The Institute for Healthcare Improvement’s 19th annual National Forum on Quality Improvement in Health Care was as much about traffic flow as patient safety, something that wasn’t an accident.
A virtual army of cheerful IHI staff members clad in blue shirts was responsible for helping the some 7,000 conference participants find their way around, from the main conference room to the myriad rooms for breakout sessions or the exhibition hall at the Orlando (Fla.) World Center Marriott & Convention Center. That the sea of people who flew in from around the world to attend seminars and speeches did not get lost or stuck in jams—and could still smile even while part of large migrating crowds—is attributed to the rigorous training staff members underwent so they could answer any question that might arise.
This testament to traffic flow could also be a lesson in how to achieve patient-safety measures, according to an IHI spokeswoman. The institute wanted to be sure it was following the practices it is preaching to hospitals. How would it look if the IHI, which touts using training, education and leadership to improve safety and outcomes in hospitals, could not control its own outcomes during its largest conference of the year?
But several participants could be seen thanking the “blue shirts,” as they were referred to, for successfully organizing the biggest crowd yet for the IHI.
Relationships are key to safe outcomes, said Donald Berwick, president and chief executive officer of the IHI, who welcomed attendees Dec. 11 during a keynote address that outlined the healthcare industry as a branch of sociology. Relationships, cultural beliefs and behaviors, and communities are where practitioners and researchers need to focus their energy to bring about change, he told the audience.
Some of the methods supported by the IHI, such as rapid-response teams, have recently come under question by some researchers and physicians, who argue that the evidence doesn’t yet exist to show such teams improve outcomes. Berwick addressed those concerns in a speech that some participants said was uncharacteristic of his usual visionary themes.
Berwick himself acknowledged that he was stepping out of his usual territory so he could share some more technical aspects of the IHI’s initiatives.
While evidence and research are critical to developing processes that will improve quality and safety, just thinking linearly about “cold, hard facts” will not change an environment, he said.
“Try making your marriage better with a randomized clinical trial,” he said, evoking knowing nods from the audience.
Hospitals are not static environments, and because of the range of behaviors, attitudes and cultural beliefs found there, change will be fluid, Berwick said. In the case of rapid-response teams, research hasn’t disproved their effectiveness, but inconclusive studies only point to the need for more research. Indeed, quality improvement initiatives “almost always say more research is needed,” he said.
“We need more evidence, more powerful evidence that drives broader outcomes in diverse settings,” he said.
But that evidence should come from sources other than data. Berwick suggested four ideas for change: The healthcare industry needs to reconsider attitudes toward their threshold of action, their view of “bias” and their “mood, affect and civility” while broadening research methods to include context in addition to methods. Doing so could widen the use of science while also incorporating more passion into the system, he suggested.
Passion and science have room to coexist to improve healthcare, Berwick said. Scientists “should be less the skeptics” and more the cheerleaders of change, he added.
“What your eyes cannot always see, your heart can,” he said.
