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Tejal Gandhi galvanized as merger of IHI, NPSF multiplies efforts around patient safety

By | July 17 th,  2017 | chief executive officer, patient safety, Blog, Institute for Healthcare Improvement, National Patient Safety Foundation, Tejal Gandhi | 1 Comments

 

One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2017. Furst Group and NuBrick Partners, which comprise the companies of MPI, sponsor the awards.

 

The merger of the Institute for Healthcare Improvement and the National Patient Safety Foundation is now official, and Tejal Gandhi, who led the NPSF, couldn’t be happier.

 

“The reason for the merger was really based on mission,” she says. “IHI had been wanting to strengthen its efforts in patient safety, and that was part of its new strategy that it had been thinking about. And we on the NPSF side felt we had been doing some meaningful work in safety, but we’re small and wanted to expand our reach. It was a perfect union.”

 

In the new structure, Gandhi, a frequent honoree as one of the top leaders in healthcare, moves to a new role as chief clinical and safety officer for IHI. “I’ll be overseeing all of the safety efforts and, more broadly, getting engaged on some of the IHI’s other efforts across the spectrum of quality.”

 

In this, Gandhi will lean on her experience as the former executive director of quality and safety at Brigham and Women’s Hospital, and chief quality and safety officer at Partners Healthcare.

 

The patient-safety movement includes dozens of groups, with many different approaches and agendas. As a result, sometimes the approach and effectiveness can be fragmented. Gandhi says she hopes the merger, which combined two respected entities, can help focus future work.

 

“We want to be a single unified voice,” she says.

 

The NPSF released a major report in December 2015 called Free From Harm: Accelerating Patient Safety Improvement Fifteen Years After To Err Is Human, which outlines eight steps that the healthcare industry can take to significantly reduce mistakes and injuries in the healthcare setting. IHI’s muscle will allow for a broader discussion of the themes in that report. In addition, in conjunction with the American College of Healthcare Executives, IHI/NPSF recently released an executive “blueprint” to help healthcare leaders implement real, not theoretical, steps to reduce safety events under their watch.

 

“We think culture is driven through leadership,” Gandhi says. “The C-suite needs to take ownership and drive this culture of safety. We’ve been saying this for 15 years but haven’t necessarily given the C-suite the real tools to do it.”

 

The blueprint is designed to help change that. “If you look at data around the safety culture, we have a lot of room for improvement,” she says.

 

“There’s still about 40 percent of people who answer surveys who say they are worried about punishment if they speak up about an issue.”
A wide range of CEOs, safety officers and researchers convened to decide what would go into the blueprint.

 

“We’re very excited about the work,” she says. “It includes practical strategies and tactics for organizations to drive toward a culture of safety. And then, with the partnership of ACHE to help disseminate it, we have a lot of follow-up education planned.”

 

Gandhi also is taking her knowledge to the board room, knowing that directors can set the tone for healthcare organizations. Last October, she was asked to join the board at Aurora Health Care, a major Wisconsin health system.

 

“They wanted a physician, and they wanted someone who very much understood quality and safety,” Gandhi says. “I think Aurora has a great track record already in quality and safety, and they were enthusiastic about taking it to the next level. Given my new role at IHI, the opportunity to bring new ideas will be really exciting.”

 

Some of Gandhi’s ideas, thankfully, are catching on in patient safety, like looking at patient care in all settings, not just the hospital.

 

“When I started out in patient safety, my research area of interest was patient safety in the ambulatory setting,” she says. “We have constantly been pushing the fact that we need to think about safety across the entire care continuum. I think we’re finally seeing a shift now. People understand that it’s not just a hospital issue.”

 

IHI/NPSF currently has a grant from the Moore Foundation to conduct research on patient safety in the home, and Gandhi lists other areas that need scrutiny as well, from primary care to ambulatory surgery to dialysis centers.

 

Behind all these activities stands the need for transparency, which Gandhi has called a paramount attribute in a culture of safety.

