Institute for Healthcare Improvement Annual National Forum on Quality Improvement in Health Care

Peter Lanser, MS CHE CPHQ

The Institute for Healthcare Improvement (IHI) is a not-for-profit organization dedicated to improving the quality of healthcare in the United States and around the world (http://www.ihi.org). For the past 14 years, the IHI has hosted an "Annual National Forum on Quality Improvement in Health Care." The IHI's 2002 National Forum was held on December 10-13, 2002.

Donald M. Berwick, MD, MPP is President and CEO of the IHI. Dr. Berwick opened the conference with a passionate talk about his optimism for the healthcare system. He challenged the 3,600 attendees to work with the "assumption of abundance." He explained that there is an abundance of patients and families bringing their lives, expertise, and capacities to heal to caregivers. Dr. Berwick told a story of Jim Lang and his daughter Alecia who has cystic fibrosis. Mr. Lang has told his daughter's caregivers that his job is to make sure that Alecia gets to go to her prom on 5/4/08, yet many caregivers have told Mr. Lang that they are "maxed out and too busy." Dr. Berwick told the audience, "If Jim's job is to get Alecia to the prom - our job is to help him. Arguments of scarcity cannot cut it. We need to work from an attitude of abundance."

He said that the largest research and development laboratory in healthcare is healthcare itself and "we pay the tuition, but we don't take the course" meaning that many healthcare providers don't listen and learn. One of the roadblocks to quality improvement, according to Berwick, is the lack of transparency. Rather than fighting over the accuracy of data, Dr. Berwick suggested that we "accept the accuracy of less than perfect data, accept that there are problems with quality, and take personal ownership of the problems."

Dr. Berwick highlighted stories of two of his personal heroes. He told a story of how Cincinnati Children's Hospital made their quality data public and then looked to other organizations to help improve their organization. Unfortunately, because of initial resistance by organizations such as the Cystic Fibrosis Foundation, discovering which organizations perform best was difficult. Luckily the Cystic Fibrosis Foundation determined that, according to Dr. Berwick, "keeping the data secret is unethical." Cincinnati Children's Hospital was able to identify and visit other hospitals that were exceptional in their treatment of cystic fibrosis patients. Mr. Lang's daughter, Alecia, gets her treatment at Cincinnati Children's Hospital who, according to Dr. Berwick, operates with an attitude of abundance. Dr. Berwick congratulated Cincinnati Children's Hospital for "the courage to show your results and help Alecia get to the prom."

Dr. Berwick's second hero is Duncan Moore, the President and CEO of Tallahassee Memorial HealthCare (TMH). TMH is one of the seven organizations chosen to participate in the second phase of the $20.9 million quality improvement initiative, Pursuing Perfection: Raising the Bar for Health Care Performance. During a visit to TMH, Dr. Berwick reviewed a study that looked at risk-adjusted mortality rates among a large sample of hospitals with Mr. Moore. Dr. Berwick reviewed the mortality study at a session with 300 TMH staff members, the TMH Board of Directors, and via closed-circuit TV to the hospital's patients. During the public session, Mr. Moore asked Dr. Berwick to identify where TMH was relative to mortality. TMH had a mortality rate 30% higher than the risk-adjusted expected. Mr. Moore challenged his organization to go from being 30% over the expected to 20% below.

Several other projects were highlighted: QualityHealthCare.org is the new web site developed by the IHI and the British Medical Journal Publishing Group. It is free and contains quality improvement tools, tips, and success stories. IMPACT is a network of change-oriented health care organizations focusing on improving patient outcomes, patient, provider, and staff satisfaction, and the bottom line.

The IHI conference also offered additional learning labs and mini courses. I was fortunate enough to attend an all-day mini course with Brent James MD, Mstat the Executive Director of the Institute for Health Care Delivery Research at Intermountain Health Care. There were approximately 250 people in Dr. James' all day session, mostly physicians. The three major themes were: the culture of clinical care delivery must change; there is an intense need for information systems, data, and measurement; and the organizational structure must change in order to use data to hold people accountable for clinical improvement.

For more information about the Institute, visit www.ihi.org.

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