I had the pleasure recently of attending the Institute for Healthcare Improvement's seminar titled "Achieving the Triple Aim: The Simultaneous Pursuit of Excellent Health, Ideal Care, and Controlled Costs." IHI is a Massachusetts-based nonprofit that seeks to improve all aspects of health care: better quality, lower cost, more efficient. You might have heard of its current campaign to prevent five million incidents of medical harm. That's really just the tip of the iceberg; to find out more, visit them on the Web.

The conference was among the first at the fancy new National Harbor complex just south of Washington, D.C. (truly a sight) over two days. Conferences typically use classroom-style learning, lectures, panels, and powerpoints. This seminar featured a prominent role for small group exercises where we were able to reason out how to implement some of the solutions that were being discussed; how to make them go from theory to practice. Groups of about 10 sat around tables and shared stories. I was quite intrigued by a delegation from a Gulf Coast state that included both physicians and insurance officials who were able to engage in a real life, cross-organization workshop.

We used vignettes to describe different scenarios, and thought about how the health care system could address them. Examples: Darryl is an eight year old with asthma. His working mom has trouble getting him in for appointments. His father, whom he stays with on weekends, doesn't believe he has asthma despite multiple hospital admissions. Eleanor is a 79-year-old retired nurse with diabetes and mild congestive heart failure who has a stroke. Don is a 52-year-old who's been street homeless for four years, is in methadone therapy and drinks heavily; he has four hospitalizations in the last 18 months. During the course of the seminar, we learned different ways to improve the health of these individuals, improve their experience within the health system, and limit their financial cost. In subsequent posts this week I'll explore each of the three triple aims.

One more item of note: I was very surprised how international the attendees were. There were 125 American participants, 20 from Canada, eight from the United Kingdom, two from South America, one from continental Europe, and one from Africa. From talking with other participants, I can tell you that other nations, whether they insure all their people or not, face many of the same obstacles in care delivery. That's why the triple aim attracted them. I'll be back tomorrow with a look at population health.