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?’ ”