Now Viewing: Health Care Quality

The Next Phase of the OpenNotes Movement

Feb 2, 2016, 10:49 AM, Posted by Susan Mende

What happens when patients gain access to the notes their doctors and nurses take during a visit? A culture shift with empowered and motivated patients at the center.

Medical professions looking at patient records.

In December I was proud to announce an exciting partnership with three other foundations—the Cambia Health Foundation, Gordon and Betty Moore Foundation, and the Peterson Center on Healthcare—to take a bold step to expand access to clinical notes written by doctors, nurses, and other clinicians to 50 million patients nationwide. The $10 million in new funding to OpenNotes will allow the initiative to dramatically step up its efforts to create a new standard of care and set a new bar for patient-centeredness.

We know that physicians can help their patients become more engaged in their own care, and that this kind of patient activation can lead to improved outcomes and lower health care costs. Of course, that is easier said than done—especially when clinicians are already under pressure to adopt new technologies, implement new models for delivering health care, and make data on the quality of their care publicly available.

Health care innovators are unrelenting in their search for simple, scalable solutions to help both clinicians and consumers—and philanthropists can help put these bright ideas to the test to determine what works. OpenNotes is one such solution.

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Do-It-Yourself Health: How the Maker Movement is Innovating Health Care

Nov 16, 2015, 11:14 AM, Posted by Anna Young

MakerNurse is changing the game for nurses by tapping into their natural problem-solving skills and bringing the spirit of invention, creativity, and innovation into medical settings.

Debra Flynn shows off the prototype of the shower sleeve she designed at the first medical maker space. Debra Flynn shows off the prototype of the shower sleeve she designed at the first medical maker space.

Anyone who has spent time in a hospital knows that—more often than not—nurses are the professionals who catch the little problems with your care: the uncomfortable IV tube, the bandage that doesn’t quite fit, the pill bottle that’s hard to open.

Nurses are natural problem solvers. They cut down bandages to fit preemies. They fashion a plastic cup around an IV site to stop it from snagging clothes. They roll up two hospital blankets and wrap them in tape to make a “cough pillow”—something to clutch against your stomach to ease the pain of laughing or coughing after abdominal surgery. These DIY medical devices are made by nurses every day in hospitals.

Nurses are uniquely positioned to spot such problems. So, why not encourage nurses to continue devising their own solutions, then give them the tools to create them?

With MakerNurse, that’s exactly what we’re doing.

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What Right Care Means to Me: The Physician’s View

Oct 21, 2015, 1:11 PM, Posted by Kathleen Grimm, Vikas Saini

Two physicians describe how they are mobilizing patients, providers and others, to change the culture of overuse in health care, to one that is individualized, compassionate and just.

Two doctors standing in a corridor consult together over some paperwork.

The end of life can be fraught with emotion and excruciating decisions for families. It is a time when overuse of treatments and interventions occurs far too frequently. The culture of medicine teaches physicians to “do everything you can” to keep patients alive, with an underlying message that more is better when it comes to treatments and interventions. For doctors, patients and their families, making the decision to refuse extraordinary measures can feel like giving up.

As physicians who are active in the Lown Institute’s RightCare Alliance, we are dedicated to changing this culture. We know that a range of practices persist as standards that don’t improve the length or quality of life. Overuse and inappropriate care are baked into how we do things to the point that they are almost invisible. From frequent blood draws in the hospital to unneeded imaging for a normal pregnancy and futile chemotherapy in end-stage cancer, our goal is to keep patients safe from unnecessary diagnosis, treatment, and ultimately, harm. We think that it is critical to combine an understanding of the true benefits and risks of procedures and therapies with a respect for a patient’s wishes. Such a thoughtful approach that individualizes care, promotes doing more for the patient and less to the patient.

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Is More Always Better? Not Necessarily When It Comes to Health Care

Oct 19, 2015, 8:00 AM, Posted by Emmy Ganos, Tara Oakman

Health care professionals, patients, and allies across the nation are banding together to promote an understanding of what good medical care can and should be with RightCare Action Week.

