#MEQAPI – Tweetchat Jan 4-2018 3:00ET Perfection in Healthcare

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org

In the previous blog on “Perfection in Healthcare”, I described a quality improvement method in which we reflect on a specific operation, and explore what it would look like if it were “perfect”. I defined what we would mean by “perfect”, thus:

QI poses a more practical, but still distant and largely unavailable level of perfection. This is the Theoretical Capacity, and is an expression of what a process could theoretically yield if everything was running at 100% performance and there were no defects. This is the level of perfection that will be the topic of the next few #MEQAPI chats.

For this chat, we are going to run headlong through five components of the overall healthcare workflow:

  1. Patients
  2. Physicians
  3. Nurses
  4. Specialists
  5. Environment

For each of these, we are going to reflect of what it would look like if were perfect- what would the perfect patient be like, the perfect physician, the perfect nurse, etc. In future chats, we will take the input and explore more deeply.

Perfection I

For example, if we listed “timeliness” as feature of the “perfect patient”, in a future session we may a scan the six arms of the QI framework, and discuss what challenges are encountered patient’s ability to be timely. For instance, are there policies that make timeliness more or less likely? Are there machine factors that influence timeliness, environmental factors, measurement aspects, materials, etc.

Patient Timeliness

 

Topics

  1. What features, properties, or behavior does the “Perfect Patient” have
  2. What features, properties, or behavior does the “Perfect Physician” have
  3. What features, properties, or behavior does the “Perfect Nurse” have
  4. What features, properties, or behavior does the “Perfect Specialist” have
  5. What features, properties, or structure does the “Perfect Care Environment” have

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.

 

 

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Perfection in Healthcare

There is a useful mental tool in Quality Improvement (QI), in which one conjures up what the perfect situation would be in order to identify gaps between the desired and the actual situations. This is not to say that we think we are going to get perfection, but it’s a very useful way to find things to fix to get us closer to what we want.

There are three theoretical levels of perfection: what we have in the real world, what we could achieve in theory, and what in a perfect universe would be the archetype of what we are doing.

Last things first: The idea of an archetype dates back at least to Aristotle and Plato, and involves the idea that everything (presumably including medical policies, processes, and technologies), has an ideal, perfect, and universal form. These forms are unachievable in the real world of man, but serve as the archetype and exemplar towards which we can strive. Somewhat romantic, but fun to think of what perfection in another universe of forms might look like.

The last range in the perfection scale is where we actually live most of the time, but wish to escape. The place where we sometimes forget what the objective was because we are up to our necks in conflicting demands, mistakes, and things that waste our time.

Between the exalted realm of Platonic archetypes and the undesirable reality of what we typically have, QI poses a more practical, but still distant and largely unavailable level of perfection. This is the Theoretical Capacity, and is an expression of what a process could theoretically yield if everything was running at 100% performance and there were no defects. This is the level of perfection that will be the topic of the next few #MEQAPI chats.

As a mental exercise, we are going to imagine what perfection in the QI sense would look like if it existed in our facility. What does the perfect patient look like? What does the perfect ED look like? What does the perfect medical training look like? … and in what ways do they differ from what we actually wound up with?

For example, what characteristics would the perfect patient have?

Would they show up on time for appointments? What does the perfect patient bring with them? What did they think about before they came to the appointment? How does the perfect patient convey the information to their HCP?

Hope to see you soon during the #MEQAPI chats, and hear your thoughts on perfection in healthcare!

 

#MEQAPI – Tweetchat Nov 30-2017 3:00ET Obesity: Effects on Practice

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

The steep rise in prevalence of obesity has had an effect on how medical practices operate. Everything from the width of doorways to seating configurations in waiting rooms, OR and inpatient bed reinforcements, gurney and stretcher design, hypodermic needle length, and dosage increments have had to accommodate the increasing size of patients.

Many years ago on an ambulance call to a local restaurant, and before the obesity epidemic, I came face to face with the practical problems related to obesity. The patient was a middle-aged male complaining of radiating chest pain, shortness of breath, and that old specter of “impending sense of doom”. Immediate history was a large meal, several units of wine, brandy and cigars, and a fierce argument with his wife over desert. What may have started with indigestion, anger, and a touch of gastric reflux turned into stress-induced angina. Of course, his 5’8″ 250 lb frame and history of hypertension added to the mix.

