View a recording of this webinar here: https://www.healthcatalyst.com/webinar/the-patients-power-in-improving-health-and-care/ Around the globe, we are facing a trifecta of healthcare challenges: financial constraints, an aging population, and an increased burden of chronic disease. We need to turn healthcare upside down, empowering our patients to take action for their health and helping physicians, nurses, and healthcare professionals move from being sages to guides. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you”? Through her work at the Institute for Healthcare Improvement (IHI), Maureen Bisognano has worked diligently to support the IHI Triple Aim: improving the experience of patient care, improving the health of populations, and lowering costs. In this webinar she will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease. In this webinar you will learn: - Lessons from the “flipped school” in the education system and how they can be successfully applied in healthcare to improve patient behavior. - How increased patient engagement can help to improve healthcare outcomes and deliver a better care experience while reducing costs. - Ways that technology can effectively improve data capture, patient accountability, and decision-making. - The impactful stories of four patients who became innovators in their own care. improve data capture, patient accountability, and decision-making.

1. The Patient’s Power in
Improving Health and Care
Maureen Bisognano - President
Emerita and Senior Fellow, IHI

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• Across the world, we’re facing significant financial constraints, the aging of
the population, and the increasing burden of chronic disease.
• We’ll need to move to the Triple Aim of improving the experience of care,
improving the health of the population, and lowering per capita costs.
• “More and faster” won’t get us there…we need new ways to think about
care.
• Many answers here in this room…“all teach, all learn”.
“Our” Shared Challenge
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• The students’ results flipped in every grade
• In every class, failure rates dropped
• Graduation rate rose to over 90%
• College attendance rates rose from 63% to 80%
• Most important, the “flipped classroom” closed the gap between the
students from socio-economically challenged families and their peers
• It helped teachers identify the “silent failers” (the students most in need)
and then work with them in the classroom
Flipping the Classroom
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5. “Sage on the stage”
to
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“Guide on the side”
From

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IHI Triple Aim
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Experience of Care Per Capita Cost
Population Health

7. What’s the matter?
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What matters to you?
Source: Barry MJ, Edgman-Levitan S. ”Shared Decision Making – The Pinnacle
of Patient-Centered Care.” N Engl J Med. 366;9. pp 780-782

8. dis-ease
to
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health-ease
Move from

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The Next “Blockbuster Drug”
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• Patients in a coordinated care setting (focused on engagement) have 88%
reduced risk of dying of a cardiac-related cause when enrolled within 90
days of a heart attack compared to those not in a program
• Clinical care teams reduced overall mortality by 76% and cardiac mortality
by 73%
• “Imagine what the headlines would be if a new cardiac drug showed this
kind of effectiveness? It would be malpractice not to use it!”
Patient Engagement
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Source: Leonard Kish. HL7 Standards Blog. 8/28/12. available at: http://www.hl7standards.com/blog/2012/08/28/drug-of-the-century/

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Trevor
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Link

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• “Energy to do all I need”
• “College life is hectic, the schedule is unpredictable, so being able to
predict and control my health and energy…I can thrive”
Trevor’s Definition of Health
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• No surprises
• Straight answers
• Advice
• Easy Access
• He’d love to be able to email in questions, but when I asked about texting, he said
he thought he could, “cut the old people some slack.”
• He thinks they might need more time before technology is fully optimized in daily
care.
What Trevor Needs from Health Care
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• A strong bond with doctor and care team
• Ability to express a concern or ask a question and get straight answers
and advice
• Would love to “FaceTime” visits — sees the future as human connections
and continuous communication
• All without going to the office
Trevor’s Dream
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What percent of your young patients are like Trevor (prefer to manage
their own health and care)?
1. 0% - 25% — 19% of respondents
2. 26% - 50% — 26% of respondents
3. 51% - 75% — 36% of respondents
4. 76% - 100% — 19% of respondents
Poll Question
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16. 5000
Hours
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• Complications are costly
• …in human terms
• …in disability terms
• …in dollar terms
• …and in terms of hospital utilization
The Cost of Diabetes
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The Old Way
• Ryhov Hospital in Jönköping had a traditional hemodialysis and peritoneal
dialysis center
• But in 2005, a patient, Christian, asked about doing it himself
Change the Balance of Power
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Christian taught a 73-yr-old woman how to do it…
The New Way
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…and they started to teach others how to do it.