Red buttons display the motto, "Right Care Right Now."

Sometimes, more is definitely better. Getting that extra hour of sleep can greatly benefit your mind, body and day. Cars that get more miles per gallon are cheaper and cleaner to run. And who would argue against more vacation time?

But when it comes to health care, more is not always better. Unnecessary diagnostic tests, treatments or hospitalizations can drive up health care costs, and in some cases, actually harm patients. For example, excess imaging increases exposure to radiation. Overuse of screening and diagnostic tests can lead to stressful false positives. And unnecessary treatments, drugs or procedures increase the risk of serious complications. In the larger picture, the estimated $200 billion spent on inappropriate care each year diverts resources away from services that are actually needed both within and outside of the health system—in mental health, housing, and infrastructure, for example—that can help all Americans lead healthier lives.  

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How Public Health Sharing Arrangements Fit Into the Value Equation

Oct 6, 2015, 11:05 AM, Posted by Meshie Knight

In recent years, cross-jurisdictional sharing has been a focus for policymakers and public health officials wishing to increase effectiveness and efficiency in the delivery of public health services. Measuring its impact is next.

public health nursing banner

Well-functioning, high-value public health departments are critically important to ensuring the conditions for good health in communities. In recent years, however, health departments have been faced with exceptional financial challenges mostly in the form of repeated reductions in state and local funding for public health budgets. At the same time, expectations for their roles and responsibilities—as monitors and chief health strategists for communities and as partners within and beyond the health sector—are growing.

In 2012, RWJF launched a program to investigate a potential strategy for strengthening health departments that could be especially effective in times of financial or administrative hardship, and importantly, could also help to augment the capabilities of health departments serving particularly small or rural jurisdictions: cross-jurisdictional sharing (or more simply, publicly authorized sharing of public health services across jurisdictions). The Center for Sharing Public Health Services (CSPHS) was designed to help build the evidence for how cross-jurisdictional sharing (CJS) arrangements can be planned for and implemented in different environments.

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Three Lessons on Improving Quality of Care in Communities

Sep 15, 2015, 10:16 AM, Posted by Anne Weiss

Aligning Forces for Quality not only transformed care in 16 communities, but it provided insights to help shape efforts building a national Culture of Health through high value care.

In a Culture of Health, how can communities improve the quality and value of health care? What happens when people who get, give, and pay for health care locally work together? In 2007, the Robert Wood Johnson Foundation (RWJF) set out to answer these questions when it launched Aligning Forces for Quality with an audacious goal: To transform the quality, equality, and value of regional health care markets.

Along the way, we explored what happens when the people who get, give, and pay for health care locally, work together. Our investment sparked deep and meaningful change in 16 very different communities across America, and important lessons learned in each and every one. But three lessons in particular helped drive success and can be applied to our work to build a national Culture of Health.

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Three Things the United States Can Learn About Public Health From Around the World

Jul 23, 2015, 10:45 AM, Posted by Najaf Ahmad

When it comes to bridging health and health care delivery, the U.S. has an opportunity to learn from global innovations that link the public health, social services, and health care systems.

Globe Image via Joseph Li

It started with three hundred Boy Scouts from across Uganda being trained as “social monitors”. They were tasked with reporting the conditions of their communities to Uganda’s Ministry of Health through their mobile phones. In less than a year, these “U-reporters” grew to over 89,000. The U-report itself is a free SMS-based system that allows young Ugandans to share what’s happening in their communities and work with community leaders and government to affect positive change. The information gathered is disseminated through radio, TV, websites, youth events, community dialogue and other ways.

This system of real time surveillance is a vital new development for the world’s fifth-fastest growing country. Reliable health information in Uganda can mean the difference between life and death. As has been seen recently, epidemics like Ebola or West Nile thrive on information delays. Furthermore, U-reports are empowering Ugandans to share responsibility for creating healthier conditions within their communities.

