Resource Center

The urgency for action to enhance human resources for health internationally was recently highlighted by the World Health Report 2006: Working Together for Health which revealed an estimated worldwide shortage of almost 4.3 million doctors, midwives, nurses and support workers. The 59th World Health Assembly recognized this crisis and adopted a resolution in 2006 calling for a rapid scaling-up of health workforce production through various strategies including the use of "innovative approaches to teaching in industrialized and developing countries."

Ideas for an international association had been debated between interprofessional exponents on both sides of the Atlantic ever since the 1997 All Together Better Health conference. Those ideas became tangible when John Gilbert and his colleagues at the University of British Columbia volunteered to take the lead encouraged by influential supporters worldwide.

As a component of its next accreditation system, the ACGME has established the CLER program to assess the graduate medical education (GME) learning environment of each sponsoring institution and its participating sites. CLER emphasizes the responsibility of the sponsoring institution for the quality and safety of the environment for learning and patient care, a key dimension of the 2011 ACGME Common Program Requirements.

In response to growing interest from the hospital community in better understanding and improving the experience of patients and their families during hospitalization, the Institute for Healthcare Improvement (IHI) conducted an in-depth review of the research, studied exemplar organizations, and interviewed experts in the field.

A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to rapidly spread innovations and new ideas. Pockets of excellence exist in our health care systems, but knowledge of these better ideas and practices often remains isolated and unknown to others. One clinic may develop a new way to ensure that all diabetics have their HbA1c levels checked on a regular basis, or one medical-surgical unit in a hospital may develop a consistent way to reduce pain for post-operative patients.

People with multiple health and social needs are high consumers of health care services, and thus drivers of high health care costs. The elevated cost of care in this population offers a tremendous opportunity to understand the individuals and their priorities and needs, and to craft a service delivery plan that meets their needs more effectively at a significantly lower cost.

In 2001, the Institute for Healthcare Improvement (IHI) developed the “bundle” concept in the context of an IHI and Voluntary Hospital Association (VHA) joint initiative — Idealized Design of the Intensive Care Unit (IDICU) — involving 13 hospitals focused on improving critical care. The goal of the initiative was to improve critical care processes to the highest levels of reliability, which would result in vastly improved outcomes.

Despite significant efforts to improve the care provided to patients in clinics and office practices, it is still not nearly what it should be. Patients often cannot access or do not receive the care necessary to ensure positive health outcomes. Compounding this, the structure of service delivery, traditional workforce roles, and the reimbursement system all create barriers to making widespread improvements to primary care. A different system is needed, one that is reliable, proactive, efficient, and engages patients in ways that ensure the best outcomes.

The Pursuing Perfection initiative was an eight-year demonstration program (2001 through 2008) funded by the Robert Wood Johnson Foundation (RWJF) in the US. Supported by technical assistance from the Institute for Healthcare Improvement (IHI), the initiative’s goal was to learn if and how health care organizations could make dramatic improvements in performance across the organization, resulting in a considerably more efficient and effective health care system.

Because waits, delays, and cancellations are so common in health care, patients and providers assume that waiting is simply part of the care process. But recent work on assessing the reasons for delays suggests otherwise.