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• Now, they aim to have 75% of patients to be on self-dialysis
• They currently have 60% of patients
The New Way
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• From Anette (nurse leader):
• Surprised at design differences between patients, family, and staff
• Managing at 1/2 - 1/3 less cost per patient
• Evidence of better outcomes, lower costs, far fewer complications and infections
• “We brought in the country’s employment, helped the patients make or update the
CVs, and trained them for a new career.”
Lessons to Date
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• Now calculated costs at 50% of costs in other hemodialysis units
• Complications dramatically reduced and subsequent expensive care
avoided
• Measuring success by “number of patients working”
Update
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Successful Spread – Waco, Texas
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Comparison of In-Center Self-Care
Hemodialysis to Non-Self Care
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Employment rate:
26% vs 7% in a
facility within the
same building
Source: Edward R Jones, MD, MBA, Medical Director, Self-care FMC Mt Airy Phila.

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• The patient starts by selecting a few values
that matter most to them when choosing a
treatment plan
• Then detailed information is provided to help
the patient rate treatment options according
to how well they match each chosen value
My Dialysis, My Choice
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Source: mydialysischoice.org

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• Based on the patient’s rankings on each value, the results are compiled to
help them decide which dialysis treatment option is best for their lives and
health
My Dialysis, My Choice
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Source: mydialysischoice.org

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• If we can flip care to coordinate all aspects of care — physical, social,
functional, emotional, and safety — we can prevent hospitalizations,
improve the quality of life for millions, and save millions.
All Aspects of Care
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Centering Pregnancy
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Source: Boston Medical Center

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• Young woman from Boston – 24 weeks pregnant with her first child
• Her husband is still back in Nigeria and she’s hoping he’ll be here for the
birth
Norah
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• Norah, like all the young women who participate in the group visit, takes
her own vital signs, weighs herself, and enters all the info into her record.
• She shares the record with the physician and midwife – it’s flipped! – and
then moves to the back of the room to be examined before the group
portion of the visit begins.
• While the exams are conducted, there is a lot of chatter, a lot of questions
asked and advice given, and a lot of relationship-building.
Centering Model
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“I’m very afraid of labor. I’m terrible with pain. I’m scared. I don’t think I’ll be
able to do it.” The midwife said, “those of you who have had babies before,
what advice do you have for Norah?”
• Relaxed
• Ice cubes
• Confidence
What Matters to Norah
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• Reduced the risk of preterm birth by 33%1
• Reduced racial disparities for preterm births
• Hispanic women in Centering demonstrated lower preterm birth rates than those in
traditional care models (5% vs. 13%)2
• Reduced the odds of preterm births by 41% in African American women3
• Nearly twice the number of Centering Healthcare participants breastfed
(46%) than those in a comparison study (28%)4
Centering Results
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1Ickovics, et al. Obstetrics and Gynecology, 2007
2Tandon, et al. J. Midwifery & Women’s Health, 2012
3Ickovics, et al. 2007
4J of Midwifery & Women’s Health, 2004

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What If We Flipped the Patient
Discharge Process?
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Link

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• Interprofessional team who are the first to meet with new patients in need
of home-based care
• Occupational therapists
• Physiotherapists
• Nurses
• Social workers
• Work towards independence and mastery of everyday life, transitioning
patients to either:
• Discharge without need of further healthcare, or
• Home-based care with the best possible function
Reablement – Oslo Kommune
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Source: Thomas Lystad

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• Assess the needs of the patient:
• Interests
• Resources
• Limitations
• Current function
• Goal
• Plan
• Assessment of the care and adaptation of the plan is ongoing
• Goal: Transfer or discharge the patient when we have achieved best
possible function and a stable need for healthcare
Reablement – Oslo Kommune
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Source: Thomas Lystad

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• History
• 70 year old man with COPD, type 2 diabetes, and two
previous heart attacks
• Suffered a major stroke, and spent a month in the hospital
• Left side paralysis, poor cognitive and physical function
Jarle
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Source: Thomas Lystad
• Began prescribed reablement program, which was continuously
reassessed; made good progress and entered health rehab
• Came back to reablement after challenges; they helped him find a new,
more accessible apartment
• Now largely independent, and needs a wheelchair only for long distances

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Flo
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Link

