All Together or Not at All: The Snuggle for Existence

Transcription

1 2017 IHI National Forum on Quality Improvement in Health Care Orlando, FL All Together or Not at All: The Snuggle for Existence Donald M. Berwick, MD, MPP President Emeritus and Senior Fellow Institute for Healthcare Improvement December 13,

2 Black Holes Colliding (computer simulation) 2

3 One Part in One Sextillion 1 in 1,000,000,000,000,000,000,000 In the 93 million miles that separate the earth and the sun, that is The width of one atom! LIGO Observatory: Livingston, LA 3

4 LIGO Scientific Collaboration (LSC) members, 90+ institutions, 16 countries The LSC is the organization that conducts the science of LIGO Source: Gabriela González 2017 Nobel Prize in Physics Rainer Weiss, MIT Barry Barish, Cal Tech Kip Thorne, Cal Tech 4

5 The advanced GW detector network Detecting Gravitational Waves All together, or not at all. 5

6 The ICU Team at Work The ICU Team at Work 6

7 Supercooperators Nowak and Highfield The Snuggle for Existence (I)f you are a cooperator, you will find yourself surrounded by other cooperators so that what you reap is what you sow to succeed in life, you need to work together pursuing the snuggle for existence, if you like just as much as you strive to win the struggle for existence. Cooperation - not competition - underpins innovation. 7

8 The Snuggle for Existence Drs. Ed and Justin Coffey 8

9 Suicide Rates Among Henry Ford Medical Group HMO Members C. Edward Coffey MD / Henry Ford Health System: National Vital Statistics Reports. NEJM Catalyst (catalyst.nejm.org) Massachusetts Medical Society Ohio Perinatal Quality Collaborative Dr. Jay Iams Dr. Mary Applegate Dr. Carole Lannon 9

10 OPQC = 108 maternity hospitals in Ohio 75% decrease in early elective deliveries since 2008, >67,000 births shifted to term Dr. Ty Reidhead 10

11 Incidence of diabetes-related end-stage renal disease among adults aged 18 years, by race and ethnicity United States, AI/AN Black Hispanic Asian White Special Diabetes Program for Indians (SDPI) MMWR, January 13, 2017, Vol. 66(1) Dr. Jennifer Walthall 11

12 Indiana Persons Living with HIV Disease as of December 31, 2014 Top Number: New HIV/AIDS Reports January 1, 2014 December 31, 2014 Bottom Number: Total Persons Living with HIV/AIDS including cases diagnosed in other states and currently living in Indiana as of December 31, 2014 Posey 11 LaPorte St. Joseph Elkhart LaGrange Steuben 30 7 Lake Porter Noble DeKalb Marshall 1, Starke Kosciusko Jasper W hitley Allen 34 Pulaski Fulton Newton Miami W abash Huntington White Cass W ells Adams Benton 23 Carroll Grant Tippecanoe 6 Howard Blackford Jay Warren 69 Clinton 106 /8 Tipton 167 Madison Delaware 11 / Randolph Fountain 16 Montgomery Hamilton 6 Boone Henry W ayne Parke Hendricks Marion Hancock 54 Putnam Rush , Shelby Fayette Union 67 Johnson /8 Vigo Clay Morgan Franklin Owen Decatur Monroe Brown Bartholomew 5 18 Dearborn Sullivan 9 17 Ripley Greene /17 Jennings Jackson 16 Lawrence Ohio Knox 12 Martin Jefferson Switzerland 40 Daviess 31 /10 /26 Scott Washington Orange /21 Clark Pike Gibson Dubois Crawford 292 Harrison Floyd Perry / W arrick Vanderburgh Spencer Vermillion * The subject heading HIV Disease found within this document refers to a combined total of persons with HIV or AIDS including those where progression to AIDS has occurred. Note: Data are suppressed when counts are or if determined identifiable. Spotlight on HIV/STD/Viral Hepatitis, 2014 Indiana Annual Report, January 1, 2015 Page 9 Why Austin? Expanding epidemic of injection drug use heralded by dramatic increase in acute HIV infections Suryaprasad Clin Infect Dis; 2014, 59(10):

