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2013 Massachusetts General Hospital
Professional Practice Symposium

Innovations in Care
Delivery:
Advancing a Professional Practice Model

Presented by
The Institute for Patient Care
Innovation: A New (and
old) Frontier of Patient
Care
1846
The use of ether
as an anesthetic
is demonstrated
and surgery is
performed without
pain for the first
time.
1874-1876

Linda Richards served as the
superintendent of the Boston
Training School for Nurses, later
renamed the Training School at
Massachusetts General
Hospital. Richards was the first
student to graduate from a
training school for nurses in
America.
1905
Dr. Richard Cabot, a senior
physician at Mass General,
hired the first social worker
to provide social work
services in the outpatient
clinics. In 1906, Dr. Cabot
met Ida Maude Cannon and
hired her to jointly organize
the nation's first hospitalbased social work program.
• Failures in Care
Delivery

• Failures in Care
Coordination
• Lack of Evidence
Based Practice
• Need for Better
Engagement of
Patients and Families
Guided by the needs of our patients and
their families, we aim to deliver the very
best health care in a safe, compassionate
environment; to advance that care through
innovative research and education; and to
improve the health and well-being of the
diverse communities we serve.
Better Care at Lower Cost, IOM,
2012
Culture Change
Creating Norms:
To create new norms we
must first understand
existing norms & barriers
to change

Change Process:
Every change requires
effort and the decision to
make that effort is a
social process
1:00 PM - 2:00 PM
2:00 PM - 2:30 PM
2:30 PM - 3:30 PM
3:30 PM - 4:00 PM
4:00 PM - 5:00 PM
5:00 PM - 6:00 PM
6:00 PM - 8:00 PM
8:30 AM - 8:45 AM
8:45 AM - 9:45 AM
9:45 AM - 10:45 AM
10:45 AM - 11:15 AM
11:15AM - 12:10 PM
12:10 PM - 1:00 PM
1:00 PM - 1:55 PM
2:00 PM - 2:55 PM
3:00 PM - 3:30 PM
3:30 PM - 4:30 PM
4:30 PM - 5:00 PM

Monday, October 28, 2013
Arrival/Networking
Innovation: The Frontier of Patient Care
The Strategic Imperative for Innovation
Poster Session
Innovation in Care Delivery: The Patient Journey
Book Signing
Cocktail Reception in the Museum of History and Innovation
Tuesday, October 29, 2013
Welcome
Creating the New Culture Through Relationship-Based Care
The Attending Registered Nurse
Poster Session
Breakout Session #1
Lunch
Breakout Session #2
Breakout Session #3
Poster Session
Tales from the Front Lines: The Clinician’s Experience (Panel)
Closing Remarks

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Innovation: The Frontier of Patient Care

  • 1. 2013 Massachusetts General Hospital Professional Practice Symposium Innovations in Care Delivery: Advancing a Professional Practice Model Presented by The Institute for Patient Care
  • 2.
  • 3. Innovation: A New (and old) Frontier of Patient Care
  • 4. 1846 The use of ether as an anesthetic is demonstrated and surgery is performed without pain for the first time.
  • 5. 1874-1876 Linda Richards served as the superintendent of the Boston Training School for Nurses, later renamed the Training School at Massachusetts General Hospital. Richards was the first student to graduate from a training school for nurses in America.
  • 6. 1905 Dr. Richard Cabot, a senior physician at Mass General, hired the first social worker to provide social work services in the outpatient clinics. In 1906, Dr. Cabot met Ida Maude Cannon and hired her to jointly organize the nation's first hospitalbased social work program.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. • Failures in Care Delivery • Failures in Care Coordination • Lack of Evidence Based Practice • Need for Better Engagement of Patients and Families
  • 13. Guided by the needs of our patients and their families, we aim to deliver the very best health care in a safe, compassionate environment; to advance that care through innovative research and education; and to improve the health and well-being of the diverse communities we serve.
  • 14.
  • 15. Better Care at Lower Cost, IOM, 2012
  • 16. Culture Change Creating Norms: To create new norms we must first understand existing norms & barriers to change Change Process: Every change requires effort and the decision to make that effort is a social process
  • 17. 1:00 PM - 2:00 PM 2:00 PM - 2:30 PM 2:30 PM - 3:30 PM 3:30 PM - 4:00 PM 4:00 PM - 5:00 PM 5:00 PM - 6:00 PM 6:00 PM - 8:00 PM 8:30 AM - 8:45 AM 8:45 AM - 9:45 AM 9:45 AM - 10:45 AM 10:45 AM - 11:15 AM 11:15AM - 12:10 PM 12:10 PM - 1:00 PM 1:00 PM - 1:55 PM 2:00 PM - 2:55 PM 3:00 PM - 3:30 PM 3:30 PM - 4:30 PM 4:30 PM - 5:00 PM Monday, October 28, 2013 Arrival/Networking Innovation: The Frontier of Patient Care The Strategic Imperative for Innovation Poster Session Innovation in Care Delivery: The Patient Journey Book Signing Cocktail Reception in the Museum of History and Innovation Tuesday, October 29, 2013 Welcome Creating the New Culture Through Relationship-Based Care The Attending Registered Nurse Poster Session Breakout Session #1 Lunch Breakout Session #2 Breakout Session #3 Poster Session Tales from the Front Lines: The Clinician’s Experience (Panel) Closing Remarks

