ORLANDO — This is the last Institute for Healthcare Improvement Forum for Maureen Bisognano, as the influential industry figure plans to retire from her duties at the close of 2015. But she left hospital leaders with a few words of advice during her opening keynote Tuesday morning.

Bottom line: Hospital leaders and their clinicians need to start rethinking nearly every aspect of how they’ve routinely done their work.

Bisognano — who’s spent some 20 years with the health care improvement org, taking over as CEO in 2010 — distilled her decades of experience into five lessons learned. She believes the organization has made tremendous strides in improving traditional health care since the forum started 27 years ago, but there’s a whole new frontier to tackle outside of the hospital and in the community.

“We still have lots to do,” Bisognano told the more than 5,000 attendees, representing 52 different countries. “We’re seeing increasing burdens of disease. We’re seeing the impact of social determinants on health, and that means that our job is still pretty big out there.”

To help hospitals achieve the IHI’s Triple Aim (better care, better health and lower costs) and finish this transformation, she offered five lessons from her career:

  1. How we improve: Think about new ways to collaborate with others, new partners in the field, and rewrite the rules for improvement. Early on, hospitals started with quality assurance departments to work toward improving health care. But the field quickly realized that this work needed to be removed from such a silo and spread out across the entire organization. Bisognano gave two such examples of ways the IHI is looking to form new partnerships in the field. Its Leadership Alliance is a group of about 40 health care organizations committed to transforming the business, and which recently came up with 10 rules to radically redesign health care. Plus, it’s also involved in the 100 Million Health Lives initiative, a collaboration of 684 organizations and individuals across the world working to improve the health of millions by 2020.
  2. How we hear: Begin actually listening to the voice of the patient and wondering “What matters to you?” rather than just “What’s the matter?” Asking that simple question can transform the whole health care experience. Bisognano gave the example of one cranky older lady, whose relationship with her care team was turned on its head after caretakers asked a few probing questions and found out she spoke Portuguese and flew with the Women in the Air Force in World War II. One hospital in Glasgow believes so much in the practice that it’s started putting sheets of paper on the door of every visitor’s room, detailing what matters to the patient, and Bisognano believes it will one day be incorporated into electronic health records.
  3. How we teach, learn and see: Adapt to new roles as part of the care team, and offer care in new and unusual places. Being a skilled practitioner isn’t enough in health care, Bisognano believes. Clinicians need to move from being the writers of prescriptions and diagnoses to being guides who shepherd patients through the system. Doctors aren’t the captains of teams anymore, she believes, and we need to start instilling that in medical students at an early age.
  4. How we care: Think about different ways to address the health and well-being of patients, prescribing “parks” and “rides,” not Ritalin. Health care providers need to think of themselves as “upstreamists” who head off health care problems before they snowball into chronic diseases down the line. Kaiser Permanente, for one, has offered mobile lactation counseling over smartphones to help mothers raise healthier children. Or, Bisognano offered this fascinating example from overseas of how postal workers are being used to extend the health care system and check in on the frail elderly, delivering prescriptions and appointment reminders.
  5. How we lead: In days past, it may have been OK for leaders to simply “fix and forget” any problems that may arise in their institutions. But nowadays, in a workplace that includes four generations of folks all with different expectations and work habits, the preferred leadership style is “see, solve and share.” Good leaders should look to others for ideas and guidance; she believes a high “curiosity quotient,” rather than IQ, is one of the most important traits of a strong leader. Plus, executives must also be able to instill joy in the workplace.

“I think ensuring joy is the role of leaders,” she said. “You’ve all heard that you can’t give what you don’t have and if you’re not joyous in your own work, you can’t create joy in your staff. It’s about building resilience.”