Learning and Doing – a COVID-19 Puzzle

I have a background in Knowledge Management (KM) and perhaps as a result, very sensitive to knowledge creation, knowledge re-use, and how knowledge is updated or goes stale.

One of the bedrock concepts in KM is that much can be gained from re-use of knowledge, and from vicarious learning. So it is more than a little disconcerting to see how past knowledge – generated and curated at much cost and effort – was simply not used when COVID-19 heaved into view.

It was not so much that we were surprised by it, or that it was an event we didn’t know how to address, or that there weren’t sufficient examples of how we and others had dealt with similar episodes in the past (and recent past).

We as a society, in fact, knew exactly what to do. We had existing and recently updated playbooks, we had people whose roles and expertise were relevant, and we had the policies, processes, and funding ready to go.

We just didn’t use any of it when the time came.

We knew what a fire looked like. We had the tools and materials to fight fires. We had people with training and specialized fire-fighting skills. We had money and policies about fighting fires. We even had a big sign that said “Yes, This Is a Fire”

Instead of triggering the playbook, using the materials, deploying the people, we collectively stared out the window until the smoke started obscuring the view.

In terms of using knowledge, this is about as bizarre as one gets, and I suppose that no amount of really good knowledge is of any help if one just doesn’t use it.

Life During COVID-19

I am doing two research studies during and related to the COVID-19 pandemic.

  1. An Appreciative Inquiry look at how healthcare stakeholders have been responding to the pandemic
  2. A 10-20 year Foresight study on what the alternate futures might be, and what forces of change may be driving us down those paths

 

#MEQAPI – January 31 2019 3:00ET Patient Voice in Radiology

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

We have written before that “Patient voice” is a critical component of quality improvement (QI) and has been a neglected area in healthcare. While clinicians and healthcare workers strive to be patient-centered and to do their best for patients, this does not often manifest in including patients when it comes to planning changes, making decisions, or developing policies. As a result, patients are often a neglected voice in healthcare improvement, even when they are the central goal.

As we describe in a Physician’s Weekly blog “Micro-Study: Discovering the Patient Voice“, we are conducting a study into how patients and care-givers experience radiology:

This micro research project seeks to understand key experiences of the patient’s journey. The project will focus on the radiology care pathway, and the patient journey through the end-to-end experience, from initial encounter that decided on a radiological service, to the final discussion of findings, and billing for radiology services. One aspect the study will seek to illuminate is the opportunity to establish patient reported outcomes (PRO) measurements. PRO metrics will be a BIG DEAL in improving the care experience and reducing medical mistakes.

In their British Medical Journal (BMJ) paper titled “What can patients tell us about the quality and safety of hospital care? Findings from a UK multicentre survey study“, O’Hara et al discuss a study of patient experience of safety. The study analyzed data from 2,471 patients across 33 wards in three English NHS Trusts, between May 2013 and September 2014.

O’Hara et al found a high rate of patient-reported incidents, but perhaps the most eye-opening finding was that 10% of the patients identified a patient safety issue (boldface added)

Of the 2471 inpatients recruited, 579 provided 1155 patient-reported incident reports. 14 categories were developed for classification of reports, with communication the most frequently occurring (22%), followed by staffing issues (13%) and problems with the care environment (12%). 406 of the total 1155 patient incident reports (35%) were classified by clinicians as a patient safety incident according to the standard definition. 1 in 10 patients (264 patients) identified a patient safety incident, with medication errors the most frequently reported incident.

To put this number into perspective, CDC figures for 2015, show that 83.6% of the U.S. adult population had at least one healthcare encounter in the preceding year, translating into 125.7 million hospital visits, and 990.8 million physician office visits. If 10% of patients discovered and reported a safety issue in that year, millions of additional opportunities for improvement would result.

Some additional sources for this chat:

  1. Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention
  2. How might health services capture patient-reported safety concerns in a hospital setting? An exploratory pilot study of three mechanisms
  3. The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study
  4. Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation
  5. The Patient Feedback Response Framework – Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study

Topics

  1.    In your experience with radiology as a patient or care-giver, can you recall something that surprised you?
    – What was it?
    – What part of the radiological process did it relate to? E.g. getting an x-ray, booking an appointment, filling in the forms, etc.
    – How did this affect you? i.e did something bad happen, like missing an appointment, etc.