Editor's Notes

  1. I’m Gaurdia Banister, the Executive Director of the Institute for Patient Care. I’m delighted to welcome you to our second symposium entitled Innovations in Care Delivery: Advancing a Professional Practice Environment. This symposium builds upon our first symposium which was held last year examining strategies for Creating and Sustaining a Professional Practice Environment. We have an exciting and informative 2 day program for you. We’re thrilled that you’ve joined us and we have participants from the United States, Canada, Spain, Japan and England. I encourage you to network with your colleagues and our staff who are here, ask questions and also share how you are innovating in your own organizations. We see this as an opportunity where we can learn from each other. You’re in a sport town. The Patriots won and also the Red Sox that are in the World Series . Unfortunately the Bruins lost on Saturday but they have a 7 -3 record.If you need any help, please look for staff with IDs that say >>>>>> , they will be happy to help you. In our effort to go green, most of the material such as speaker biographies, powerpoint slides, your individual agendas (if you don’t have it or can’t access it, we’ll be happy to print a copy for you and other information pertaining to the symposium can be found on-line. Just a reminder, after the presentations today, we will be hosting a sale and book signing of the 2013 Sigma Theta Tau International “Best of Book Author Award Fostering Nurse-Led Care: Professional Practice from the Bedside Leader edited by Jeanette Ives Erickson, Dorothy Jones and Marianne Ditomassi. We will also have copies available of Nursing at 200 at MGH .
  2. The closure of the federal government related to the Affordable care act.
  3. When we are considering using the word innovation, is sometimes the word is being used as a new term or an approach but we all know that Innovation has been around for a long time. I thought I would start with what I know at the MGH.
  4. William T. G. Morton instructed a patient to inhale the fumes from a ether soaked sponge. After the patient was sufficiently sedated, a surgeon removed a tumor from his neck. When he work up, the patient reported that it felt like he had a scratch on his neck. How different it was from holding down patients who were kicking and screaming and asking them to bit a bullet or a belt to suppress their screams.
  5. Linda received forma training as a nurse and the superintendent, she embedded what she had learned in the training school for other nurses.
  6. Critical part of our interprofessional/interdisciplinary team
  7. I have to reference the government shut down with a focus point on the affordable care act. In addition, with the debacle of the healthcare.gov website where people are trying to sign up for health insurance. There is a lazer focus on health care right now.
  8. OK
  9. Failures of care delivery. This category includes poor execution or lack of widespread adoption of best practices, such as effective preventive care practices or patient safety best practices. Delivery failures can result in patient injuries, worse clinical outcomes, and higher costs. Failures of care coordination. These problems occur when patients experience care that is fragmented and disjointed--for example, when the care of patients transitioning from one care setting to another is poorly managed. These problems can include unnecessary hospital readmissions, avoidable complications, and declines in functional status, especially for the chronically ill.Nearly one-fifth of fee-for-service Medicare beneficiaries discharged from the hospital are readmitted with 30 days; three-quarters of these readmissions--costing an estimated $12 billion annually--are in categories of diagnoses that are potentially avoidable. Failures of care coordination can increase costs by $25 billion to $45 billion annually.   Overtreatment. This category includes care that is rooted in outmoded habits, that is driven by providers' preferences rather than those of informed patients, that ignores scientific findings, or that is motivated by something other than provision of optimal care for a patient. Overall, the category of overtreatment added between $158 billion and $226 billion in wasteful spending in 2011, according to Berwick and Hackbarth. Administrative complexity. This category of waste consists of excess spending that occurs because private health insurance companies, the government, or accreditation agencies create inefficient or flawed rules and overly bureaucratic procedures. For example, a lack of standardized forms and procedures can result in needlessly complex and time-consuming billing work for physicians and their staff. Overall, administrative complexity added $107 billion to $389 billion in wasteful spending in 2011.  Pricing failures. This type of waste occurs when the price of a service exceeds that found in a properly functioning market, which would be equal to the actual cost of production plus a reasonable profit. For example, Berwick and Hackbarth note that magnetic resonance imaging and computed tomography scans are several times more expensive in the United States than they are in other countries, attributing this to an absence of transparency and lack of competitive markets. In total, they estimate that these kinds of pricing failures added $84 billion to $178 billion in wasteful spending in 2011. Fraud and abuse. In addition to fake medical bills and scams, this category includes the cost of additional inspections and regulations to catch wrongdoing. Berwick and Hackbarth estimate that fraud and abuse added $82 billion to $272 billion to US health care spending in 2011.(http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=82)
  10. Gleicher’s Change Formula*created by Richard Beckhard and David Gleicher, refined by Kathie DannemillerThree factors must be present for meaningful organizational change to take place. These factors are:D = Dissatisfaction with how things are now;V = Vision of what is possible;F = First, concrete steps that can be taken towards the vision;If the product of these three factors is greater thanR = Resistancethen change is possible. Because D, V, and F are multiplied, if any one is absent or low, then the product will be low and therefore not capable of overcoming the resistance.To ensure a successful change it is necessary to use influence and strategic thinking in order to create vision and identify those crucial, early steps towards it. In addition, the organization must recognize and accept the dissatisfaction that exists by communicating industry trends, leadership ideas, best practice and competitive analysis to identify the necessity for change.