The power to improve health and health care using science, collaboration, storytelling, and the wisdom of patients and communities was vividly illustrated today as Derek Feeley, President and CEO of the Institute for Healthcare Improvement (IHI) kicked off the 2019 IHI National Forum on Quality Improvement in Health Care. Addressing more than 5,000 clinicians, leaders, researchers, students, patient advocates, and community improvers in attendance, Feeley and colleagues distilled central elements of IHI’s work over the past year with partners in multiple regions of the world, from health systems to whole states to whole countries.
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In an opening Keynote Session, IHI President and CEO Derek Feeley and colleagues gave details of IHI’s work in global health, safety, care for older adults, and reducing inequities in maternal care. (Photo: Business Wire)
“There is a gap between what we in health care know and what we do,” Feeley said. “We close that gap by sharing knowledge and creating a community of purpose that can achieve more together than any individual person or entity can achieve alone.”
Four of IHI’s senior leaders joined Feeley to highlight work in global health, patient safety, care for older adults, and racial inequities in maternal care.
Pierre Barker, MD, MBChB, Chief Global Partnerships and Programs Officer at IHI, began with a look at C-sections, which are estimated to be medically necessary in 10 percent to 20 percent of births. In Brazil, the procedure is used excessively, while in India, it is often not used, even when it would be necessary for a good outcome. Barker gave examples of how women’s lives are affected and shared results to show how applying and rapidly testing new ideas has impacted C-section rates in both countries.
Emphasizing collaboration, Tejal Gandhi, MD, MPH, CPPS, IHI’s Chief Clinical and Safety Officer, spoke of her family’s experience of adverse events in health care and how collaboration can advance safety. She offered a glimpse into the work of the National Steering Committee for Patient Safety, convened by IHI, which includes 27 members — patient advocates as well as representatives of federal agencies, professional societies, health care provider organizations. The group is developing a national action plan to enable and encourage greater coordination of safety efforts across the US.
Shifting to the need to understand what matters to patients, Kedar Mate, MD, IHI’s Chief Innovation and Education Officer, talked about how his grandmother, considered near death, benefited from changes in care, including appropriate medication and physical therapy, that brought her an additional 10 years of good quality life. He described how IHI and partner organizations have distilled mountains of evidence into a simple and useful framework for improving care for older adults.
Trissa Torres, MD, MSPH, IHI’s Chief Operations and North American Programs Officer, highlighted IHI’s work in maternal health in the US, where maternal mortality is on the rise, and black women are four times more likely to die in and around childbirth than are white women. She emphasized the need to co-produce care with women by listening to and learning from the wisdom of those in the communities being served.
In closing the session, Feeley noted, “These are not new problems, but we’ve begun to understand how to solve them. There is science and a method behind the solutions.”
IHI convened this year’s National Forum (December 8–11, 2019) in an atmosphere where health care is broadening its focus to concentrate more directly on mental health, substance use disorders, social determinants of health, and economic, ethnic, and racial inequities that contribute to poor health outcomes. Reflecting this reality, the Forum’s Sessions are organized in 10 topic tracks that include Equity, Improvement Science, and Population Health. A number of sessions are especially relevant to mental health and well-being or to maternal and neonatal health.
Early Results on Maternal Health
As Torres mentioned in her Keynote remarks, maternal deaths are increasing in the US, with black women disproportionally affected. Last year, IHI began a multi-year project, supported by a grant from Merck for Mothers, with the goals of spreading the use of evidence-based care practices to reduce complications; deploying strategies to reduce inequities in maternal outcomes; and partnering with women, their caregivers, health care providers, and community initiatives to better learn and address factors that improve health outcomes for mothers and newborns.
On Wednesday, the session “Better Maternal Outcomes: Redesigning Systems with Black Women,” will offer early results of IHI’s partnerships to reduce racial inequities in maternal outcomes in Detroit, partnering with Henry Ford Health System and, in Washington, DC, partnering with DC Primary Care Association. Among the solutions the two teams worked on are a “Respectful Care Mini Toolkit”; a “5 Do No Harms Checklist for Health Care Providers”; and a means for strengthening the collaboration of community-based doulas and medical staff.