 

“We’re making progress, but we have a long way to go – I feel like I say that about everything in safety,” she explains. “Compared to 15 or 20 years ago, there’s much more transparency about errors. There’s transparency about errors when they happen with disclosures and apologies, transparency with the public with data about mortality, infections and readmissions being available, and there’s transparency between clinicians or within and across organizations. But it’s far from perfect.”

 

Yet with all the progress, Gandhi remains wary about errors on another front – electronic health records.

 

“I’m a firm believer that EHRs can provide safety benefits through things like decision support and data accessibility,” she says. “We’ve seen many studies on the benefits of EHRs for quality and safety. But the flip side is that a lot of those studies were done in places that had customized, home-grown EHR systems developed with the end-user in mind. Most EHR systems aren’t like that. And we’ve seen examples of these systems actually creating unintended consequences or new errors.”

 

Gandhi says the IHI-NPSF merger is important because safety remains a bedrock issue that the healthcare industry has not fully come to terms with.

 

“I have spoken to many clinicians who say they would never let a loved one stay in a hospital without them present at all times,” says Gandhi, herself an MD. “But it’s unrealistic to think that’s a solution. Not everyone has a clinician in the family, and even those who do cannot avoid risks entirely. We need to improve safety for all patients in all settings at all times.”

 

 

SIDEBAR: Eight recommendations on safety from ‘Free From Harm’

 

Tejal Gandhi, MD, mentioned the report, “Free From Harm,” contains eight key goals for “achieving total systems safety”:

 

  • Ensure that leaders establish and sustain a safety culture.
  • Create centralized and coordinated oversight of patient safety.
  • Create a common set of safety metrics that reflect meaningful outcomes.
  • Increase funding for research in patient safety and implementation science.
  • Address safety across the entire care continuum.
  • Support the healthcare workforce.
  • Partner with patients and families for the safest care.
  • Ensure that technology is safe and optimized to improve patient safety.
  •  

     

    Classic content from 2015 Top 25 Women in Healthcare: Maureen Bisognano from the IHI

    By | October 30 th,  2015 | Healthcare, Triple Aim, hospitals, IHI, Maureen Bisognano, Modern Healthcare, Blog, CEO, Institute for Healthcare Improvement, leadership, MOOC, safety, upstream, quality, Top 25 Women in Healthcare | Add A Comment

     

    Classic content from 2015: One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

     

    For the last 20 years, it’s been common for healthcare executives to look to the aviation industry for both inspiration and best practices in improving quality and safety. But Maureen Bisognano, CEO of the Institute for Healthcare Improvement, thinks perhaps we should look beyond the horizon for the next step.

     

    “Twice this year, IHI has led a study tour down to NASA,” says Bisognano, who is retiring at the end of the year. “When you walk into NASA, there is a wall that tracks the journey of a space shuttle from when it comes onto the launch pad until it returns safely back home.”

     

    That board also tracks every near-miss, equipment failure, employee injury and fatality that has happened across the shuttle program. And when teams see that wall, that gets them thinking about the depth of the details in such transparency.

     

    “Nobody in healthcare understands safety that way,” she says. “If we make an analogy to healthcare, the left side of the map might answer questions like: Have we safely admitted patients into the hospital? Do we understand everything about that patient’s care and life outside the hospital, and have we brought that knowledge to the people who will be caring for that patient in the hospital?”

     

    The other side of the board, Bisognano says, could provide responses to the question, “Have we safely guided this patient back into the community with access to medications, food and care?”
    Looking at healthcare issues from a different angle is standard operating procedure at the IHI, which can usually be found on the cutting edge of health innovation. And, while it is true that the healthcare industry is adjusting to some of the biggest changes in its history under the Affordable Care Act, it’s Bisognano’s belief that the current disruptions are small compared to what’s coming down the pike.

     

    “I think leadership is in the midst of a transition,” she says. “Leaders are going to be out in the community in ways they never were before. They’re going to begin to understand what it’s like to live in a particular neighborhood –how can their hospital or physician practice or ACO create health in that environment? They’re going to be looking way outside the walls of the organization. I think they’re going to be challenged by managing multi-professional teams, because there is no way that healthcare can be provided by a specific discipline anymore.”

