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D/E28: Activating our Rising Leaders: Students and Residents as an Engine for Change
IHI National Forum on Quality
Improvement in Health Care
The presenters have
nothing to disclose.
Wednesday, December 12
#IHIFORUM
Disclosure:
James Moses, Kate Hilton, Gina Deitz, Emileigh Canales, Becca
Engels, Nick Christian, and Michael Holbrook today have no
relevant financial or nonfinancial relationship(s) within the
services described, reviewed, evaluated, or compared in this
presentation.
Session Objectives
Explore the importance of leveraging student and resident
leadership to achieve system-wide transformation.
Learn how to co-design work with students and residents to
implement community and action-oriented improvement efforts.
Understand how to apply a quality improvement and community
organizing framework to build intrinsic motivation, engage key
stakeholders, and build momentum for change.
Workshop Agenda
Welcome, Introductions, and Overview
Bright Spot 1: Emory University
Bright Spot 2: PSU/OHSU
Discussion of Key Learnings
Leveraging the Open School Network for Large-Scale Change
Conclusion and Wrap-Up
Workshop Presenters
Becca Feistritzer Engels, MD, MPH
Medical Resident, Emory University
Gina Deitz
Open School Senior Program
Manager, IHI
Emileigh Canales, MPH
QI Analyst, CareOregon
Nick Christian, MD, MPH
Medical Resident, University of
Texas – Austin
Michael Holbrook, MBA
Medical Student, Wright State
University
Kate Hilton, JD, MTS
Founding Director and Senior
Consultant at ReThink Health and IHI
Faculty and Open School Advisor
James Moses, MD, MPH
Chief Quality Officer and VP of Quality
and Safety, Boston Medical Center and
Open School Advisor
Challenges in Engaging Students and Residents
Transient population
Varying skills / experiences
Investment of time upfront to orient them to the system
Lack experience in quality improvement and patient
safety
Need greater understanding of the system – it’s too early
in their careers for them change it
Generational Differences
Challenges in Engaging as Students and Residents
Unsure of relationships and opportunities outside of their
institution
Organizational hierarchy
Little space to lead and a “seat at the table”
Project opportunities are non-existent or misaligned with their
interests
Zero sum curriculum
Antiquated curriculum
Lack of IPE or team based approaches to learning
Mentor availability / time
Interests that students, residents and
professionals bring to partnerships
Students/Residents Professionals
• To lead
• To learn
• To make an
impact
• To gain
experience
• To be in
community
• To feel
supported
• To generate
results
• To connect
interprofessional
stakeholders
effectively
Collective
power
Assets that students, residents and professionals
bring to partnerships
Students/Residents Professionals
• Fresh ideas
• Energy
• Passion
• Time
• Experience
• Expertise
• Mentorship
• Resume-
building skills
• Networking
Collective
power
“There are two elements of prophetic
vision. One is criticality, recognition of the
world’s pain. Second is hope, recognition of
the world’s possibilities.”
-Walter Brueggemann
IHI Open School Mission
“Advance health care improvement and patient safety
competencies in the next generation of health professionals
worldwide.”
IHI Open School Launch - 2008
Shift to a bottom-up approach, a “revolution from the
basement”:
– Leverage students’ ability to create change in their local settings
– Introduce a disruptive innovation that would translate to a scalable
model to all universities
– Create the “other school” – an educational community that’s free
and open to students in all health professions no matter where
they are.