“Our approach has been to listen, learn, and lead together with black women in these communities,” said Torres. “We are drawing out the wisdom of those who birth to create more respectful care and to improve experience and outcomes for pregnant women and new mothers.”
Improving Care for Older Adults
Among the highlights of this year’s meeting is recognition of hospitals and health care practices that are part of Age-Friendly Health Systems, an initiative of The John A. Hartford Foundation and IHI in partnership with the American Hospital Association (AHA) and the Catholic Health Association of the United States. Age-friendly care, which Mate spoke of during the opening Keynote, focuses on four essential, evidence-based elements, called the 4Ms: what matters to older adults; medication, if needed, that is age-friendly; attending to mentation, including delirium, depression, and dementia; and mobility so older adults can maintain function.
“Each of us has a story about the health and care of an older adult in our life,” said Leslie Pelton, MPA, Senior Director, IHI “With the support of The John A. Hartford Foundation, IHI has been able to build the Age-Friendly Health Systems movement, which enables leaders across the country to turn their personal experience into real system improvements in care of all older adults.”
The goal is to spread age-friendly care to 1,000 hospitals and health care practices by the end of 2020. As of November 2019, 247 hospitals and practices had been recognized as Age-Friendly Health Systems Participants, meaning that they have IHI-approved plans for putting the 4Ms into practice. Of these, 117 are designated as Age-Friendly Health Systems — Committed to Care Excellence, for showing exemplary alignment with the framework’s elements by reporting the number of older adults reached with the 4Ms over at least a three-month time period. Hundreds more hospitals and practices are working on applying the 4Ms framework in their care.
Last week, IHI was awarded a $6 million grant from The John A. Hartford Foundation to continue scaling up age-friendly care. “We are so gratified and proud to see the groundswell of interest from hospitals and health care practices to ensure safe, evidence-based care for patients as they grow older,” said Terry Fulmer, PhD, RN, FAAN, President of The John A. Hartford Foundation. “We believe the Age-Friendly Health Systems movement holds great promise for all health care settings, including nursing homes and long-term care facilities, and for all older adults in every community. We are grateful to IHI for its stellar work to help us all age with dignity and health.”
Moving Measurement into Action
Current methods of measuring health care quality and safety have limits, for example, mostly focusing on inpatient care. At present, the health care field lacks universally accepted, standard methods for measuring, understanding, and improving the safety of patients across the care continuum.
In September 2019, the IHI Lucian Leape Institute partnered with Salzburg Global Seminars to bring together 50 health care leaders, researchers, patients, design thinkers, and experts in measurement and quality improvement to develop standards for safety measures. Released today, the Salzburg Statement Moving Measurement into Action: Global Principles for Measuring Patient Safety details the eight principles the group agreed upon. IHI Senior Fellow Susan Edman-Levitan, PA, will discuss the principles at a Forum Lunch & Learn on Wednesday.
For more information on the Forum and remaining keynote and workshop sessions, please visit ihi.org/forum or refer to the conference media advisory.
Journalists unable to travel to the 2019 IHI National Forum have the option of tuning in to livestream broadcasts of the Keynote and Spotlight Sessions. For details on how to listen and watch, contact Joanna Clark at joanna@cxocommunication.com.
About the Institute for Healthcare Improvement
The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization based in Boston, Massachusetts, USA. For more than 25 years, IHI has used improvement science to advance and sustain better outcomes in health and health systems across the world. IHI brings awareness of safety and quality to millions, catalyzes learning and the systematic improvement of care, develops solutions to previously intractable challenges, and mobilizes health systems, communities, regions, and nations to reduce harm and deaths. IHI collaborates with a growing community to spark bold, inventive ways to improve the health of individuals and populations. IHI generates optimism, harvests fresh ideas, and supports anyone, anywhere who wants to profoundly change health and health care for the better. Learn more at ihi.org.
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