Special Section: Health Care Reform

IHI 5M Lives Campaign

Energizing health care improvement

A Chinese philosopher said, “It is better to light one candle than to curse the darkness.”

Rising costs and outcomes that trail the world provide plenty of darkness for American health care, but there are also flickers of light that give reason for optimism.

Some of that illumination comes from the Institute of Healthcare Improvement’s 5 Million Lives Campaign. In Portland May 8, hospital representatives shared their experiences adopting the campaign’s efforts to address the most common causes of patient injury.

Joe McGannon, IHI National Campaign Director for 5 Million Lives, called these efforts “a great source of energy to us at the Institute and a great source of energy for the rest of the nation.”

McCannon shared the campaign’s progress over its first 17 months.
“We’ve come a long way, even though we aren’t where we need to be,” McCannon said.

It’s difficult to make changes in health care in the United States because the system is not unified, as are the health systems of most nations. Competing interests make it hard to achieve consensus. Because providers are, for the most part, paid only when they deliver health care services, there is a financial disincentive for keeping people well.

Discover, test, spread

IHI’s contribution to health care improvement is to discover and encourage best practices, test them and spread the best ideas around the country, McCannon said.

That’s the concept of the 5 Million Lives Campaign and its predecessor, the 100,000 Lives Campaign.

“We want to take practices we’re confident about and have hospitals show that we can make changes,” he said. “We know that all the best ideas are those that reside in the front lines.”

More than 3,800 hospitals have signed on, McCannon said.

“Our real challenge is keeping up with the great work you all are doing,” he said.

The Triple Aim

At the same time hospitals are addressing quality and patient safety under the 5 Million Lives Campaign, IHI also wants to address broader heath care issues.

The “Triple Aim” targets:

• Improving individual experience
• Improving population health
• Controlling inflation of per capita costs

Reaching these objectives, McCannon said, means putting into place:

• Transparent measurement so that we can understand how the system functions.
• Public health intervention to deal with broad societal issues that have an impact on health, such as obesity.
• Care coordinated at the patient level, such as adopting the patient-centered, multidisciplinary team approach of the medical home primary care model.
• Universal access to care.
• A financial management system that supports the Triple Aim rather than prevents it.
• And integrators: organizations that can pull together all the elements of health care.

This will require a major shift in perception by the stakeholders: the individual physicians, the hospitals and the other components of health care that are now separate and don’t necessarily have complementary objectives. Under the current system, the business models of nearly all U.S. health care organizations depend on keeping the triple aims separate.

“We need to view health care as an interdependent system,” McCannon said.

Reaching toward a health care utopia

What would a health care utopia look like?

Pam Mariea-Nason, CareOregon’s Public Policy and Community Affairs Director, posed the question and suggested an answer:

Hospitals would be the true center of the health community. Physicians, hospitals and patients would have aligned goals.

People would get their needs and wants met even before they become patients.

Costs and reimbursements would reflect real values and be sustainable.

To reach this goal will mean making some major changes to the current fundamentals of health care delivery to align hospitals with the Triple Aim:

Health of the population

We need to acknowledge a fundamental disconnect between the system and the objective of keeping the population healthy. Hospitals now aren’t paid to keep people healthy; they provide illness care and, if it pays well, elective care.

Some do provide community benefit resources, such as wellness programs and classes, but hospitals’ role in the health of their communities needs to be more expansive.

Patient care experience

Patients desire the care they want and need, when they want and need it. But hospitals also need to tread carefully near patients’ desire for control.

A 32-year-old woman giving birth, for example, has very different needs for control than a 32-year-old women brought to a trauma center after a motor vehicle accident.

Hospital systems must make a cultural shift to be “patient centric.” They must decide if the hospital is run to achieve the goals of those receiving care, or those providing it, Mariea-Nason said.

And really improving quality is a huge commitment.

Cost of care

We need to take a good look at technology.

“It is no secret to us that just because something costs more doesn’t necessarily mean it is better care or better for the patient,” she said. Patients and policy makers don’t always know that.

Moving ahead

To overcome these obstacles, align health care with the Triple Aim and reach toward health care utopia, IHI is looking for organizations willing to be “macro integrators” in their communities, Mariea-Nason said.

IHI describes a macro integrator as not necessarily a new structure or organization. Instead it is an entity that can pull together the resources to support a defined population, help optimize the system for the benefit of the population and help to improve the front-line systems that support individuals, including physicians, hospitals and clinics.

Starting this summer and continuing into 2009, IHI will be recruiting organizations interested in pursuing this objective. Interested organizations may contact Carol Beasley at IHI by phone, 617-301-4838, or e-mail cbeasley@ihi.org.

IHI 5M Lives Campaign

Transforming health care in Oregon

In all corners of Oregon, hospitals are taking steps to eliminate some of the most common causes of inpatient injuries under the umbrella of the 5 Million Lives Campaign. By enlisting hospitals across the country, the Institute of Healthcare Improvement hopes to prevent 5 million incidents of medical harm in a two-year period..

Eighteen of the Oregon hospitals participating in the campaign presented their experiences at the Oregon 5M Lives Network’s “Transforming Health Care in Oregon” conference May 8 in Portland.

Each provided not only an approach to fixing the causes of patient harm but also lessons in implementing change.

Continue here for a few of their stories...