Some of the redesign work that ICSI is doing focuses primarily on bringing medical groups and/or hospitals together to learn from each other and outside experts. In addition to its Redesign for Results (R4R) initiatives and ongoing work with guidelines and protocols, ICSI has engaged its member health care organizations in two significant collaborative projects to address two critical issues: patient activation and safety.

Patient Activation Redesign Collaborative
Understanding how to engage patients and increase their ability to be active managers of their health care is an important part of the work of ICSI.

"‘Patient activation’ is a term used to describe the ability of a patient to understand and to implement activities that will improve his or her health outcomes,” said ICSI Care Improvement Facilitator Sylvia Robinson, BSN, MBA.

The ICSI Patient Activation Redesign Collaborative is bringing the expertise of Judith Hibbard, PhD, University of Oregon, Institute for Policy Research and Innovation, Eugene, Ore., and Zeev Neuwirth, MD, Vice President, Clinical Effectiveness and Physician Affairs, Harvard Vanguard Medical Associates, Boston, Mass., as content experts. The collaborative will learn more about the concept of patient activation, the Patient Activation Measure (PAM) tool developed by Hibbard, and the need to identify methods to better provide patients with the skills necessary to become fully engaged in managing their care.

The PAM tool assesses an individual patient’s level of activation, from which care plans can be tailored. There are four stages of patient activation:
1. The patient believes an active role in health care is important.
2. The patient has the confidence and knowledge to take action.
3. The patient takes action.
4. The patient stays the course.

"Oftentimes treatment interventions are focused at about the third stage,” Robinson said. "But if patients are at an earlier stage and you give them too many instructions—when they don’t have awareness or an understanding of their role in their care—the intervention won’t fit.”

With the help of the national experts, this redesign collaborative will work toward creation of a patient activation model that can be applied by ICSI medical groups to increase the ability of patients to become active partners with the medical community in managing their health care.

"As teams identify methods to incorporate the PAM into their work flow, ICSI will provide support to help them learn how to apply these techniques in their organizations,” Robinson said.

The Patient Activation Redesign Collaborative began meeting in March and will continue its work through January of 2008. This work is innovative in that the PAM tool previously had been used only in research settings. The ICSI collaborative brings a real-life testing ground for feasibility in medical practice and exploration of interventions that might change a patient’s activation.

"Patient activation is another way of moving toward becoming more patient-centered and getting more patients involved and engaged in their care,” said ICSI Medical Director Gary Oftedahl, MD.

Reliability Centered Surgical Care Redesign Collaborative
The ICSI Reliability Centered Surgical Care Redesign Collaborative provides hospital teams with an opportunity to learn about and implement the strategies and philosophies of High Reliability Organizations (HROs) into their surgical areas.

A total of ten ICSI member hospital teams have committed to this year-long collaborative, which began in April 2007. Michael Leonard, MD, Kaiser Permanente, Evergreen, Colo., and Al Frankel, MD and Paul Satwitz, MD, Partners HealthCare, Boston, Mass., will serve as the external content experts.

The focus of the collaborative is on the use of high reliability principles that have been forged in other high-risk industries, such as the nuclear power industry and commercial airlines, to create a safe and reliable atmosphere in the surgical care area.

"Three surgical protocols developed by ICSI members—safe site surgery, surgical site infection prevention, and the unintentionally retained foreign objects in surgery protocol to be released in September—provide the technical foundation for the collaborative,” said ICSI Director of Education and Resources for Improvement Nancy Jaeckels. "But just as important—if not more important—is building a culture of high reliability. We’re bringing together the technical protocols with the adaptive culture work, and focusing on the system that connects all of them.”

A survey about how surgical teams function and the culture of safety in surgery also will be developed and administered.

"This is cutting-edge work in that we’re taking experts from ten hospitals, such as surgical staff, anesthesiologists, and surgeons, and coming together to focus on patient safety in the very complex environment of the operating room,” said Director of Surgical Services Dana Langness, RN, BSN, MA, HealthPartners Regions Hospital, who serves as the internal content leader of the collaborative.

This redesign collaborative directly supports one of Safest in America’s 2007 safety focus topics—prevention of unintentionally retained foreign objects in surgery.