     

    Those are bold words, but Bisognano says that scenario is the end result of what it means to move “upstream” into a community to deliver care, a concept that has been around for years but is gaining new urgency as hospitals and health systems seek to prevent readmissions. And data is the key to that, Bisognano notes.

     

     

    “The notion of ‘upstreamism’ means that people are going to be engaging with data and technology in ways that they never did before,” she says. “We need roles like ‘upstreamists’ and ‘extensivists.’ Upstreamists are people who say, ‘I will look at all of the population health data, and I will help us to think about what kinds of interventions will have the greatest impact on health by looking way upstream.’ ”

     

    In a new project called One Hundred Million Healthier Lives, Bisognano and the IHI are having the chance to put a grand notion like that into practice by partnering with community organizations as well as a number of healthcare providers across the country.

     

    “As an example, I’m seeing in some communities that the upstream data is telling the healthcare system that the biggest impact it could have is to work on getting homeless veterans into permanent housing,” she says. “In another community, we’re looking at the healthcare system partnering with others to work on the health of children under 5, because the children of that community are not healthy right now.

     

    “By ignoring that population, these children are going to experience a future 70 years of bad health and lots of unnecessary cost and burden on the healthcare system. But if we put our focus and attention on those kids, we’re hopefully buying them and the healthcare system 70 years of good health.”

     

    IHI’s sphere of interest extends far beyond North America. Bisognano and the IHI have long studied other nations’ healthcare systems, and she is quick to note that U.S. healthcare providers can get quite an education from other nations.

     

    “I have the great fortune to be in a position to work in different countries all over the world. I see opportunities for us to learn from other countries – some low- and middle-income countries – and certainly from countries like Sweden and Denmark,” she says. “With the speed of change needed here, leaders who can look up and look out will be able to incorporate new models, new ways of thinking in a way that gets to the Triple Aim much more quickly.”

     

    The Triple Aim, of course, is one of the IHI’s signature initiatives – improving the patient experience, improving population health, and lowering healthcare costs. It has been adopted by numerous hospitals and health systems. Through its conferences, research and open school (265,000 students in 73 countries), the IHI has multiplied its influence over the past two decades. Now, it is partnering this fall with the Harvard TH Chan School of Public Health to offer a free massive open online course (MOOC) that Bisognano hopes will attract more than 30,000 physicians and nurses in the next year.

     

    Through all of these channels, Bisognano hopes the IHI will play no small role in preparing next-generation leaders. “I’m so encouraged with the students who are learning improvement. They see improvement as just a way of life, so they don’t feel the frustration. They also don’t tend to get as burned out because, when they see a problem, they have the tools to improve it.”

     

     

    Maureen Bisognano looks beyond the healthcare silo for improvement

    By | October 16 th,  2015 | Healthcare, Triple Aim, hospitals, IHI, Maureen Bisognano, Modern Healthcare, Blog, CEO, Institute for Healthcare Improvement, leadership, MOOC, safety, upstream, quality, Top 25 Women in Healthcare | Add A Comment

     

    One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

     

    For the last 20 years, it’s been common for healthcare executives to look to the aviation industry for both inspiration and best practices in improving quality and safety. But Maureen Bisognano, CEO of the Institute for Healthcare Improvement, thinks perhaps we should look beyond the horizon for the next step.

     

    “Twice this year, IHI has led a study tour down to NASA,” says Bisognano, who is retiring at the end of the year. “When you walk into NASA, there is a wall that tracks the journey of a space shuttle from when it comes onto the launch pad until it returns safely back home.”

     

    That board also tracks every near-miss, equipment failure, employee injury and fatality that has happened across the shuttle program. And when teams see that wall, that gets them thinking about the depth of the details in such transparency.

     

    “Nobody in healthcare understands safety that way,” she says. “If we make an analogy to healthcare, the left side of the map might answer questions like: Have we safely admitted patients into the hospital? Do we understand everything about that patient’s care and life outside the hospital, and have we brought that knowledge to the people who will be caring for that patient in the hospital?”

