Discharge to Assess (D2A) (also referred to as "flipped discharge") is a redesign of the care process at Sheffield Teaching Hospitals in the UK that involves assessing a patient’s needs after discharge in the patient’s own home rather than in the hospital. Activities that traditionally happen at the end of a hospital admission are instead performed successfully and safely at home, thus enabling patients who are medically ready to go home earlier and spend less time in the acute care setting.
November 9, 2017 | The health care quality improvement movement has rallied around some significant innovations over the years, many of which have had a lasting impact.
This tool is intended to be used as a starting guideline for individuals in the health care delivery context as they work to identify key areas of focus on racial justice and health equity, serving as a resource to begin conversations with teams within the organization toward developing a deeper understanding of structural racism and its impact on achieving health equity.
This article explains an emerging care model for older adults focused on the “4Ms” of Age-Friendly Health Systems — What Matters, Mobility, Medications, and the Mentation of older adults — that is in the testing phase at five health systems, as part of the Creating Age-Friendly Health Systems initiative led by IHI.
This curated publication highlights 10 ideas that have emerged from IHI's systematic 90-day innovation approach, including reflections on the Triple Aim, the concept of a health care Campaign, the Breakthrough Series Collaborative model, and other frameworks and fresh thinking that have been replicated around the world.
October 26, 2017 | These days, no one thinks twice about getting a mole removed or undergoing cataract surgery outside of a hospital. Upwards of 20 million outpatient procedures are performed in the US each year. As those numbers rise, so do concerns about safety.
This white paper guides health care leaders and quality improvement teams through an in-depth examination of a system-wide view of patient flow within (and outside) the hospital, including high-leverage strategies and interventions to achieve hospital-wide patient flow.
This article proposes quality improvement and implementation initiatives in health care, regardless of scope and resources, can be enhanced by applying epidemiological principles adapted from Bradford Hill Criteria to strengthen evidence of effectiveness.
In a systematic review of the literature on quality improvement collaboratives, a widely adopted approach to shared learning and improvement in health care, the authors conclude that, overall, the QI collaboratives included in their review reported significant improvements in targeted clinical processes and patient outcomes.
This article describes the building blocks of a value-management system in health care. The approach that IHI co-developed includes a simplified method to understand quality, cost, and workforce capacity on a weekly basis; a visual management system to present and analyze this data regularly; and daily, point-of-care communication to support continuous improvement.
October 12, 2017 | Often, what goes around really does come around. And that's been a good thing for an initiative focused on housing chronically homeless individuals along with high numbers of US veterans who are living on the streets.
The authors propose measuring quality from the patient’s perspective as an expression of his or her personalized health needs. The Personalized Perfect Care Bundle combines several distinct measures into one and is scored as “all-or-none,” with the patient’s care being counted as complete if he or she has met all of the quality measures for which he or she is eligible.
A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. This article finds a high frequency of blame in a random sample of safety incident reports in the UK, suggesting that there are still opportunities to shift toward a more systems-focused, blame-free culture in health care.
Engaging practice facilitators — individuals trained to build the improvement skills of ambulatory care teams — is an increasingly attractive approach, supported by a growing body of evidence that these facilitators are highly effective. This article lays out a framework to guide practice facilitators in building improvement capacity.
The article gives an overview of how five early-adopter US health systems — working in partnership with IHI and The John A. Hartford Foundation as part of the Creating Age-Friendly Health Systems initiative — are testing prototype models for age-friendly care using continuous improvement efforts to streamline and enhance new approaches to geriatric care.
This article describes the background, evidence-based changes, and testing, scale-up, and spread strategy that are part of the design of the Creating Age-Friendly Health Systems initiative to improve care for older adults.
A power imbalance often still exists in the patient-provider relationship, particularly when high-stakes health decisions have to be made. This article explores this dynamic, likening it to “hostage bargaining syndrome” — that is, the patient behaves as if negotiating for their health from a position of fear and confusion -- and suggests ways to counteract this behavior.
September 28, 2017 | Burnout in health care is a big and complex topic, and joy in work doesn't happen overnight, but we're in it for the long haul.
The vast majority of Americans are having positive experiences with the health care system, but 21 percent of adults report having personally experienced a medical error, according to a new national survey released today by the IHI/NPSF Lucian Leape Institute and NORC at the University of Chicago. The survey further finds that, when errors do occur, they often have lasting impact on the patient’s physical health, emotional health, financial well-being, or family relationships.
The Institute for Healthcare Improvement, newly merged with the National Patient Safety Foundation (NPSF), and thousands of physicians, nurses, quality leaders, administrators, front-line staff, researchers, public health and community leaders, quality and safety professionals, patients and patient advocates, and students sharing new approaches to improving the health and health care of patients and communities.