     

  2. In your experience with radiology as a patient or care-giver, can you recall something that confused you?
    – What was it?
    – What part of the radiological process did it relate to? E.g. getting an x-ray, booking an appointment, filling in the forms, etc.
    – How did this affect you? i.e did something bad happen, like missing an appointment, etc.
  3. In your experience with radiology as a patient or care-giver, can you recall something that frustrated you?
    – What was it?
    – What part of the radiological process did it relate to? E.g. getting an x-ray, booking an appointment, filling in the forms, etc.

    – How did this affect you? i.e did something bad happen, like missing an appointment, etc.

  4. Looking over the entire experience, what parts did you feel worked well for you – anything from the way appointments were booked or parking was set out to how the scan or procedure was done
  5. What parts did you feel worked poorly for you – again, could be anything from the way appointments were booked or parking was set out to how the scan or procedure was done
  6. What one thing (or two) would you say radiologists need to improve, and what would that look like?

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 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.

 

 

#MEQAPI – Tweetchat DEC-20 2018 8:00 PM ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc will be participating in a twitter-based Rapid Improvement Event (RIE)

Participants have carried out the following steps:

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants were encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants captured what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants ranked items in descending order of the rating

The chat will have six topics, following the Lean Six Sigma DMAIC process.

  • Define: Identify and refine the problem, the stakeholders, the critical to quality elements, the voice of the customer
    • Supplier
    • Inputs
    • Process
    • Outputs
    • Customers
  • Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results of any solution
    • Output metrics – what will measure the outcomes we want
    • Process metrics – what do we need to measure while things are being done and which will predict success of the outcomes metrics
    • Balancing metrics – how will be check that we aren’t making anything else worse. What do we need to measure to ensure that no untoward side effects are being caused
  • Analyze: Root cause analysis and analysis of alternatives
    • Policies & Procedures
    • Equipment & Technology
    • Measurement
    • Environment
    • People
    • Materials
  • Improve: Implement solutions
    • Plan
    • Do
    • Study
    • Act
  • Control: ongoing monitoring and evaluation to make the solutions stick and to ensure that the desired outcomes are realized.
    • M&E
    • Organizational Change Management (OCM)
    • Induction and Training
    • Ongoing process improvement

Issue

Topics

  1. Define: What is the problem you want to solve, the stakeholders, the critical to quality elements, the voice of the customer, what is the future state?
  2. Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results?
  3. Analyze: What are the root causes and what alternatives do you have for Policies, Equipment, Measurement, Environment, People, Materials?
  4. Improve: What do you need to plan for, what will you do, how will you see what happened, what will you do to adopt?
  5. Control: How will you make it stick – what will you do iro M&E, OCM, Training, Ongoing process improvement?
  6. Next Steps:  What do you need to do next to get clear on what has to happen, get agreement, get started?

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 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.

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 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.

 

 

#MEQAPI – Tweetchat Dec-6 2018 8:00ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. The co-host will explain how they see their issue in terms of the fishbone root cause dimensions, and other participants will assist by asking clarifying questions, offering insights, or describing their past experiences related to the issue.

To identify their selected issue, the co-host will have kept a diary of everything in the work or care environment that

  • Was Surprising
  • Was Frustrating
  • Was Confusing

During the chat the co-host will address their issue to each of the fishbone arms, and Tweet two things. What they think is a cause, and what they think might be a fix. Usually we would do these apart, but it’s an hour, its Twitter, so we are doing them together.

Issue

Topics

  1. Policy: What laws, policies, rules, regulations, etc. cause your issue, what are potential solutions to your issue?
  2. Equipment: What equipment and device factors cause your issue, what are potential solutions to your issue?
  3. Measurement: What quality, safety, and performance metrics cause your issue, what are potential solutions to your issue?
  4. Environment: What environmental factors cause your issue, what are potential solutions to your issue?
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc cause your issue, what are potential solutions to your issue?
  6. Materials: What “medical stuff” that patients need cause your issue, what are potential solutions to your issue?