     

    The other side of the board, Bisognano says, could provide responses to the question, “Have we safely guided this patient back into the community with access to medications, food and care?”
    Looking at healthcare issues from a different angle is standard operating procedure at the IHI, which can usually be found on the cutting edge of health innovation. And, while it is true that the healthcare industry is adjusting to some of the biggest changes in its history under the Affordable Care Act, it’s Bisognano’s belief that the current disruptions are small compared to what’s coming down the pike.

     

    “I think leadership is in the midst of a transition,” she says. “Leaders are going to be out in the community in ways they never were before. They’re going to begin to understand what it’s like to live in a particular neighborhood –how can their hospital or physician practice or ACO create health in that environment? They’re going to be looking way outside the walls of the organization. I think they’re going to be challenged by managing multi-professional teams, because there is no way that healthcare can be provided by a specific discipline anymore.”

     

    Those are bold words, but Bisognano says that scenario is the end result of what it means to move “upstream” into a community to deliver care, a concept that has been around for years but is gaining new urgency as hospitals and health systems seek to prevent readmissions. And data is the key to that, Bisognano notes.

     

     

    “The notion of ‘upstreamism’ means that people are going to be engaging with data and technology in ways that they never did before,” she says. “We need roles like ‘upstreamists’ and ‘extensivists.’ Upstreamists are people who say, ‘I will look at all of the population health data, and I will help us to think about what kinds of interventions will have the greatest impact on health by looking way upstream.’ ”

     

    In a new project called One Hundred Million Healthier Lives, Bisognano and the IHI are having the chance to put a grand notion like that into practice by partnering with community organizations as well as a number of healthcare providers across the country.

     

    “As an example, I’m seeing in some communities that the upstream data is telling the healthcare system that the biggest impact it could have is to work on getting homeless veterans into permanent housing,” she says. “In another community, we’re looking at the healthcare system partnering with others to work on the health of children under 5, because the children of that community are not healthy right now.

     

    “By ignoring that population, these children are going to experience a future 70 years of bad health and lots of unnecessary cost and burden on the healthcare system. But if we put our focus and attention on those kids, we’re hopefully buying them and the healthcare system 70 years of good health.”

     

    IHI’s sphere of interest extends far beyond North America. Bisognano and the IHI have long studied other nations’ healthcare systems, and she is quick to note that U.S. healthcare providers can get quite an education from other nations.

     

    “I have the great fortune to be in a position to work in different countries all over the world. I see opportunities for us to learn from other countries – some low- and middle-income countries – and certainly from countries like Sweden and Denmark,” she says. “With the speed of change needed here, leaders who can look up and look out will be able to incorporate new models, new ways of thinking in a way that gets to the Triple Aim much more quickly.”

     

    The Triple Aim, of course, is one of the IHI’s signature initiatives – improving the patient experience, improving population health, and lowering healthcare costs. It has been adopted by numerous hospitals and health systems. Through its conferences, research and open school (265,000 students in 73 countries), the IHI has multiplied its influence over the past two decades. Now, it is partnering this fall with the Harvard TH Chan School of Public Health to offer a free massive open online course (MOOC) that Bisognano hopes will attract more than 30,000 physicians and nurses in the next year.

     

    Through all of these channels, Bisognano hopes the IHI will play no small role in preparing next-generation leaders. “I’m so encouraged with the students who are learning improvement. They see improvement as just a way of life, so they don’t feel the frustration. They also don’t tend to get as burned out because, when they see a problem, they have the tools to improve it.”

     

     

    At HealthPartners, Mary Brainerd's leadership approaches solutions from a nuanced angle

    By | August 5 th,  2015 | Affordable Care Act, delivery, merger, payers, Triple Aim, financing, Modern Healthcare, organizations, ParkNicollet, providers, Blog, cancer, CEO, Head + Heart Together, Institute for Healthcare Improvement, leadership, Mary Brainerd, Northwest Alliance, safety, HealthPartners, quality, Top 25 Women in Healthcare | Add A Comment

     

    One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.

