Tuesday, December 07, 2010

Maureen sets the tone

#IHI Maureen Bisognano has just welcomed the 6000 delegates here and 15,000 watching around the world at the opening session of the IHI Annual Forum. The CEO's address establishes the theme for the Forum and for IHI's activities for the coming year and is a highlight of the conference.

Maureen's empathy and kindness come through in all she says and does, and so it was not surprising that her address focused on the patient experience. Some excerpts:

When [my nephew] Robbie was four months old, my sister took him back to his doctor for another routine check-up. During the visit, the doctor told my sister he would be giving Robbie his 4-month DPT shot. My sister asked, “Don’t you remember what happened last time?” The doctor paused. My sister described the hospitalization after the last shot, and the doctor told her that the illness was unrelated. He hesitated for a moment and then said, “I’ll give him half a dose,” and then administered the vaccination. Robbie died within 24 hours.

My sister asked me three questions that changed my life. She asked:

Why did the doctor not have the hospital records on hand?

How did he not know what the right care was?

Why didn’t he listen to me?

[Referring to some 220 patient and family histories for 34 different diseases and conditions taped by the New York Times' Karen Barrow:] I’ve been comparing the burden of illness, the voices of the patients in these videos, the experiences of patients and families I meet traveling around the country, to the clinical encounters I see. The conversations are really quite different, in many cases. I see empathy and technical excellence, but the conversation is medical, focused on the disease and often not on the total burden.

[Citing from Henry Ting and Victor Montori at the Mayo Clinic:] When we can’t lessen or ease the burden of illness, we can redesign to lessen the burden of treatment – they call this “minimally disruptive medicine.”

An ideal health system balances the contributions of science and the strengths and needs of the individual; and most important for achieving the specific outcomes with the patient, it has a robust learning system “for the patient”; “for the science” at all levels to modify plans when changes will help, and to leave things as they are when tampering is expensive and ineffective.

Then there is the personal part of caring and healing. How do we best teach new nurses and physicians, clinicians and leaders, how to care and how to improve?

Sometimes caring is minimally invasive technology that optimizes great advancements in the tools of care and minimizes pain and the length of time a patient has to stay in a hospital. Sometimes caring is minimally disruptive processes that are designed to care with and for the patient. Sometimes caring is just standing there. And sometimes, caring is partnering.

Rather than thinking about our work as caring for illness, Antonovsky offers a model of a continuous variable – a “health-ease” instead of a “dis-ease” continuum. A major factor in producing health is resilience – a sense of control and understanding. This will require new and deeper partnerships between patients and families and their provider teams. For years, we’ve had providers with empathy and a strong sense of caring. But what I’m adding today are processes and new designs to support and accelerate the conversations and to build resilience.

Together, our destination is the Triple Aim. It won’t be easy. It’ll take courage, new leadership skills, new care models, new business models, a commitment to equity, and new assumptions:

-- Health care systems can be sustained with modest annual cost increases; and

-- There is enough capacity in the systems to provide equitable, high-quality care to all; and

-- Solutions to national problems will be designed and implemented at the local level.

The theme of this year’s Forum is Taking Care. With a focus on our health, we’ll be better able to take care of those who rely on us. We’ll be better partners with our patients and families. We’ll take care when we need to strengthen our capacity. We’ll take care of the precious resources of our time and our spirit. We’ll take care of our system. And with the new models we’ll build and share in 2011, I can call my sister and answer her questions about Robbie....

Welcome to the 22nd Annual National Forum. Take care, everyone.

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