March 30, 2015

Reducing Hospital Readmission Rates -- What Really Works?

Erika Linnander, GHLI Senior Technical Officer

Unplanned hospital readmissions are estimated to cost more than $17 billion each year for Medicare alone. Across the country, hospital executives, clinicians, policymakers, and researchers search for the best ways to reduce unplanned hospital readmissions. Hospitals are intently focused on this issue, and are joining quality improvement networks and programs to guide their efforts. A dizzying array of tools and best practices are available, but which approaches are in fact tied to reduced readmission rates?

Researchers at Yale’s Global Health Leadership Institute continue to study which strategies work best for providing quality patient care and reducing hospital readmissions. Between 2010 and 2012, they found significant increases in the use of nine frequently recommended strategies among hospitals participating in the State Action on Avoidable Rehospitalization initiative or the Hospital-to-Home Campaign.

The latest evidence appearing in the May 2015 issue of the Journal of Internal Medicine shows that hospitals that incorporated any combination of three or more of these strategies which focused on changes to hospital culture and administration, saw significantly larger reductions in risk-standardized readmission than those hospitals that took up fewer strategies. After adjusting for hospital size and location, hospitals that implemented several strategies reduced their readmissions rates by 0.4 percentage points more than hospitals that implemented fewer strategies. Scaled nationally, this improvement could save the Medicare $400 million annually.

The study findings showed rather than a single recipe, many different combinations of strategies led to similar reductions in readmission rates.

What can health care professionals make of these results? First, there is no silver bullet. None of the nine strategies alone accounted for sizable reductions in readmission rates. Second, the successful hospitals were implementing at least three new strategies to reduce readmissions. Because readmissions have multiple root causes, a bundle of strategies is likely needed. Different hospitals used different means for achieving results. Last, change is hard. Despite their enrollment in major quality improvement initiatives, 70% of the hospitals surveyed had taken up fewer than three strategies during the course of the study.  

March 26, 2015

Leadership Towards the Advancement of Human Rights

Photo Credit: Thi Nhat Le
Zahirah McNatt, GHLI Director, Leadership Education and Practice

As part of the Senior Leadership Program (SLP), I recently worked with delegates from Cambodia, Laos, Myanmar, Philippines, and Viet Nam in Phnom Penh, Cambodia to address strengthening the enabling environments for persons with disabilities. Each team brought with them a national problem - high staff turnover, too few rehabilitation professionals, poor access to physical rehabilitation centers and limited knowledge among people with disabilities about their legal rights.

For this program, all written materials were translated into four languages and we had simultaneous interpretation during lectures and group activities. For five days, we explored problem solving, leadership and management, good governance and the United Nations Convention on the Rights of People with Disabilities (UNCRPD).

The trip was an awe-inspiring opportunity to encourage collaboration among several stakeholders. We had representatives from national disabled people’s organizations, government ministries, parents, teachers and physical rehabilitation facilities. The diversity created dynamic teams and allowed for cross-country dialogue about better integrating disability rights efforts in Southeast Asia.

The SLP created a safe space for discussion on how to operationalize the aspirations of the UNCRPD. Many countries stall once ratifying such agreements and are unable to make the dreams reality. These five nations have the potential to implement practical solutions that increase accessibility and diminish discrimination against people with disabilities.

While there are many difficult stories about children who use wheelchairs being unable to get to school or people with visual impairment being denied the right to vote - I remain hopeful. I am personally motivated by the role models present in the Program itself - women and men with and without disabilities who have chosen to champion the rights of others. I left Phnom Penh struck by the power of our unified voices and further committed to encouraging and demanding justice and equality for all.

March 10, 2015

Why We Do What We Do: Nikole Allen

GHLI program manager Nikole Allen first became interested in global development as a freshman in high school. Nikole realized that, “access to education, health and economic opportunities provided to most Americans is not universal.” She became actively involved in Operation Days’ Work, a USAID-led youth development program.The program empowers students to promote international awareness and support educational initiatives in lower income countries. Nikole’s work with the program focused on funding a grant to refurbish a secondary school in rural Ethiopia. With piqued interest in the global health field, she selected a major in international studies at the Western Oregon University. 

While pursuing her Master’s of Public Health through the Peace Corps Master International program at the University of Washington she was reconnected to Ethiopia, where she worked as a community HIV/AIDS advisor. Later, she joined the Clinton Health Access Initiative’s Ethiopian Hospital Management Initiative and began working with the Ministry of Health to help hospitals interpret key performance methods -- including the measurement of patient and staff satisfaction, the uptake of patient satisfaction best practices and the implementation of the World Health Organization Surgical Safety Checklist.  

Since joining the GHLI team, Nikole has led research and training programs in the United Kingdom, Tanzania and Rwanda. GHLI has provided her with the opportunity to collaborate with a variety of groups in different health systems. She particularly enjoys learning about each group’s challenges and providing them with the guidance and support to generate strategies to address those problems. 

“The GHLI leadership programs are incredibly valuable because they offer country participants the ability to learn outside of their regular environment and reflect on their challenges.”

“I appreciate that GHLI recognizes that health system challenges exist everywhere, so we have domestic projects and partners in high income countries as well,” said Nikole. “I’m looking forward to continuing to explore the intersection of public health and development across the globe.”   