     

    While HealthPartners CEO Mary Brainerd is pleased that more people now have insurance through the Affordable Care Act, you’ll have to excuse her if she’s a little frustrated with how the law has had a rocky start in Minnesota, where innovations that already existed were scuttled by Obamacare.

     

    For example, Minnesota residents who had pre-existing conditions already had insurance coverage through a special high-risk pool that included businesses as well as individuals. It had been functioning just fine for 30 years. The ACA shut the program down. Those individuals were forced to buy insurance products on the clunky exchange and now, in Year 2, are facing rate hikes of more than 50 percent because the risk pool is too small.

     

    “That’s a federal issue, and we wish it would change,” Brainerd says. “But it appears no one has the political will at the federal level to ask, ‘What’s not working, and how can we help make it better?’ The more you segment the market when people have serious health conditions, the higher the costs are both for these individuals and for these smaller funding pools that are responsible for covering their costs.”

     

    It’s an intriguing patient-centric perspective on Brainerd’s part, and comes from an angle that’s a little different than the typical healthcare-industry party line. But perhaps that’s to be expected from a respected executive with a degree in philosophy (as well as an MBA).

     

    “I think there are actually a lot of areas in which both philosophy specifically and liberal arts in general add value, and that is that you spend time studying many different perspectives on the same topic,” she says. “So when you’re faced with challenges and decisions, you’re less likely to think there’s a formulaic right answer. Instead, you’re more likely to think there are many perspectives on this issue to explore and understand before moving to quick decisions.”

     

    A 2013 merger with the ParkNicollet system was significant for HealthPartners because it doubled the organization’s patient base to more than 1 million and expanded the payer-and-provider capabilities that the company had been executing for 50 years. Other healthcare organizations are now jumping into the payer-provider mix, and Brainerd has some advice for them.

     

    “I think the challenge for organizations that are just creating those capabilities is not to think of them as two separate businesses but instead to look at them as very integrated, synergistic businesses that have the same strategy. We have the same strategic plan for our delivery system as we do for our health plan, and it’s focused on people as our chief resource and asset.”

     

    Yet the enormity of merging two large organizations was a challenge.

     

    “There are 23,000 people making decisions across our organization every minute of every day, and so what we do and how we do it has to come from that shared sense of value and a common sense of purpose,” Brainerd says.

     

    As the vehicle for that mission, HealthPartners’ culture is known as “Head + Heart, Together.” Internally, it has helped build cohesion. Externally, it has encouraged the organization get in front of the trend toward collaboration. For example, HealthPartners, Allina Health and a physicians’ group were all thinking about building an MRI center in one region of the Twin Cities metroplex. Instead, they worked together and built one center that they all utilize.

     

    HealthPartners and Allina also joined forces in an initiative called the Northwest Alliance, with a view to achieving Triple Aim results in quality and health improvement, especially in urgent care and mental health services.

     

    “Neither of us alone would have been able to bring that capability to the community,” she says.

     

    The results, she says, have been so strong that HealthPartners and Allina are planning to extend the original 7-year agreement before it even expires.

     

    Brainerd is equally committed to HealthPartners’ ties with the Institute for Healthcare Improvement, making, as in the case with the Northwest Alliance, the Triple Aim its overarching view of care. The Triple Aim’s focus on quality and safety is an area in which her personal experience has shaped her.

     

    More than a decade ago, she was a patient in her own system as she dealt with breast cancer. Her care was excellent, but there were some less-than-stellar interactions with the system that made her re-evaluate what HealthPartners’ patients experience.

     

    “I think anyone I know who has worked in healthcare and then has encountered the healthcare system as a patient, either themselves or a close family member, is changed by that experience,” she says. “Still, to this day, I almost viscerally recall that feeling of vulnerability that you have, and also the understanding that the physical challenges of treatments and surgeries is in many respects not even half the challenge of the emotional and psychological impact of a serious illness.

     

    “It was a life-changing experience for me, and I hope it made me a better leader for our organization.”

     

    While Brainerd says she believes the healthcare industry had made significant progress in safety, she also wonders what other blind spots exist.

