WELCOME An Introduction to IHI Penny Carver Senior Vice President

1. WELCOMEAn Introduction to IHIPenny CarverSenior Vice President Carnegie Foundation Knowledge Alliance Working Meeting January 20, 2010

2. IHI Mission The Institute for Healthcare Improvement is a not-for-profit organization driving the improvement of health by advancing the quality and value of health care.

3. Why We Exist “Between the health care we have and the care we could have lies not just a gap, but a chasm.” - Institute of Medicine, Crossing the Quality Chasm, 2001

4. Defects….for example… • 45% of needed care is not received • 22% of chronically ill adults report a “serious error” in their care • 74% of chronically ill adults say the system needs “fundamental change” or “complete rebuilding” • Case-mix adjusted hospital death rates vary 400% • Resource use in the last six months of life varies >500% among 77 top-rated US hospitals • Per capita annual health care costs: • US: ~$6000 • Sweden: ~$2800

5. Variation in Practice Hysterectomy by age 70 Prostatectomy by age 85 70 60 50 40 30 20 10 0 Main Maine Maine Maine Iowa Iowa Iowa Iowa hospital hospital hospital hospital hospital hospital hospital hospital

6. International Comparison of Spending on Health, 1980–2005 Average spending on healthper capita ($US PPP*) Total expenditures on healthas percent of GDP * PPP=Purchasing Power Parity. Data: OECD Health Data 2007, Version 10/2007. 8 Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008

7. Is there an achievement gap in education?

8. Our Blueprint: the IOM’s Six Aims • Safe – no needless deaths • Effective– no needless pain or suffering • Patient-Centered – no helplessness in those served or serving • Timely– no unwanted waiting • Efficient– no waste • Equitable – for all

9. We Do This By… • Building the will for change • Cultivate promising improvement ideas • Putting those ideas into action through effective execution “Improvement of any system requires will, ideas and execution.” - Tom Nolan, PhD

12. Institute for Healthcare Improvement2010 IHI Strategic Plan WHO WE ARE We are a reliable source of energy, knowledge, and support for a never-ending campaign to improve health and health care worldwide. WHAT WE WILL ACCOMPLISH In the US and abroad, we will improve the lives of patients, the health of communities, and the joy of the health care workforce, and reduce health care costs. We work with health care providers and others to accelerate the measurable and continual progress of health care systems throughout the world toward Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity. WHAT WE WILL BECOME We will be a recognized and generous leader, a trustworthy partner, and the first place to turn for expertise, help, and encouragement for anyone, anywhere who wants to change health care fundamentally for the better. Strategy #1: Motivate Stimulate the desire and optimism for change Strategy #3: Get Results Ensure wide adoption of sound changes Strategy #2: Innovate Create, find and test new models of care Strategy #4: Raise Joy in Work Help build a better health care workforce A. Publicize widely the case for improvement, promising designs and impressive results B. Publish widely in peer-reviewed journals C. Ally with influential organizations that share our aims to amplify our effectiveness D. Influence the national health policy debate A. Discover health care processes and systems that will deliver better outcomes and lower costs B. Demonstrate the efficacy of new models and codify content in preparation for spread A. Convene and manage vibrant networks, communities and partnerships to deploy proven changes rapidly B. Disseminate health care improvement ideas and methods through world-class learning events C. Create and expand a world-class web presence to propel the spread and adoption of improvements at very low cost A. Ensure that young health professionals are prepared for effective participation in improvement B. Ensure that executives, boards, and relevant public officials are prepared to support improvement C. Develop and nurture a cadre of improvement leaders Strategy #5: Stay Vital for the Long Haul Sustain IHI’s viability A. Continually improve IHI’s leadership system and plan for succession B. Make IHI the best place to work in the eyes of its employees and faculty C. Maintain a sound operating margin, continually reduce overhead costs D. Raise funds reliably to help support unfunded community benefits

13. How We Change the World

14. The Technical Approach

15. “Every System Is Perfectly Designed to Achieve Exactly the Results It Gets” (Therefore, although not all change is improvement, all improvement Is change) The First Law of Improvement

16. What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Act Plan Study Do Model for Improvement

17. DATA A P S D Repeated Use of the Cycles Changes that Result in Improvement A P S D A P S D A P S D Hunches Theories Ideas

18. P P P P A A A A D D D D S S S S S D S S S D D D A P A A A P P P A A A A P P P P S S S S D D D D P P P P A A A A D D D D S S S S Multiple PDSA Cycle Ramps Testing and adaptation Triage Diagnostic Testing Fast Track Patients Capacity/ Demanding Change Concepts

19. Applying the Model for Improvement to Education

20. The Social System Breakthrough Series Collaboratives

21. P P A D A D S S The Breakthrough Series Participants Select Topic Prework Printed Reports Change Concepts National Congress LS 1 LS 2 LS 3 Expert Group Supports Visits Documents E-mail Phone Assessments

23. Pursuing Perfection An IHI program funded by The Robert Wood Johnson Foundation to improve patient outcomes dramatically by pursuing perfection in all of the major care processes. Pursuing perfection means striving to: • Deliver all indicated services at the right time; • Avoid services that are not helpful to the patient or reasonably cost effective; • Avoid safety hazards and errors that harm patients and employees; and • Respect patients’ unique needs and preferences.   January 2001-April 2006

24. Unnecessary Hospital Deaths: Developing a Learning System • Do people die unnecessarily every single day in our hospitals? • In order for us to understand this, we need a diagnostic journey that moves out of a model for judgment and into a model for learning. • New model: - What can we learn from the deaths? - Was perfect care given? • You need to get a clearer understanding of local conditions that contribute to mortality.