• 32+ online courses, including set
of GME courses
• More than 5.5 million courses
completed
• More than 700,000 learners have
completed a course
• More than 145,000 learners have
earned the Basic Certificate
• More than 1,500 universities and
health care organizations using
the courses
IHI Open School Courses
IHI Open School Community
• More than 920
Chapters started in 94
countries
• Over 50% of our
Chapters are
interprofessional
• Leading work to:– Train peers in quality and
safety
– Lead educational reform to
incorporate quality and
safety into their formal
curriculum
– Host events and facilitate
activities and learning
sessions
– Conduct local QI project
work
Ready to lead change together
8 Chapters worked together over the course of 10
months
Two sites: University of British Columbia and
University of Toronto with 400 attendees
6 keynote speakers, 2 panels, more than 20 workshop
sessions
27 Chapters in 8 countries worked
together over the course of 3 months
5,000+ pledges collected; topics
relevant to health initiatives in local
communities
International Pledge-a-Thon IHI Open School Canadian Chapter Network Conference
Deming’s System of Profound Knowledge
To improve, people are our fundamental source of value
and must be treated as partners. That requires offering
people the agency to make choices, tools to be effective,
and a learning system for continual improvement.
Psychology in Improvement
• People want to create value and are
our fundamental source of value
• Move from systems driven by fear
and extrinsic motivators to those
driven by intrinsic motivation
• Creating a culture that respects
people and treats them as partners
takes work and expertiseW. Edwards Deming
AGENCY
The ability of an individual or group
to choose to act with purpose
Power
The ability to
act with purpose
Courage
The emotional resources
to choose to act
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Psychology of Change
Unleash Intrinsic Motivation
Tapping into sources of intrinsic motivation galvanizes people’s individual and
collective commitment to act.
Co-Design People-Driven Change
Those most affected by change have the greatest interest in designing it in ways that are meaningful and workable to them.
Co-Produce in Authentic Relationship
Change is co-produced when people inquire, listen, see and mutually commit to one another.
Distribute Power
People can contribute their unique assets to
bring about change when power is shared.
Adapt in Action
Acting can be a motivational experience for people to learn and iterate to be effective.
IHI Psychology of Change Framework
zzActivate
People’s
Agency
Organizing: People, Power & Change
• People-powered approach to (the psychology of) change
• Brings people together on the basis of shared values (i.e.
intrinsic motivations)
• Offers people agency to contribute their unique assets
• Unleashes people as partners in the co-production of change
(i.e. improvement)
Clarkston Community Health Center
• Clarkston, Georgia, USA
• “The most diverse square mile in America.”
• CCHC founded to provide primary/preventive care to refugee, indigent, underinsured, and uninsured
• One student with an idea
Adapt in Action
Adapt in Action z
z
Activate
People’s
Agency
Acting can be a motivational experience for people to learn and iterate to be effective.
Recommended Practices
1. Coach and Be Coached
2. Adapt a Growth Mindset
3. Fail Forward
4. Embrace Emergence
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Co-Produce in Authentic Relationship
Co-Produce in Authentic Relationship
zz
Activate
People’s
Agency
Change is co-produced when people inquire, listen, see, and commit to one another.
Recommended Practices
1. Practice One-to-One Meetings
2. Ask Open and Honest Questions
3. Practice Appreciative Inquiry
4. Listen Deeply
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Bridges Collaborative Care Clinic
– Identified need for an
interprofessional student-
run clinic
–Recruited
interprofessional faculty
advisors
–Partnered with community
partner serving homeless
Bud Clark Commons
Bridges Clinic Timeline
January 2016 – began organizing students and community partners; mobilized leadership teams
September 2017 – established Board of Directors
October 2017 – opened BCCC health clinic
June 2018 – Access to 2 additional TPI Shelters
July 2018 - 501c3 status received
October 2018 – Dental Clinic opened
38
First Year Outcomes
39
• 100+ unique
participants seen
• 5,000 hours of service
donated by students
• 13 academic programs
represented
AGENCY
The ability of an individual or group
to choose to act with purpose
Power
The ability to
act with purpose
Courage
The emotional resources
to choose to act
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Psychology of Change
Unleash Intrinsic Motivation
Unleash Intrinsic Motivation
zz
Activate
People’s
Agency
Tapping into sources of intrinsic motivation
galvanizes people’s individual and collective
commitment to act.
