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Hospice Care garnered nearly 2,000 votes from readers compared 
with less than 700 for runner-up Institute for Healthcare Improvement.
Hospice Care garnered nearly 2,000 votes from readers compared with less than 700 for runner-up Institute for Healthcare Improvement.

The Big Impact Tournament: Hospice wins

Hospice care defeats Institute for Healthcare Improvement to take Modern Healthcare's Big Impact Tournament crown

By Modern Healthcare
Posted: July 25, 2011 - 12:01 am ET

CHICAGO, July 25, 2011—Death beat life to win Modern Healthcare's Big Impact Tournament. By a nearly 3-to-1 margin, Hospice Care defeated the Institute for Healthcare Improvement as the one person, event, organization or innovation that had the biggest impact on the healthcare delivery system over the past 35 years. The final score was 1,968 to 682.

Hospice Care, a No. 12 seed in the Innovations region, is a widely embraced model for compassionate care for people facing a terminal illness. Hospice, and closely related palliative care, involves a team-oriented approach to medical care, pain management, and emotional and spiritual support tailored to the individual patient's needs and wishes. Involvement from the patient's family also plays a key role. In many cases, hospice care is provided in the patient's home, usually the patient's preferred setting. Hospice care also is provided in freestanding hospice centers, hospitals, nursing homes and other long-term-care facilities.

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Palliative care involves the principles of hospice care applied to a broader population that could benefit from receiving this type of care earlier in their illness or disease process. According to the National Hospice and Palliative Care Organization, the term “hospice” was first applied to specialized care for dying patients in 1967 by Dr. Dame Cicely Saunders, who founded the first modern hospice—St. Christopher's Hospice—in a residential suburb of London. The use of hospice has been growing steadily, with an estimated 1.56 million patients in 2009.

To reach the championship round against the IHI, Hospice Care upset a number of heavy favorites in the Innovations bracket, including No. 1 seed Electronic Health Records, which Hospice Care defeated in the third round of the Big Impact Tournament. It also beat No. 2 New Models of Integrated Delivery Systems; No. 4 Patient-Safety Advocacy; No. 3 Clinical and Financial Performance Transparency; and No. 2 in the Events bracket, Release of the Institute of Medicine's To Err is Human Report.

The IHI, meanwhile, had an equally tough—and much more ironic—path to the big game. The IHI, the No. 8 seed in the Organizations region, needed to beat its founder, Dr. Donald Berwick, in the fifth round to reach the championship game against Hospice Care. Berwick was the No. 3 seed in the People bracket. Along the way, the IHI topped fellow Organizations bracket competitors National Quality Forum (No. 9); the CMS (No. 1); Kaiser Permanente (No. 5); and the Centers for Disease Control and Prevention (No. 3).

Founded in 1991, the Cambridge, Mass.-based organization aims to save the lives of patients through quality healthcare. With a staff of about 100, the IHI has partnerships and faculty around the world. The organization identifies its focus on the “No Needless List,” which includes no needless deaths, pain or suffering, no helplessness in those served or serving, no unwanted waiting, no waste and no one left out. Prior to being appointed by President Barack Obama to head the CMS, Berwick served as head of the IHI. The Triple Aim initiative, developed by the IHI under Berwick, is a vision to reform the healthcare system through the pursuit of three aims: improving the cost of healthcare, improving the health of populations and reducing per capita costs of healthcare.

The championship match culminated an exciting tournament that began on April 4 with 64 contestants—16 in each of four brackets: People, Events, Organizations and Innovations. Modern Healthcare asked its readers to vote online on its website,, for the person, event, organization or innovation that they thought had the biggest impact on healthcare over the past 3� decades. Every two weeks, the field narrowed by half until the championship round, which ran from June 13-24. Below are the results of the Sweet 16 phase of the tournament.

To view the complete results, readers can visit Modern Healthcare's 35th anniversary website at

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