25. IHI Approach to Mortality Reduction

26. Areas of Improvement That We are Focusing On • Box 3 Changes (ICU) • Ventilator Bundle • Central Line Bundle • Multidisciplinary Rounds/Shared Goal Sheet • Glycemic Control • Sepsis Bundle and detection • Appropriate tidal volume for ARDS/Acute Lung Injury patients - very early work for us

27. Areas of Improvement That We are Focusing On • Box 4 Changes (non-ICU) • Rapid Response Team • Improved communication • SBAR • Shift handoffs • Early Warning System • Multidisciplinary Rounds outside the ICU • Glycemic Control outside of ICU • Crew Resource Management Training

28. The “100,000 Lives Campaign”

29. The Campaign “Planks” -- Six Changes That Save Lives • Deployment of Rapid Response Teams • Delivery of Reliable, Evidence-Based Care for Acute Myocardial Infarction • Medication Reconciliation • Prevention of Central Line Infections • Prevention of Surgical Site Infections • Prevention of Ventilator-Associated Pneumonias

31. Six Additional Planks • Prevent Pressure Ulcers • Reduce Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection • Prevent Harm from High-Alert Medications • Reduce Surgical Complications (the Surgical Care Improvement Project (SCIP)) • Deliver Reliable, Evidence-Based Care for Congestive Heart Failure • Get Boards on Board

34. IHI Programs • The Improvement Map • WIHI • STAAR • Safer Patients Network • Scottish Patient Safety Programme (SPSP) • Triple Aim • How Do They Do That? • R&D • The IHI Open School

35. Builds on the great work of participants in the 100,000 Lives Campaign and the 5 Million Lives Campaign. • “Help us make sense of the many complex and competing demands we face.” • Brings together the best knowledge available on the key process improvements that will lead to exceptional hospital care.  • Helps hospital leaders set change agendas, establish priorities, organize work, and optimize resources. • An open resource, available free of charge to anyone, anywhere. • Launched on September 15, 2009.

37. Safer Patients Initiative An IHI Program Funded by The Health Foundation • The 100,000 Lives Campaign was built around 6 interventions • The Safer Patients Initiative combined 5 of the “Campaign 6” plus 10 other change elements • Phase 1: Four acute hospital trusts – Wales, Northern Ireland, England, and Scotland

38. Safer Patients Initiative Multiple “Centers of Gravity” • The SPI change package addresses five clinical areas: • - Medicines management • - Infection prevention and control • - Peri-operative care • - Critical care • - Care on general wards • All supported by an organisational wide effort to bring about a change in culture working at all levels but with a key role for senior leaders

39. Safer Patients Initiative

40. The “Triple Aim” • Improve Individual Experience • Improve Population Health • Control Inflation of Per Capita Costs The root of the problem in health care is that the business models of almost all US health care organizations depend on keeping these three aims separate. Society on the other hand needs these three aims optimized (given appropriate weightings on the components) simultaneously. --- (Tom Nolan, PhD)

41. How Do They Do ThatLow-Cost, High-Quality Care • July 21, 2009: Meeting in Washington, DC with Don Berwick, Elliott Fisher, Atul Gawande and Mark McClellan • Involving health care leaders from a select group of high-performing regions of the U.S. to share their experiences • Sponsored by the Institute for Healthcare Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, the Harvard School of Public Health, and the Engelberg Center for Health Care Reform at The Brookings Institution

42. $10,250 to 17,184 (55) 9,500 to < 10,250 (69) 8,750 to < 9,500 (64) 8,000 to < 8,750 (53) 6,039 to < 8,000 (65) Not Populated Much has been learnedPrice-adjusted per-capita Medicare spending 2006

43. Hope

44. 90-Day Project Topics November 2009-Janurary 2010 Hospital Projects • Waste Reduction Tool • Financial Implications for Hospitals of Reduce Readmissions • Learning from Specialty Care and ED Use Prototyping • Work Place Safety Program Development • Other Hospital Waste and Cost Reduction Projects as needed Triple Aim Projects • Triple Aim in a Region • Improvement at a Country Level • Connecting and Activating Community Health Care and Other Resources • Socially Complex Patients

45. The IHI Open School Mission “Advance health care improvement and patient safety competencies in the next generation of health professionals worldwide.”

46. The IHI Open School

47. Progress • Registration • Over 20,000 students registered on IHI.org • Over 6,000 faculty and deans registered on IHI.org • Online courses • Over 20,000 courses completed (50% students, 50% professionals) • Available: 6 Quality Improvement, 3 Patient Safety, 1 Leadership • Online Resources • Over 30,000 downloads of case studies, glossaries, exercises, activities • Over 58,000 downloads of audio and video recordings • Online Community • YouTube, Facebook, Blog, Twitter

48. IHI Open School Chapters 173 Chapters • 173 Chapters on 185 campuses • 119 US Chapters in 40 states • 54 International Chapters in 24 countries

49. Experiential Learning • Projects initiated by students • WHO Surgical Checklist Student Project • Projects initiated by faculty • Beverly Hospital Chapter • Projects initiated by the IHI Open School team • Shadowing students of another health profession

50. So Where Will IHI Lead? • To meet the challenge of moving the “big dots” • To create new, more effective designs • To ensure deep results and broad reach • To restore joy and confident capability