Jared Capouya, MD, FAAP
Mary Bridge Children’s Hospital
In December 2017 I attended the Institute for Healthcare Improvement (IHI) National Forum on Quality Improvement in Health Care in Orlando. Two presentations really resonated with me at this forum. The first centered around achieving health outcomes while decreasing costs at a large clinic in Anchorage, Alaska. A couple of key points:
- Clearly defining who is on the primary care team and what their roles are in relation to the needs of the empaneled patient population – 1,110-1,400 per provider. They determined 80 percent of their population had low to moderate needs that could be effectively managed by support staff and/or care managers.
- They created a learning system where they identified a condition or measure and looked for where process was either being done or not done in relation to an associated outcome. This allowed them to eliminate wasteful processes having no impact on the outcome. We can all think of activities we do each day that do not enhance the outcome we are trying to achieve. They then identified where processes were having an impact and drilled into the teams and providers to adapt across various patient populations.
- Lastly, they looked for patterns in labs, treatments and procedures that might signal decompensation in their patients: nebulizer treatments, blood gases, d-dimers, an admission perhaps, and then looked at these patterns across age, zip code, condition and gender to more optimally deliver the processes mentioned above.
The second presentation that made an impact on me focused on leadership for system improvement and centered around three core questions of how we should be leading improvement work:
- Why: Develop knowledge and understanding of the key drivers to a motivated clinical workforce that is continuously improving. This section really focused on taking joy in work and being engaged in your work to reach potential.
- How: Access new thinking on ways to cultivate a learning environment that supports clinical leaders and promotes new talent development. Create a shared mental model or vision and create continuous learning amongst team members. Requires some autonomy. Be creative!
- What: Explore through sharing and examples, key impactful interventions from leadership development experiences to inform and help develop participants’ own leadership framework. They referenced a Mayo Clinic study (Mayo Clin Proc. 2015;90(4):432-440) that showed the key dimensions of physician leadership are to: Inform, Engage, Inspire, Develop and Recognize. These are aligned with committing to resilience, one of the principles of being highly reliable.