Recommended Practices
1. Public Narrative
2. Motivational Task Design
3. Play and Celebrate
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Kick Off: January 2016
Actors: 36 students and faculty representing 7
programs and 2 community partners
Value and asset mapping
Co-Design People-Driven Change
Co-Design People-Driven Change
zz
Activate
People’s
Agency
Those most affected by change have the greatest
interest in designing it in ways that are
meaningful and workable to them.
Recommended Practices
1. Become Aware of Bias
2. Map Actors
3. Craft People-Driven Aim
Statements
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Distribute Power
Distribute Power
zz
Activate
People’s
Agency
People can contribute their unique assets to
bring about change when power is shared.
Recommended Practices
1. Create a Shared Purpose
2. Develop Distributed Leadership
3. Establish Working Agreements
4. Cede Power
Source: Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, MA: Institute for Healthcare Improvement; 2018. ihi.org/psychology
Builds an equal status contract around a
shared purpose
Is commitment-driven, not compliance-based– Cultivating people’s agency to act increases joy
and improves health
Builds capacity that serves as an ongoing
asset for addressing other problems
48
Distributed Leadership
‘Leadership is accepting responsibility for enabling
others to achieve shared purpose in the face of
uncertainty.’
• A practice, not a position
• Authority is earned, not
bestowed
• Focus is on developing
others, not just yourself
What is Leadership?
Unleash Intrinsic Motivation
Co-Design People-Driven Change
Co-Produce in Authentic Relationship
Distribute Power
IHI Psychology of Change Framework
Adapt in Action
zzActivate
People’s
Agency
Discussion Questions
• How are you leveraging these strategies in your work?
• Where is there an opportunity for you to bring these strategies
into your approach with students and residents?
• How can you help students and residents bring these skill sets
into their work?
Our Dream
A world in which substance use disorders are not seen as a source of shame but as chronic
diseases that can be prevented, managed, and treated; in which individuals are free of suffering caused by
substance use disorders, communities thrive, and health care systems serve
patients equitably and compassionately.
Our Aim
The IHI Open School Recover Hope Campaign promotes
awareness, prevention, and treatment of substance use
disorders. Together, we will improve the lives of 50,000
people living with substance use disorders around the
world by April 2020. We will do this by engaging 150,000
members of our diverse, global network of change agents
and 150 IHI Open School Chapters to take action together.
www.ihi.org/recoverhope
(1) Who are our People?
(2) What Change do they want?
(3) How can they get the Power they
need to achieve that change?
Organizing = People, Power & Change
CommunityOverdoseAc onTeamPublicHealthDayton&MontgomeryCounty
ILLEGALOPIOIDSUPPYCONTROLBRANCH
EDUCATION&INFORMATIONBRANCH
PREVENTIONBRANCHTREATMENT&
RECOVERYBRANCHPRESCRIPTIONOPIOIDS
BRANCHHARMREDUCTION
BRANCH
Decreasethesupplyofillegalopioidsandotherillicitsubstances.
Raiseawareness&knowledgeofthedangersofopioidsandillicitdrugmisusebyimplemen ngpublicawarenessac vi es.
Preventopioidandillicitdrugmisuse.
Promoteuseofbestprac cesamonghealthcareprovidersforprescribingopioidsforacuteandchronicpain.
Expandaccesstotreatment&communitysupportprograms.
Increasecapacityofharmreduc onprogrammingtoprovideoverdosepreven on&engageclientsinsupportservices.
PHA MACY
N ING w POFE IONAL PYCH w OCIAL WO K
NDE G AD A E DIE w MO E…
DaytonOpenSchool
Distributing Leadership
Getting Started: Set an Aim, Build Capacity!
1. Aims: Stabilize and reduce the number of people
dying from drug overdoses in Montgomery County.
2. Capacity Built: Launch two projects in which
students can get hands-on QI experience before
May 26, 2017.
3. Leadership Developed: Have 20 health
professional student members representing at least
3 different professional programs involved in the
IHI Open School Chapter through the Student
Opioid Coalition by May 26, 2017.