     

    “If, 10 years ago, we didn’t see those issues in patient safety, what are the things we’re not seeing today that future leaders will reference and say, ‘Why weren’t they focused on that?,’ ” she says. “For example, in our aim to minimize pain, we’re actually creating an environment where there are many worse health consequences as the result of the abuse, misuse and overuse of narcotics. More than 80 percent of the world’s narcotics are prescribed in the United States. And then I wonder what tomorrow’s example will be. I want to look for it.”

     

     

    Personal experiences add passion to Maureen Bisognano's drive for patient-centered care

    By | July 18 th,  2013 | Triple Aim, IHI, Maureen Bisognano, Modern Healthcare, nurses, patient-centered, patient safety, president, Blog, board of directors, CEO, Institute for Healthcare Improvement, leadership, nursing, safety, quality, Top 25 Women in Healthcare | Add A Comment

     

    One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

     

    Questions.

     

    Maureen Bisognano asks a lot of them. She asked many questions when she was a nurse, and when she ran a hospital. Now, she asks plenty as the President and CEO of the Institute for Healthcare Improvement, the renowned organization that helps the healthcare industry improve the quality and safety of care.

     

    Leadership in these areas, Bisognano says, has to start at the top.

     

    “Many boards and leadership teams still don’t understand the meaning of these quality measures, in cost terms, and in terms of the impact they have on patients,” she says. “Leaders get a quality report that is red, yellow or green -- self-defined colors that don’t tell them nearly what they need to know When I go to visit a board or a senior team, I ask them four questions to provoke them to think at a deeper level.”

     

    Here are Bisognano’s four questions, with some of her comments for annotation:

     

    **Do you know how good you are as an organization? “It’s knowing this qualitatively and quantitatively, not just in terms of red, yellow or green. Do you hear what patients are saying? Do you have patients at the board meetings? Not just patients who have been harmed, but ones who have had a great experience, because boards need to know where to reinforce quality as well as where to push for better quality.”

     

    **Do you know where your variation is? “Boards and leaders mostly look at averages. So they don’t know if they’ve got some performers in their organization who are superstars and some who are really poor performers. By looking only at averages, they’re tolerating a level of bad performance that they wouldn’t if they better understood variation.”

     

    **Do you know where you stand relative to the best? “Most leaders don’t know the answer to this. They look at their own data and they may not realize that there are other organizations in their state, in the country, or in the world that are doing dramatically different, dramatically better. And that provokes thinking.”

     

    **Do you know your rate of improvement over time? “If you’re looking at static numbers, and thinking that they’re getting better, you may never know what the rate of improvement is. So I suggest to leaders that they always look at the rate of improvement over time.”

     


    As the developers of the Triple Aim, IHI’s knowledge and unique culture encourage and nurture respect.
    “At IHI, we are very much a team-based culture and our layout in Cambridge, Mass., reflects this,” Bisognano says. ”Everybody’s working throughout the course of a day on teams, so there’s constant challenge and learning and a great sense of camaraderie.”

     

    Even Bisognano, the CEO, doesn’t have an office of her own.

     

    “In my office, there are multiple workstations and a big table in the middle. So all day long, you’ll hear different conversations taking place. It’s very much a culture where, if you’re in the middle of something, you may need to stay focused on that. But if you’re interested in what your colleagues are talking about, you can turn around and contribute.”

     

    Currently, Bisognano’s office has ten names listed outside its doors, representing a diverse mix of IHI senior executives, Fellows, and Senior Fellows, including the former chief executive of the National Health Service in England as well as the president of the National Academy of Medicine in Mexico.

     

    Bisognano says IHI’s influence is felt in four concentric circles. Every 90 days, the members of the IHI R&D team select five to seven unsolved problems in healthcare to research in an attempt to generate solutions. That’s the inner innovation ring. The second circle is one focused on partnerships with organizations like Premier, Catholic Health Partners, Kaiser Permanente and the nation of Scotland to test out those solutions and demonstrate results.