13 Spectrum of services One- Stop Shop Addiction Treatment Medical Care Laboratory Testing Epidemiology (state and federal) DIS (six states) Executive Order Resources Syringe Exchange Faith Based community Media and Messaging Jail Services Community Capacity Building Outbreak Insurance coverage (HIP 2.0) Major Progress in Scott County Number Total number of persons who have enrolled in addiction treatment at the SSP location Average number of syringes needed by clients each day Number of new HIV infections diagnosed Syringe needs are stable More persons getting addiction treatment New HIV infections remain low No evidence of increased drug use 20 0 Source: Indiana State Department of Health, Indiana Family and Social Services Administration, and IU Fairbanks School of Public Health 13

14 Prof. David Shoemaker - LIGO How does collaboration happen at large scale to solve problems that cannot be solved any other way? What is the secret of snuggling? 14

15 All Together, or Not At All Chronic Illness and Aging Systemic Patient Safety Prevention Social Determinants of Health Costs Modern Technology Prevailing Theories Will Not Work The workforce is not trying hard enough lean on them Incentives will fix it Rig payment to force changes Regulations will fix it Tighten controls - Enforce goals Measurement is a primary driver Measure and report Formal experiments will point the way Use RCT s More technologies will solve it Build stuff If only professionals could seize the controls Require spread 15

16 Helping My Brother Survive NOT.. Try Harder INSTEAD Helping My Brother Survive NOT.. Try Harder INSTEAD We Are in This Together 16

17 Helping My Brother Survive NOT.. Try Harder Pay for Performance INSTEAD We Are in This Together Helping My Brother Survive NOT.. Try Harder Pay for Performance INSTEAD We Are in This Together Pride and Joy in Work 17

18 Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules INSTEAD We Are in This Together Pride and Joy in Work Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed 18

19 Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Measure to Learn 19

20 Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report Randomized Trials INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Measure to Learn Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report Randomized Trials INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Measure to Learn Focused Empiricism 20

21 Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report Randomized Trials More INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Measure to Learn Focused Empiricism Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report Randomized Trials More INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Measure to Learn Focused Empiricism Less 21

22 Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report Randomized Trials More Doctors Rule INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Measure to Learn Focused Empiricism Less Helping My Brother Survive NOT.. Try Harder Pay for Performance Follow the Rules Measure and Report Randomized Trials More Doctors Rule INSTEAD We Are in This Together Pride and Joy in Work Use Principles Modify as Needed Measure to Learn Focused Empiricism Less Only a Team Can Succeed 22

23 How to Snuggle Clear, Common Purpose (the glue is aim ) All Together, or Not at All A Safe Vessel Permission to Fail Shared Honor Affection Within, Not Accountability from Outside Only Leaders Can Set the Conditions 23

24 Common Threats and Challenges Chronic Illness 24

25 Causes of Mortality in Brazil (The Lancet : ) % of Population 65 Years Old: 2015 and

26 Common Threats and Challenges Chronic Illness Social determinants of health Rising costs Not All Health Care Helps: Overuse 26

27 Common Threats and Challenges Chronic Illness Social determinants of health Rising costs New technologies Globalization of health threats Imbalance of acute care and prevention Workforce stresses Quality defects safety, etc. Spread of successes Current Designs Are Unfit for Purpose Hospital centric Fragmented health and social care Lagging technologies Guilds 20th century workforce for 21 st century needs 27

28 Three Panels on Global Care Quality Syringe-Sharing Network of Persons with Newly Diagnosed HIV Infection. 536 unique persons 1058 unique contacts Contact Type (1-56) Frequenc y Syringe-sharing 841 (79.5%) Sexual 81 (7.7%) Syringe/Sexual 136 (12.8%) Social Contact 83 (15.4)% Peters PJ et al. N Engl J Med 2016;375:

29 Continuum of HIV care in Austin, Indiana November 9, % 100% 75% 55% Eligible* Engaged in Care** Care coordination Virally suppressed*** N=217 N=21 N=12 N=163 Total diagnosed=227 (226 confirmed). Persons were 7 ineligible if deceased 0 (n=7) or outside of the jurisdiction (n=3); estimates are based on the number of eligible persons (n=217);** Patients engaged in care if have at least one VL or CD4 *** Percent virally suppressed is stable at 75% when denominator changed to number engaged in care. Clinical services were initiated 3/31/15. 29