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 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.

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 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.

 

 

#MEQAPI – Tweetchat Nov-29 2018 8:00 PM ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc will be participating in a twitter-based Rapid Improvement Event (RIE)

A companion blog at Physicians Weekly provides additional detail of the RIE approach using the daily diary method to identify opportunities.

Participants have carried out the following steps:

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants were encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants captured what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants ranked items in descending order of the rating

During the chat (Nov 1st) we will conduct QI cafe’

The chat will have six topics, following the Lean Six Sigma DMAIC process.

  • Define: Identify and refine the problem, the stakeholders, the critical to quality elements, the voice of the customer
    • Supplier
    • Inputs
    • Process
    • Outputs
    • Customers
  • Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results of any solution
    • Output metrics – what will measure the outcomes we want
    • Process metrics – what do we need to measure while things are being done and which will predict success of the outcomes metrics
    • Balancing metrics – how will be check that we aren’t making anything else worse. What do we need to measure to ensure that no untoward side effects are being caused
  • Analyze: Root cause analysis and analysis of alternatives
    • Policies & Procedures
    • Equipment & Technology
    • Measurement
    • Environment
    • People
    • Materials
  • Improve: Implement solutions
    • Plan
    • Do
    • Study
    • Act
  • Control: ongoing monitoring and evaluation to make the solutions stick and to ensure that the desired outcomes are realized.
    • M&E
    • Organizational Change Management (OCM)
    • Induction and Training
    • Ongoing process improvement

DMAIC+

Topics

  1. Define: What is the problem you want to solve, the stakeholders, the critical to quality elements, the voice of the customer, what is the future state?
  2. Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results?
  3. Analyze: What are the root causes and what alternatives do you have for Policies, Equipment, Measurement, Environment, People, Materials?
  4. Improve: What do you need to plan for, what will you do, how will you see what happened, what will you do to adopt?
  5. Control: How will you make it stick – what will you do iro M&E, OCM, Training, Ongoing process improvement?
  6. Next Steps:  What do you need to do next to get clear on what has to happen, get agreement, get started?

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 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.

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 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.

 

 

#MEQAPI – Tweetchat Nov-1 2018 8:00 PM ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc will be participating in a twitter-based Rapid Improvement Event (RIE)

Participants have carried out the following steps:

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants were encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants captured what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants ranked items in descending order of the rating

During the chat (Nov 1st) we will conduct QI cafe’

The chat will have six topics, following the Lean Six Sigma DMAIC process.

  • Define: Identify and refine the problem, the stakeholders, the critical to quality elements, the voice of the customer
    • Supplier
    • Inputs
    • Process
    • Outputs
    • Customers
  • Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results of any solution
    • Output metrics – what will measure the outcomes we want
    • Process metrics – what do we need to measure while things are being done and which will predict success of the outcomes metrics
    • Balancing metrics – how will be check that we aren’t making anything else worse. What do we need to measure to ensure that no untoward side effects are being caused
  • Analyze: Root cause analysis and analysis of alternatives
    • Policies & Procedures
    • Equipment & Technology
    • Measurement
    • Environment
    • People
    • Materials
  • Improve: Implement solutions
    • Plan
    • Do
    • Study
    • Act
  • Control: ongoing monitoring and evaluation to make the solutions stick and to ensure that the desired outcomes are realized.
    • M&E
    • Organizational Change Management (OCM)
    • Induction and Training
    • Ongoing process improvement

DMAIC+

Topics

  1. Define: What is the problem you want to solve, the stakeholders, the critical to quality elements, the voice of the customer, what is the future state?
  2. Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results?
  3. Analyze: What are the root causes and what alternatives do you have for Policies, Equipment, Measurement, Environment, People, Materials?
  4. Improve: What do you need to plan for, what will you do, how will you see what happened, what will you do to adopt?
  5. Control: How will you make it stick – what will you do iro M&E, OCM, Training, Ongoing process improvement?
  6. Next Steps:  What do you need to do next to get clear on what has to happen, get agreement, get started?