     

    The third circle is where IHI concentrates on equipping thousands of professionals with improvement skills and capabilities, using the educational vehicles of forums, seminars and webinars. The last, outer ring is all about dissemination, “getting the word out” on IHI’s website, via IHI’s online ”talk show,” WIHI, through blogs and social media, and by actively working with reporters on timely stories for a wide range of media outlets. Thus, the work begun by 130 people in IHI’s offices can reach millions.

     

    “A lot of people know us by the Forum and by the Open School, but it’s a much more strategic and all-encompassing view when you look at us from the inside out,” she notes.

     

    The focus on partnerships is critical, Bisognano says, because IHI wants to help equip healthcare providers with the tools they need to achieve optimal care. And to do that, the care needs to be patient-centered. That’s a mission and a journey that is very personal to Bisognano.

     

    When she was in nursing school, Bisognano’s younger brother (she’s the oldest of nine children) was diagnosed with Hodgkin’s disease at a young age, a disease that ended his life.

     

    “I watched healthcare provide what it could for him. But I also watched what it didn’t do for him, and that was to support him and our family facing this inevitable death,” she says.

     

    She also grew in her own understanding, moving from a focus on what medicine could do, to what the patient wanted. She remembers vividly a day in a Boston academic medical center. The doctors had made their rounds as her brother Johnny grew weaker. One radiation oncologist, though, came back into the room.

     

    “Johnny, what do you really want?” he asked.

     

    “I want to go home,” he said.

     

    The physician didn’t say a word. He came over to Maureen, took her jacket from her, and wrapped it around Johnny. Then he carried Johnny to Maureen’s car.

     

    “I know that doctor broke every rule but he taught me an incredible lesson,” Bisognano says. “I thought my role was to give him encouragement and say, ‘Let’s try another round of chemotherapy.’ But my role was to ask him what he wanted. So when I got him home, I asked him what he wanted. He said, ‘I want to be 21.’ He died about five days after his 21st birthday. Those last few weeks were very meaningful, but very different. He was home, and we had all the family coming around to visit.”

     

    She learned another lesson from Robbie, her sister’s son. Robbie was a perfectly healthy baby, but had a severe allergic reaction to a DPT shot at 2 months old that put him in the intensive care unit for a week. He recovered. At his 4-month exam, the doctor was about to give his 4-month DPT vaccine, when Bisognano’s sister stopped him.

     

    “Don’t you remember what happened the last time?” she asked.

     

    “No, what?” asked the physician.

     

    She explained the reaction, the fear, the long hospitalization. The doctor paused for a moment, then said, “I don’t think the shot had anything to do with it, but I’ll only give him half a dose.”

     

    The vaccine was administered. Robbie was dead within 24 hours.

     

    Like Bisognano herself, her sister had questions.

     

    “My sister asked me three questions,” she remembers. “Why were his records in the hospital separate from the records in the doctor’s office? How did the doctor not know that you don’t give even half a dose if there has been an allergic reaction? And, most importantly, why didn’t he listen to me?”

     

    Those questions have driven Bisognano’s passion and guided her to this day.

     

    “What happened to Robbie changed me. But my sister never sued. Most families who have experienced medical errors don’t sue. They’re looking for recognition and acknowledgment and apology more than anything else.”

     

    One of the themes that Bisognano returns to is that healthcare is so complicated that a team approach is needed, and that one person can’t do it all.

     

    She was with a group of residents recently who had come through a Lean training week.

     

    “The first resident,” she says, “stood up to give his report and said, ‘I was blind to the mayhem. I would come in each morning, do my procedures, and I never saw all the other pieces of what was happening to these patients over the course of 24 hours, or over the course of a treatment diagnosis.’ ”

     

    That light bulb moment is similar to what nurses experience continually, she says. The Top 25 Women in Healthcare include a lot of women who, like Bisognano, got their start in nursing; she believes this view of the sum of the parts is one reason so many nurses have made the transition to the corner office.

     

    “Nurses are taught to see the whole health system, the whole journey of care, and we’re taught to see the family as part of the team,” she says. “I think that broad view of systems helps when you get to an executive level because you’re looking at how to put all the pieces together in a different and more effective way.”

