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Dispatches from IHI’s quality forum

Don Berwick is one of the leading lights of the health care quality world; an
oft-quoted and published visionary who founded the Institute for Healthcare Improvement to spread the gospel of transformation and improvement around the world. Sometimes, however, he can come across as messianic, especially when preaching to the choir in a setting like the IHI Forum, which took place last week in Nashville.

Some criticize Berwick and IHI for a lack of measurable outcomes for the interventions they preach. The most recent complaint like this concerns IHI’s 5 Million Lives campaign, which recommended that hospitals adopt a series of interventions to improve patient safety, promising that if they did so, 5 million patients would be saved. 

The campaign officially ended at this week’s conference, and no one at IHI can show data on the number of lives saved. It’s true that Berwick has a powerful voice and a broad platform, and he could use it to structure the work that needs to be done, rather than sticking to a combination of inspirational cheerleading and emotional appeal. But back when no one was thinking about quality, Berwick was championing it; and for some community hospital quality leaders who feel like they are the lone voice in the wilderness, his words keep them going all throughout the year.

For those of you who didn’t make it Nashville, here’s a quick rundown of my observations from various workshops and speakers.

I attended a fantastic session by Roger Resar of IHI on assessing and improving the risk resilience of your organization. If you ever get the chance to hear Roger speak anywhere, you should go regardless of the topic. I also went to an interesting but fairly basic session on “Leadership of Large Scale Change.” I attended because Gary Kaplan, CEO of Virginia Mason Medical Center in Seattle, spoke  and I admire Virginia Mason’s work in partnering directly with employers to create employee wellness and prevention benefits that decrease costs from overuse, keep employer insurance premiums low and efficiency of care delivery high. The session was useful, but fairly basic.

I was looking forward to the “Hippocrates Wept" program that concluded the first day events because it featured Tony Shalhoub, of TV’s “Monk,” and movie star F. Murray Abraham. It was a strange theatrical performance, featuring readings and film clips of physicians in theater, literature, and movies. One of the intentions behind the piece was to hold a mirror up to physicians to reveal how people feel about them, but because the physicians were usually stand-ins for the specter of illness or death, it wasn’t all that illuminating.

Day two kicked off with a good keynote by former Oregon governor John Kitzhaber, who covered some familiar territory about the health system in crisis and then talked about his reform plan. Politically realistic, it features basic universal coverage with a secondary market for private insurance. We’ll see how the brand new White House Office for Health Reform feels about his plan soon enough.

I attended an intriguingly-named session called “Geeky Trends for QI Experts,” which was really a description of Web 2.0. I knew I was in trouble when the presenter asked people to raise their hands if they could take a picture with their cell phone and leave them up if we could get that picture off our phones. Nearly all attendees lowered their hands with a hilarious giggle of self-realization. I sigh. We launched into an explanation of what RSS is and why we should not be afraid of it, because after all, it is “really simple.” I also learned that wiki is the Hawaiian word for “quick.” 

The fact that the session billed “Geeky Trends for Experts” is just a basic overview of tools that other industries have been using for a decade tells us something about health care. Patients are the exception here, as they are well-organized on the Web and growing, but as long as hospitals, physician groups, insurers, quality officers and safety improvement organizations remain so behind the curve, patients’ ability to leverage the Internet to manage their health will be limited.

It’s great that one patient with COPD can talk to another about her shared condition, but what about asymmetrical and timely communication with her doctor about a new medication? Or what about instantaneous notification to her case manager’s PDA if she is away from home and goes to the ED? Integration of values collected through her home health monitoring system into her EMR? Daily podcasts on managing fluids?  A “dealing with your HMO” wiki? 

I know all of this is in the works, but we need to do more to create physician and hospital leadership in this area. “Build it and they will come” will work with patients seeking advice or shared experiences; it won’t work with overworked, overwhelmed physicians or hospital administrators just trying to keep the hospital financially sound, clean, safe, and in line with mandates to report thousands of metrics to CMS, TJC, Leapfrog, etc. 

I don’t want to end on a down note. I do think hospital systems, including mine, are taking solid, incremental progress toward transparency on the web. But we’re still a long way off from the using the types of tools that already exist to improve health, and the time is ripe for a hospital leader or a prominent physician to pick this up and move it forward.  Not “build it and they will come,” but “lead and they will follow.”  Maybe what we need is a Don Berwick 2.0, who can lead the provider side into the new Health 2.0 crusade.

Amanda Goltz is a quality improvement director at a Boston hospital system.

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Amanda
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Amanda

Sarah, thank you so much for your comment. For what it’s worth I think you pitched the level of your IHI presentation exactly right for that audience. I share your passion for trying to spread these tools among QI folks, and I think one key point might be showing examples from other industries of how this has become the routine, normative way people do business. I know too many physician leaders who think blogs are authored by marginalized misfits and read by no one; and all I can say is that social media is how half of the world (and… Read more »

Sarah Fraser
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Hi there. Good summary of the ocnference that I agree with. I was the presenter for the geeky workshop and you’re right – it was very basic. There are some organisations I work with who are well advanced, however, the pitch for the IHI conference was my impassioned plea to take notice of it. The majority of QI people I encounter have not even started to think about the applications and implications. So yes, let’s look forward to the day when we can talk about the advanced applications and the interesting stuff!
Sarah