The U-report is just one of the many exciting global innovations highlighted in a report by the Robert Wood Johnson Foundation (RWJF) and AcademyHealth. Written by Margo Edmunds and Ellen Albritton at AcademyHealth, the report showcases innovations that link public health, social services, and health care systems. These initiatives serve as examples of bridging otherwise disparate elements of health and health care delivery. The authors deliberately selected racially, ethnically and economically diverse regions around the world to ensure that their innovations were applicable to and reflected the diversity of the United States. A Google Hangout also convened several experts to discuss the report’s findings.  

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How Can We Measure High Value Care? Consider the Patient Point of View

Jun 29, 2015, 4:43 PM, Posted by Anne Weiss

Health care is centered around human relationships, which is why it's so important the voices of the people the system is designed to help—patients and their families—are heard by those defining and measuring care.  

Summer has come at last! Along with all the usual endings and beginnings that come with this time of year, there’s an important new opportunity for those of us who are passionate about improving health care. The Medicare Access and CHIP Reauthorization Act of 2015 threw out Medicare’s old rules for paying physicians and substituted a new system, one that’s  supposed to reward physicians for delivering high quality, high value care. This is a game-changer many years in the making, but as with any complex new law, the details matter. How will Medicare define and measure high quality, high value care? We can get some hints from CMS’ new strategic vision for physician quality reporting.

If I were granted just one wish by the people who are going to define and measure high value care, I know what I’d say: listen to our voices, the voices of patients and families, the ultimate health care consumers. Listening to patient voices and providing care that is patient-centered can improve clinical outcomes, reduce “waste” in health care by reducing unnecessary testing, and increase the overall care experience for both patients and providers. Health care is centered around human interactions and relationships—it is critically important that those defining and measuring care truly hear the voices of the people the system is designed to help—patients and their families.

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Expanding Opportunities for Rural Communities to Get Quality Care

Jun 9, 2015, 4:58 PM, Posted by Susan Hassmiller

Initiatives like the Future of Nursing and Project ECHO are expanding opportunities for more communities to get quality health care and lead healthier lives regardless of ZIP code.

A farm in Buncombe County, North Carolina.

I read recently in The New York Times about Murlene Osburn, a cattle rancher and psychiatric nurse, who will finally be able to start seeing patients now that Nebraska has passed legislation enabling advanced practice nurses to practice without a doctor’s oversight.

Osburn earned her graduate degree to become a psychiatric nurse after becoming convinced of the need in her rural community, but she found it impossible to practice. That’s because a state law requiring advanced practice nurses to have a doctor’s approval before they performed tasks—tasks they were certified to do. The closest psychiatrist was seven hours away by car (thus the need for a psychiatric nurse), and he wanted to charge her $500 a month. She got discouraged and set aside her dream of helping her community.

I lived in Nebraska for seven years, and I know firsthand that many rural communities lack adequate health services. As a public health nurse supervisor responsible for the entire state, I regularly traveled to small, isolated communities. Some of these communities did not have a physician or dentist, let alone a psychiatric nurse. People are forced to drive long distances to attain care, and they often delay necessary medical treatment as a result—putting them at risk of becoming even sicker, with more complex medical conditions.

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Opening the Care Conversation through OpenNotes

May 4, 2015, 10:01 AM, Posted by Susan Dentzer

More than 30 health systems have adopted the practice of sharing clinicians' notes with patients, making OpenNotes more than just a revolutionary idea but a movement in health care.

Open Notes_20120530_01007

It’s a memory aid. It’s truth serum. Using it can transform relationships forever. These may sound like come-ons for the type of product typically hawked on late-night television. But in fact, they’re some of the things people are saying about OpenNotes.

OpenNotes isn’t a product, but an idea: That the notes doctors and other clinicians write about visits with patients should be available to the patients themselves. Although federal law gives patients that right, longstanding medical practice has been to reserve those visit notes for clinicians’ eyes only.

But Tom Delbanco and Jan Walker, a physician and nurse at Beth Israel Deaconess Medical Center in Boston, have long seen things differently. Their personal experiences with patients, and inability to access care records for their own family members, persuaded them that the traditional practice of “closed” visit notes had to change. So, with primary support from the Robert Wood Johnson Foundation, they launched what has now become a movement.

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