Outcomes to date
55 students engaged in the Student Opioid Coalition
in the first year
5 project leaders identified
NARCAN TRAINING EVENT
7+ disciplines involved
Medicine, pharmacy, nursing, social work, public health,
professional psychology, pre-medicine
MEDICATION DISPOSAL KIT
PROJECT100+ students attended
70+ doses of Narcan distributed
in the community
40 pharmacy locations
500 disposal kits stocked
The “B-Team”
An interprofessional and multidisciplinary group that:
1. Screens appropriate patients for buprenorphine induction,
2. Assists in the starting of this treatment while patients are hospitalized,
3. Facilitates linkage with an outpatient MAT clinic, and
4. Provides institutional education in an effort to reduce stigma and raise awareness about opioid use disorders.
Engaging Trainees
In three months time…
– 3 residents, 3 medical students, 1 pharmacy
student
– QI Data Collection: referrals, outpatient
transition
– Added capacity for staff education
– Improved patient education on community
resources
Spreading Hope
"I wanted to share with you all that during the assessment,
he became quite emotional, started crying to the point
where he could not talk (not just tearful), and expressed a
lot of gratitude for everything you all have provided there,
for him. He acknowledged that he was so relieved to not
have been kicked out after having been caught using in the
hospital, but more importantly, it really seemed to be about
his feelings, and almost disbelief, that 'they actually really
care about me.' It was kind of heartbreaking, but very
awesome that you all have made such an impact.”
-Sarah, LPC from outpatient clinic
July 2018: More than 25 Chapter Leaders attended the Open
School Leadership Academy to launch campaign projects.
Recover Hope Campaign Projects
University of Toronto: To engage 200 members of the
Toronto community in raising awareness and reducing
stigma associated with substance use disorders by building
the capacity of interprofessional students at UofT and
creating a platform for individuals to share their personal
narratives (direct or indirect) by June 2019.
Brock University: Improve rapid access to
emergent care for individuals suffering from
a substance-related overdose through
bypassing the emergency department (ED)
and moving directly to the rapid access
addiction medicine clinic (RAAMC) for care.
Others are:
Hosting NARCAN trainings
Launching video challenges to as a
platform to share stories and reduce
stigma around substance use
disorders
Changing prescription patterns for
patients admitted for an overdose
Building partnerships with local
student-run health clinics to launch
improvement efforts
www.ihi.org/recoverhope
IHI Open School Recover
Hope Work Streams
We aim to improve
the lives of 50,000
people affected by
substance use
disorders by April
2020.
AWARENESS
Raise awareness
and reduce stigma
with a focus on
equity
TREATMENT &
RECOVERY:
Improve treatment
for individuals with
substance use
disorders
1. Change the Narrative
Sharing stories to raise awareness
of substance use disorders as a
chronic disease, reduce stigma,
and confront systematic oppression
underlying substance use
2. Save Lives from Overdose
Train individuals to recognize
overdoses and intervene by
administering naloxone
4. Reform University Curricula
Promote education and training on
prevention, diagnosis, and
treatment of substance use
disorders into university curricula
PREVENTION
Prevent substance
use disorders and
unhealthy
substance use3. Improve Pain Management
Support best practice opioid
prescribing and alternative pain
management in health systems
Will you join us?
Immediate opportunities to
get involved:
– Connect with your local
Chapter to advise their project
work, partner on new work
through your institution, or
simply learn more about their
efforts locally.
– Take the pledge at the
National Forum to
www.ihi.org/recoverhope
Leverage your local network of students and residents
Connect with a local Open School Chapter to engage them with
project work at your institution:
Connect with a local Chapter
with the click of a button
www.IHI.org/OpenSchool
Build capacity at your organization
Basic Certificate in Quality & Safety
– 13 core courses in QI and patient safety
Leadership and Organizing for Change
– Learn more at www.ihi.org/lead
– Next offering: March 14 - May 22, 2019
www.IHI.org/OpenSchool
Thank you!Questions? Want to connect with the Open School or one of the presenters? Email [email protected].