
Millhopper
74th
2nd
8th
63rd 39th
23rd
63rd
43rd
43rd
23rd
16th
6th
23rd
15th
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G A I N E S V I L L E , F L : M E D I C A I D B I R T H D E N S I T Y A N D C O U N T B Y C E N S U S B L O C K G R O U P ( 2 0 0 7 - 2 0 0 9 )G A I N E S V I L L E , F L : M E D I C A I D B I R T H D E N S I T Y A N D C O U N T B Y C E N S U S B L O C K G R O U P ( 2 0 0 7 - 2 0 0 9 )
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Color Legend:Approximate Number of Medicaid Births per Square Mile
Census Blockgroups with less than 5 Medicaid Births are not labeled.
This map shows the distribution of 2,760 Medicaid Births.
Mobile Outreach Clinic Stops
The Doctor and the Sheriff
High Density Low Density
Density of Child Maltreatment (2005-2008) Density of Domestic Violence
Homeless Children Previous Address (2010)
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
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
Mobile Outreach Clinic Student Reflections
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:
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-to-
predict-surges-in-health-care-demand/
Admission-Discharge Ratio
This is knowledge that would be wasted otherwise
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]
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•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
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.
A P
S D
A P
S D
Cycle 2a:Test the Daily mile with 2 classes new classes start at a Scout Pace
Cycle 2c: Test the daily mile including all classes
Cycle 2e:All classes participating including nursery
Cycle 2d:Test the daily mile with Nursery class
Cycle 2b Test the daily mile with 4 classes
Process Change: To introduce the Daily Mile ALL other classes
Changes
Aim: To create an opportunity to get children fitter by running a mile
everyday at St Ninians School, Stirling in Scotland by June 2012
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=Dnnu43Zt-oA&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