December 10, 2014

Why We Do What We Do: Dawit Tatek

Dawit Tatek, GHLI Program Manager for the Ethiopia Hospital Management Initiative (EHMI) became interested in public health after seeing people unnecessarily die from preventable diseases. “The problems I saw were more common among residents who lived far from health facilities. Seeing positive results from health programs in improving equity in access to health service was the turning point in my career as public health professional.”

Dawit completed his undergraduate training in Medical Laboratory Technology and Clinical Nursing at the University of Gondar, Ethiopia. After working at the Gondar hospital for six years, he joined the Clinton Health Access Initiative to work in the Ethiopian Millennium Rural Initiative program, and was appointed primary health care unit coordinator. He worked in remote areas to improve implementation of the health extension program, increase HIV counseling and testing, and increase delivery of services. In 2011, Dawit joined GHLI and has been working with EHMI, managing two Master’s of Hospital Administration programs in Ethiopia while acquiring a Master’s Degree in General Public Health. 

One of the aspects of GHLI that Dawit enjoys most is the use of critical thinking and an evidence-based approach. He commends GHLI for applying scientific problem solving techniques to improve quality in hospital and healthcare management.  

“I find it extremely rewarding to help transform hospitals managers into confidant and outstanding leaders through the MHA program. It is very satisfying to receive good feedback on the program and know that I have helped.”

But Dawit's job is not without its challenges. Working with stakeholders who may not always understand the urgency of the problem can lead to inefficiency in job performance, and students are not always willing to learn and change as quickly as the program demands. However, despite these challenges, Dawit hopes to assume more leadership responsibilities and become involved in strategy management processes. He also hopes to pursue a Ph.D. in health economics and health policy in the near future.

December 1, 2014

Call me Shelemat

Shirin Ahmed, Program Manager, GHLI 

As I sat at a restaurant not far from the White House discussing Ethiopian (and Pakistani) politics and bonding over honey wine with my friends from the Ethiopian Ministry of Foreign Affairs (MFA), it struck me how issues of regional security and organizational capacity are quite similar across borders.  

I was at the end of spending two weeks with delegates from Ethiopia who were visiting the United States as part of Yale GHLI Strategic Thinking in Foreign Affairs Symposium followed by a tour in DC to meet with leaders on Capitol Hill, at think tanks and the State Department. I felt so welcomed by the group— they even gave me an Ethiopian name, Shelemat, a prize or reward in Amharic. 

During our time in DC, I was pleased to see the enthusiasm on both ends, reinforced by mutual commitments to resolving regional conflicts, fostering business development and strengthening US-Ethiopia relations. But I also sensed a concern from the Ethiopian side about its “image” in the US, often misrepresented by western interest groups and now exacerbated by Ebola. However, it was encouraging to hear that despite these perceptions, as noted by someone from the US Chamber of Commerce, Ethiopia stands at the “cusp” of economic growth and it is only a matter of time that the country would become a major player for US investments.  

One individual at the Foreign Services Institute asked me what Yale was doing with the group -- a question I asked myself at the beginning of the program. But I get it—building and strengthening.  I had seen those words in writing in our Symposium brochure, but I truly understand it now. The learning at Yale coupled with relationship building in DC may be the jumpstart for the MFA to advance its foreign policy agenda. 

With each passing day, I have new Ethiopian followers on twitter and Shelemat continues to receive thank you messages from the MFA.

November 21, 2014

Foreign Affairs in Ethiopia and U.S. – Different yet Similar

Mekonnen Haddis, Chief Advisor of the Minister, Ethiopia 
As I sat and listened to U.S. public servants discuss problems they have faced regarding employee retention and recruitment for the government, I was surprised, yet somehow comforted to realize that Ethiopia and the U.S. face similar challenges. 
Our Ethiopian delegation was so pleased to be invited to Yale University by the Global Health Leadership Institute for the Strategic Thinking in Foreign Affairs Symposium. During our visit, my Ministry of Foreign Affairs colleagues and I heard from leading practitioners and U.S. public servants who were candid in sharing their views and knowledge with us on a range of issues. Their insight helped us to develop better strategic plans on our own foreign policy, organizational capacity and leadership, which will prove invaluable when we return home.
During our week on the Yale campus, some of the work I most appreciated involved our Yale colleagues sitting down with us to solve problems we had identified within our government system. Through discussion and exercises with some of United States’ leading grand strategy thinkers, we learned to put theory and practice together to address critical problems.
We left New Haven to spend a week in Washington, D.C., visiting the State Department and government representatives. What impressed us most in DC was the priority that the U.S. officials gave us, ensuring they spent time with us in spite of their work load to help us in our endeavors to transform our ministry and country. The level of respect we received at the Department of State and all other places was exceptional. As this was the first visit to D.C for many of us, we were also anxious to see the landmarks about which we had heard so much. The Foreign Service Institute was much bigger than we had expected, and The White House, Capitol and Lincoln Memorial visits were unforgettable. 

After our impressive visit to the U.S., we confidently take home guidance and experiences to embark on a strategic mission to implement our foreign policy both with vigor and commitment.