The most immediate problem was that he had sagged into a low chair, and our three-person EMT team was unable to lift him onto the collapsible ambulance gurney – which was also too narrow and did not have sufficiently strong struts in the collapsible undercarriage to bear his weight.

This Mobi Ambulance stretcher is a good example of equipment that is designed to be light-weight, and for its ability to load and secure easily in a standard ambulance. Ours was similar, but also many years ago, before fancy titanium alloys.

mobi-3g-aluminum-alloy-stretcher

Plan-B was to use the scoop stretcher.

Civiere_a_aubes

Author CDang

We quickly realized that we couldn’t get the halves together without manhandling the patient, pinching him, or tearing chunks out of ourselves. Once on the stretcher, we found he was overflowing the sides which were putting pressure on his tissue to an alarming degree. On lifting him, our alarm shifted to an unexpected degree of bowing in the stretcher frame that threatened to pop open the catches at the ends.

Naturally, the elevator was too short to accommodate us, and the two flights of stairs to the ground level was a physical challenge, as was the process of lifting him into the back of the ambulance.

The patient was safely delivered to a ED without being dropped or harmed, but the experience and our painful backs taught us that our equipment was just not suited to heavy patients, and that we had to rethink what we would dispatch to calls that involved high-BMI patients.

In this chat, we will scan the six arms of the QI framework, and discuss what challenges are encountered in medical practices, clinics, and hospitals, and what adaptations are required to provide care  for patients with high BMI.

 

 

Obesity

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS are involved in risks, issues, or practice adaptations to obesity
  2. What MACHINE factors are involved in risks, issues, or practice adaptations to obesity
  3. What PEOPLE factors are involved in risks, issues, or practice adaptations to obesity
  4. What MATERIALS are involved in risks, issues, or practice adaptations to obesity
  5. What MEASUREMENT factors are involved in risks, issues, or practice adaptations to obesity
  6. What ENVIRONMENTAL factors are involved in risks, issues, or practice adaptations to obesity

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.

 

 

Upcoming #MEQAPI Chats

Here is the schedule for forthcoming #MEQAPI chats

  • Nov 16 – No Chat
  • Nov 23 – Obesity and practice. Adapting to the increase in patient obesity rates
  • Nov 30 – No Chat (PEX VA conference)
  • Dec 7 – No Chat (Visiting ZA)
  • Dec 21 – Perfecting Practice – What would a perfect practice look like from QI perspective

Unscheduled but planned:

  • TBI & PTSD
  • Healthcare laws
  • Perfecting Patients
  • Perfecting Physician Education

Note: suggestions welcome! – Please DM @meqapi or use the #MEQAPI hashtag to pass on your ideas/

#MEQAPI – Tweetchat Nov 2-2017 3:00ET Complementary Modalities

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Firstly, some definition around what we mean by “complementary care” modalities.

We are distinguishing between care modalities that are “alternative” and those that are “complementary”. By alternative, we mean any care modality that is not Evidence Based Medicine (EBM) and which replaces EBM. Offering aromatherapy, yoga, or homeopathy instead of EBM, would be seen in this context as “alternative”.

In contrast, some of the same modalities may be seen as complementary where they are used in conjunction with EBM. Here there is a lot to say for modalities which enhance access or efficacy of EBM and which thereby lead to improved patient outcomes.

In looking at complementary modalities, we should perhaps examine them in the light of the MEQAPI standard – will they lead to care that is STEEEPA. Will the resulting care be Safe, Timely, Effective, Efficient, Equitable, Patient-Centered, and Affordable?

Consider this: while we might dismiss the use of aromatherapy as a replacement for drugs to treat cancer, what if the aromatherapy could help the patient to stick with their chemotherapy? What if art therapy didn’t replace clinical talk therapy and anti-psychotics, but enabled the patient to attend sessions and stay on their medication?

If a complementary care modality results in a patient achieving their health goals in a way that is STEEEPA, is there any reason to object? If their drumming sessions, acupuncture, or meditation puts them in a mental place from which they are more able to access, use, and stay with their EBM care plan, should it be encouraged?

