New models of patient care are needed to achieve dramatic improvements in quality, cost, and patient experience. At the recent annual conference of the Institute for Healthcare Improvement (IHI), healthcare leaders shared examples of how they are flipping traditional approaches to care delivery. 


Get patients to coach other patients. About 20 percent of prenatal patients at Boston Medical Center share prenatal appointments with eight to 12 other mothers-to-be as part of a program called Centering Pregnancy®. While the group appointments include a checkup from a physician or midwife, the highlight is the peer-to-peer exchange that occurs, says Maureen Bisognano, the IHI’s president and CEO. For instance, Bisognano notes that she observed one appointment in which two women counseled another woman about managing pain during childbirth. 

Patients spend 20 hours in group visits, which is about 10 times more appointment time than women in traditional prenatal care get. Yet per-pregnancy costs are $2,000 less, Bisognano says. 

Shadow patients to identify opportunities for improvement. Not satisfied with HCAHPS patient satisfaction scores in the 98th percentile, the Bone and Joint Center at Magee-Womens Hospital at UPMC continues to look for ways to improve. One tool that the center uses is shadowing. A staff person, student, or volunteer follows a patient around during a particular health event (e.g., day of surgery) to identify opportunities for improvement. Shadowing was instrumental in discovering that parking problems were causing delays in OR start times. After the hospital added a valet parking service for surgery patients, start times improved. 

Put a C-suite leader in charge of transitions. Baptist Health, based in Jacksonville, Fla., does not own any skilled nursing facilities (SNFs). Yet system leaders knew the organization needed to build relationships with SNFs to improve readmission rates. One step was to put a hospital president, Joseph Mitrick, in charge of transitional care, says Baptist Health CEO Hugh Greene. Mitrick built needed relationships with local SNF leaders, which laid the groundwork for a post-acute care network that meets monthly to share performance improvement data and ideas. 

Act like private investigators. As part of a federal grant, Carolinas HealthCare system is trying to better understand patients with chronic obstructive pulmonary disease (COPD). One eye-opening step has involved regular follow-up interviews with COPD patients who are readmitted to the hospital. The interviews have helped staff see the wide array of factors that affect a patient’s ability to keep COPD under control. 

Making health education fun. Mike Evans, MD, a Canadian family physician, is helping to spread health advice on various topics (e.g., acne, joint replacement) through entertaining white-board cartoons aired via his YouTube channel ( At the IHI conference, Bisgonano played Evan’s video “Let’s Make Your Day Harder,” which encourages people to find ways to add activity to their days. (Google it for a healthy distraction.) 

Maggie Van Dyke is managing editor, Leadership, newsletters, and Forums, HFMA.

Publication Date: Wednesday, January 01, 2014

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