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• Flip the balance of care – from the hospital to the community
• Flip the balance of delivery – from individual providers to care teams
• Flip the balance of power – from the provider to the patient and family
• Flip the balance of costs – from treatment to prevention and co-production
• Flip the balance of emphasis from volume to value; and from health care
to health
Flipping Health Care
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What impedes you at the organizational level from more fully including
patient input into the care you provide?
1. Leadership — 18%
2. Daily, immediate operational challenges — 32%
3. Resources (labor, money) — 15%
4. IT documenting/workflow systems — 14%
5. Performance measures focused elsewhere — 20%
Poll Question
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• IQ — Intelligence Quotient
• Processing complex data sets and having the mental capacity to problem solve at
speed
• EQ — Emotional Quotient
• The ability to perceive, control and explain emotions; risk-taking, creating resilience
and empathy
• CQ — Curiosity Quotient
• Inquisitive, open to new experiences, finding novelty exciting
The Importance of Curiosity
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Source: Chamorro-Premuzic T. “Curiosity Is as Important as
Intelligence.” Harvard Business Review. Aug 27, 2014.

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Innovation
• Where are care models and processes broken?
• Where do we need new thinking?
• Innovation labs, design processes
• Harvesting
Spread
• Where do we see variation in performance?
• How can we reliably spread to ensure that we can provide the best care to every patient,
where they are?
• Transparent data
• Curiosity
• Spread model
Exnovation
• How do we stop what doesn’t work anymore?
• How will we eliminate wasteful practices and processes?
 It takes courage!
Innovation-Spread-Exnovation
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Do you have a CEO – “Chief Exnovation Officer”?
1. Yes — 8%
2. No — 92%
Poll Question
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Maureen Bisognano
President Emerita and Senior Fellow
Institute for Healthcare Improvement
53 State Street, 19th Floor
Boston, MA 02109
mbisognano@ihi.org
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Healthcare Analytics Summit 18
Sept. 11-13, Salt Lake, Grand America Hotel
TOBY COSGROVE, MD
former CEO and President of
Cleveland Clinic (2004-2017),
who as a cardiac surgeon
performed more than 22,000
operations and holds 30 patents
for medical innovations
KIM GOODSELL
the actualized ‘genomified,’ quantified,
digitalized “patient of the future," her debut at
the 2014 Future of Genomic Medicine
conference made headline news
announcing— “The patient from the future,
here today”
DANIEL KRAFT, MD
a Stanford and Harvard trained physician-
scientist, inventor, entrepreneur, and
innovator, Kraft is the Founder and Chair of
Exponential Medicine, a program that
explores convergent, rapidly developing
technologies and their potential in
biomedicine and healthcare
BRENT JAMES, MD
former Chief Quality Officer at
Intermountain Healthcare - known
internationally for his work in
clinical quality improvement,
patient safety, and the
infrastructure that underlies
successful improvement efforts
PENNY WHEELER, MD
President and Chief Executive
Officer of Allina Health,
returns a second time as one
of the most popular HAS
speakers ever
MARC RANDOLF
Co-founder of Netflix, Marc will
share the Netflixed story: how a
scrappy Silicon Valley startup
brought down Blockbuster and
the lessons that could be
applicable to healthcare
JILL HOGGARD GREEN
PhD, RN, Chief Operating Officer – Mission
Health and President – Mission Hospital,
and recently named to the 2017 Becker’s
Healthcare list of the country’s top Women
Hospital and Health System Leaders to
Know
ROBERT WACHTER, MD
global leader in healthcare safety,
quality, policy, IT; Chair of the
Department of Medicine, University of
California, San Francisco; best-selling
author, “The Digital Doctor: Hope, Hype
and Harm at the Dawn of Medicine’s
Computer Age”
More highlights
4 Digital Innovators (Keynotes)
AI Showcase (10 walkabout case studies)
Digitizing the Patient Showcase (10-12 stations)
28 Educational, Case Study, and Technical Breakouts
24 Analytics Walkabout Projects
More Networking (Introducing “Brain Date”)
CME Accreditation For Clinicians
5-Star Grand America Hotel Experience
96 Total Presentations
National keynotes
Employer
Innovation
Scott
Schreeve
MD, CEO, Crossover Health
Payer
Innovation
Kevin
Sears
Executive Director of Marketing
and Network Services, Cleveland
Clinic
Biosensor
Innovation
John
Rogers
PhD, Founding Director, Center
Bio-Integrated Electronics,
Northwestern University
Pricing
Innovation
Gene
Thompson
Project Director, Health City
Cayman Islands

49. Q&A

50. Thank You!