Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.
The phenomenon of one person interrupting the speech of another is fairly commonplace, but in high-risk situations is a cause for greater concern. There are striking asymmetries in who interrupts whom, and how often. Men interrupt others more than women do, and men interrupt women far more than that.
While much has been said of the causes, it is perhaps useful to consider the quality cost of interruption, and the cost of the asymmetry of interruption.
These can be seen in five areas:
- Patient and Staff Safety
- Quality & Efficiency
- Innovation & Problem-Solving
- Organizational Velocity
- Staff Burnout
Interruptions cause reduced message integrity and informational survival, resulting in higher error rates and increased unmet needs. In simpler terms, when someone’s message is interrupted, there is a high probability that the meaning of what they were conveying will be degraded or lost, and there is an increased likelihood of the message not being acted on or understood. In a healthcare setting this can have fatal outcomes.
Interrupted speech results in higher rates of error, and lower quality execution of work, with more things being missed and greater execution gaps.
Interruptions depress creativity, increase guarded thinking, and increase the amount of knowledge hoarding and knowledge hiding. This results in reduced innovation, and less effective problem solving
As a result of the combination of all those above, the organization spends more time and effort per achieved work outcome, and has less velocity in achieving strategic goals.
Perhaps the largest impact is in the effect that ubiquitous and frequent interruption has on people. It reduces a sense of organizational attachment, increases stress, and drives up the probability of burnout. People who are frequently interrupted are less committed to organizational goals, less likely to share ideas, and less likely to participate.
High interruption rates are a risk factor for low achievement, high cost, and high turnover.
We will discuss the various dimensions of interrupting using a structured approach.
- Policy: What laws, policies, rules, regulations, etc. increase or decrease the frequency and degree to which men interrupt women at work?
- Equipment: How do equipment and devices increase or decrease the frequency and degree to which men interrupt women at work? Everything from speaker phones to messaging systems.
- Measurement: How do quality, safety, and performance metrics increase or decrease the frequency and degree to which men interrupt women at work?
- Environment: What environmental factors increase or decrease the frequency and degree to which men interrupt women at work?Everything from the room where care is provided, facility location, privacy, etc.
- People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc increase or decrease the frequency and degree to which men interrupt women at work?
- Materials: What effect does the “medical stuff” patients need increase or decrease the frequency and degree to which men interrupt women at work? – the medications, instruction sheets, information, medications, test results, etc
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 Accessibility, 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.
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 and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.