There are obviously considerations and potential complications – will the complementary modality add any risks, affect dosages or create additional side effects, or lead to confusion in results of medical tests?

The potential downsides to complementary care are numerous: they are often unregulated and have wide variation is dosage and effect. Herbal and other potions, lotions, and products may containvery serious contaminants, including arsenic, lead, and mercury. Physical manipulations such as chiropractic have been linked to internal injuries, including broken bones, and may create a significant stroke risk.

Some “natural” remedies have very serious interactions with EBM drugs, and many cases have been listed of injury and death because the remedy either reduced the efficacy of a critical drug, or added to the effect in ways that resulted in harmful overdose.

We will take a QI approach, and discuss the topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

Complimentary Care

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce risks related to use of Complementary Care Modalities
  2. What MACHINE factors increase or reduce risks related to use of Complementary Care Modalities
  3. What PEOPLE issues increase or reduce risks related to use of Complementary Care Modalities
  4. What MATERIALS increase or reduce risks related to use of Complementary Care Modalities
  5. What MEASUREMENT factors increase or reduce risks related to use of Complementary Care Modalities
  6. What ENVIRONMENTAL factors increase or reduce risks related to use of Complementary Care Modalities

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.

 

 

#MEQAPI – Tweetchat Nov 2-2017 3:00ET Complementary Modalities

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Firstly, some definition around what we mean by “complementary care” modalities.

We are distinguishing between care modalities that are “alternative” and those that are “complementary”. By alternative, we mean any care modality that is not Evidence Based Medicine (EBM) and which replaces EBM. Offering aromatherapy, yoga, or homeopathy instead of EBM, would be seen in this context as “alternative”.

In contrast, some of the same modalities may be seen as complementary where they are used in conjunction with EBM. Here there is a lot to say for modalities which enhance access or efficacy of EBM and which thereby lead to improved patient outcomes.

In looking at complementary modalities, we should perhaps examine them in the light of the MEQAPI standard – will they lead to care that is STEEEPA. Will the resulting care be Safe, Timely, Effective, Efficient, Equitable, Patient-Centered, and Affordable?

Consider this: while we might dismiss the use of aromatherapy as a replacement for drugs to treat cancer, what if the aromatherapy could help the patient to stick with their chemotherapy? What if art therapy didn’t replace clinical talk therapy and anti-psychotics, but enabled the patient to attend sessions and stay on their medication?

If a complementary care modality results in a patient achieving their health goals in a way that is STEEEPA, is there any reason to object? If their drumming sessions, acupuncture, or meditation puts them in a mental place from which they are more able to access, use, and stay with their EBM care plan, should it be encouraged?

There are obviously considerations and potential complications – will the complementary modality add any risks, affect dosages or create additional side effects, or lead to confusion in results of medical tests?

The potential downsides to complementary care are numerous: they are often unregulated and have wide variation is dosage and effect. Herbal and other potions, lotions, and products may containvery serious contaminants, including arsenic, lead, and mercury. Physical manipulations such as chiropractic have been linked to internal injuries, including broken bones, and may create a significant stroke risk.

Some “natural” remedies have very serious interactions with EBM drugs, and many cases have been listed of injury and death because the remedy either reduced the efficacy of a critical drug, or added to the effect in ways that resulted in harmful overdose.

We will take a QI approach, and discuss the topic using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram will be provided ahead of time and during the chat.

Complimentary Care

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office, inferior fax paper,
      • Data: ability to securely share with correct patient, specialist, lab, etc., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc.
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS increase or reduce risks related to use of Complementary Care Modalities
  2. What MACHINE factors increase or reduce risks related to use of Complementary Care Modalities
  3. What PEOPLE issues increase or reduce risks related to use of Complementary Care Modalities
  4. What MATERIALS increase or reduce risks related to use of Complementary Care Modalities
  5. What MEASUREMENT factors increase or reduce risks related to use of Complementary Care Modalities
  6. What ENVIRONMENTAL factors increase or reduce risks related to use of Complementary Care Modalities

Background

MEQAPI focuses on healthcare improvement, and in the spirit of shameless borrowing (and efficiency), takes existing perspectives from the IHI, AHRQ, and others.

To quote the IHI on what the Triple Aim encompasses:

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered. We expand this to include Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

http://www.meqapi.org

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.