    Profiles in Leadership: Healthcare reform a worldwide need, Bisognano says

    By | September 12 th,  2011 | Healthcare, Top 25 Women, IHI, Maureen Bisognano, Modern Healthcare, patient-centered care, patient safety, president, Blog, CEO, healthcare reform, Institute for Healthcare Improvement, leadership, quality | 2 Comments

     

    One in a series of profiles of Modern Healthcare’s Top 25 Women in Healthcare (sponsored by Furst Group)

     

    In her travels around the world as the president and CEO of the Institute for Healthcare Improvement, Maureen Bisognano has discovered something: healthcare reform isn’t an exclusively American issue. Many countries, she says, are realizing they need to make some fundamental changes in their healthcare systems.

     

    “There are so many similarities that it’s uncanny,” she says. “You need to use different languages in different countries, but the fundamental problems are very, very similar.”

     

    Bisognano sees several universal issues, including finances, labor and patient-centered care.

     

    “In every country that we work in, there are insufficient numbers of skilled people to do the kind of work we need,” she notes. “Even here in the United States, we’ve got a graying population and fewer people coming into the healthcare systems as caregivers.”

     

    And, while American expenditures on healthcare outpace the rest of the world, Bisognano says the rest of the world is still wrestling with a lack of funds in that area.

     

    “Even in the developing countries, and the low and middle-income countries, finances are an issue. We need new designs in order to provide the care with limited resources. All over Europe and the U.K., we’re seeing budgets needing to be constrained.”

     

    Patients’ voices are being heard now more than ever in most sections of the globe, but Bisognano says they sometimes have a different idea of patient focus than in the U.S.

     

    “When I’m in Malawi or Ghana, in talking about patient-centered care, they actually kind of chuckle because they think that we don’t understand what patient-centered care is – and, in a sense, they’re right,” she says. “Because there, it’s not just the patient. It’s the family, it’s the village, it’s the tribe. And if you don’t get all these supports lined up, then a woman will not get to the hospital for a delivery. So they have a much more sophisticated understanding about what patient-centered care means.”

     

    IHI has long been known for its championing of patient-centered care. Bisognano and former CEO Don Berwick worked side by side for 16 years. She said she is encouraged by the strides she is seeing in this area, citing four examples:

     

    **In Sweden, a young aerospace technician wanted to do his own dialysis. A nurse taught him. He taught another patient. And now, in this Swedish hospital, 60 percent of the patients run their own dialysis, and their outcomes are better than those that don’t.

     

    **At Cincinnati Children’s Hospital, the staff conducts “Huddles” every few hours to coordinate patient care where the focus is always on the future – what might happen. “In many hospitals, you’ll see nurses meet periodically to discuss what happened, but it’s always in the past tense,” Bisognano says.

     

    **In Cedar Rapids, Iowa, Mercy Medical Center, without the benefit of being part of a large health system, has drastically reduced mortality rates and made patient-centeredness part of its DNA.

     

    **In Pittsburgh, orthopedic surgeon Anthony Digioia has redesigned the way hips and knees get replaced. Patients who go through the new process spend an average of 2-1/2 days in the hospital and 95 percent go home without a walker or a cane.

     

    Bisognano says these examples illustrate how innovation can revitalize healthcare.

     

    “I think the old methods of management that were much more top-down control don’t work when you’re undergoing transformations as radical as we need to undertake in these times,” she says. “And so, people are turning to innovation, and they’re turning to quality improvement and design.”

     

    As a former nurse herself, she sees nurses as an undertapped resource for driving improvement and innovation, because nurses have long had to troubleshoot at every turn.

     

    “If the medication wasn’t there, if supplies weren’t available, if the IV pole wasn’t there or a patient was late in arriving at the operating room, the nurse would scurry around to make up for that deficit in the process,” she says. “Nurses were rewarded for being able to adapt and overcome process-level problems.

     

    “We need to be trained a bit to be able to stop in the midst of fixing something and say, ‘Am I the only person this has happened to today? Is this a problem that happens frequently? Do I predict this will happen again tomorrow? If so, how do I use quality improvement methods to prevent this from happening tomorrow and to any other patient?’ ”

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