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 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.

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 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.

 

 

#MEQAPI – Tweetchat Oct-18 2018 3:00ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc are going to try their own QI discovery using the following steps. This chat will be to mull through questions and issues in getting started.

Before the chat, participants will have carried out the following steps

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants are encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants will capture what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants will rank items in descending order of the rating

During the chat (Oct 18th) we will conduct a speed-dating form of QI cafe’

For each of the main bones of the fishbone, get ready to attack your issue and Tweet two things. What do you think is a cause, and what do you think might be a fix. Usually we would do these apart, but it’s an hour, its Twitter, so we are doing them together. PLUS, you are going to comment or question what the other players in the game put out as their causes and solutions.

It’s going to be hectic.

You will do this with your primary issue, but maybe as time goes on and the chat is coming near, you think the secondary or tertiary issue are actually better, you can switch.

Issue

Topics

  1. Policy: What laws, policies, rules, regulations, etc. cause your issue, what are potential solutions to your issue?
  2. Equipment: What equipment and device factors cause your issue, what are potential solutions to your issue?
  3. Measurement: What quality, safety, and performance metrics cause your issue, what are potential solutions to your issue?
  4. Environment: What environmental factors cause your issue, what are potential solutions to your issue?
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc cause your issue, what are potential solutions to your issue?
  6. Materials: What “medical stuff” that patients need cause your issue, what are potential solutions to your issue?

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 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.

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 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.

 

 

#MEQAPI – Tweetchat Oct-11 2018 3:00ET QI Prep Workshop

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

This chat is a prep session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc are going to try their own QI discovery using the following steps. This chat will be to mull through questions and issues in getting started.

We will discuss the following steps

  • For three days, keep a diary of everything in your work or care environment that
    1. Surprised you
    2. Frustrated you
    3. Confused you
  • Try to keep as near to real-time capture as possible. Experience has shown, they tend to evaporate from memory pretty fast, so grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Capture what it was, what effect it has on what you are trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max
  • At the end of the three days, rank them in descending order of the rating you gave. Tweak any that in retrospect you feel MORE strongly about
  • Pick one of the top five to be your primary target
  • Pick another top five as a secondary
  • Pick another as a tertiary

You are now ready for the main chat.

During the chat (Oct 18th?) we will conduct a speed-dating form of QI cafe’

For each of the main bones of the fishbone, get ready to attack your issue and Tweet two things. What do you think is a cause, and what do you think might be a fix. Usually we would do these apart, but it’s an hour, its Twitter, so we are doing them together. PLUS, you are going to comment or question what the other players in the game put out as their causes and solutions. It’s going to be hectic.

You will do this with your primary issue, but maybe as time goes on and the chat is coming near, you think the secondary or tertiary issue are actually better, you can switch.

Issue

Topics

  1. Policy: What laws, policies, rules, regulations, etc. cause your issue, are a potential solution to your issue?
  2. Equipment: What equipment and device factors cause your issue, are a potential solution to your issue?
  3. Measurement: What quality, safety, and performance metrics cause your issue, are a potential solution to your issue?
  4. Environment: What environmental factors cause your issue, are a potential solution to your issue?
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc cause your issue, are a potential solution to your issue?
  6. Materials: What “medical stuff” that patients need cause your issue, are a potential solution to your issue?

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 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.

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 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.

 

 

#MEQAPI – Tweetchat Oct-4 2018 3:00ET Manterrupting

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:

  1. Patient and Staff Safety
  2. Quality & Efficiency
  3. Innovation & Problem-Solving
  4. Organizational Velocity
  5. 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.

Manterrupting

Topics

  1. Policy: What laws, policies, rules, regulations, etc. increase or decrease the frequency and degree to which men interrupt women at work?
  2. 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.
  3. Measurement: How do quality, safety, and performance metrics increase or decrease the frequency and degree to which men interrupt women at work?
  4. 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.
  5. 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?
  6. 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

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 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.

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 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.