#MEQAPI – Tweetchat June 22nd 2017 3:00ET: Physician Suicide

Topic:  “Physician Suicide”, QI perspective

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

Although the general public may not be aware of it, Dr. Danielle Ofri reminds us in a Slate article, “Doctors have the highest suicide rates of any professional group.” Although physicians tend to be healthier than the general public, they suicide at a far higher rate.

This week we are discussing physician suicide with Dr. Meredith Mealer of the Rocky Mountain chapter of the  VA Mental Illness Research, Education and Clinical Centers (MIRECC).

Meredith Mealer PhD is a registered nurse and an Assistant Professor of Physical Medicine and Rehabilitation (PM&R) at the University of Colorado, Anschutz School of Medicine and the Director of the Colorado Multiple Institutional Review Board (COMIRB). Her primary area of research interest is resilience training in healthcare professionals as a mechanism to mitigate psychological distress that results from the work environment.

Dr. Mealer will be attending the #MEQAPI chat, and taking questions related to clinician suicide and approaches to suicide reduction, such as resilience training. Some additional materials by Dr. Mealer include:

Physician’s Weekly have kindly shared the following highly pertinent articles:

 

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.

Physician Suicide

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 MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
      • Incompatible policies
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Access Control
      • Interoperability
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
      • Management styles
      • Malpractice litigation and threats of litigation
    • 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,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
      • Means of suicide
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc. Gender segregated space
      • 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
      • Architecture: location of work areas, gathering places, shared areas

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 influence physician suicide
  2. What MACHINE factors influence physician suicide
  3. What PEOPLE issues and expectations influence physician suicide
  4. What MATERIALS influence physician suicide
  5. What MEASUREMENT factors influence physician suicide
  6. What ENVIRONMENTAL factors influence physician suicide

Numbers for this chat

meqapi numbers june 22 2017

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.

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

 

 

 

Upcoming #MEQAPI Chats

Here is the schedule for the next four weeks:

#MEQAPI – Tweetchat June 15th 2017 3:00ET: Women in Healthcare

Topic:  “Women in Healthcare”, QI perspective

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

This week we are discussing women in healthcare. That includes the experience of being a woman in medical training, working as a physicians, nurse, or researcher, being a carer, or being a patient.

Physician’s Weekly have kindly shared the following pertinent articles:

 

In some ways, women experience the journey through healthcare in sub-optimal ways that have nothing to do with biology – they encounter social and organizational expectations of their roles, behavior, career plans etc that present barriers or distractions. These may lead to increased stress, or inhibits their participation, growth, and rewards.

It also impacts on patient service and outcomes in a variety of ways. For example, women physicians frequently encounter disbelief or assumptions that they  they are nurses or admin staff, even when they are accomplished physicians, surgeons, etc. They get called on less during grand rounds, their answers are more frequently ignored, and their advice more often goes unheeded. In patient care this has serious quality and safety implications, and has led in cases to medical mistakes, missed opportunities, and worse patient outcomes.

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.

Women in Healthcare

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 MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Access Control
      • Interoperability
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to gender, assumptions about roles
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
      • Management styles
      • Expectations related to child-bearing, child-rearing
    • 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,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc. Gender segregated space
      • 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
      • Architecture: location of work areas, gathering places, shared areas

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 influence the experience of women in healthcare
  2. What MACHINE factors influence the experience of women in healthcare
  3. What PEOPLE issues and expectations influence the experience of women in healthcare
  4. What MATERIALS influence the experience of women in healthcare
  5. What MEASUREMENT factors influence the experience of women in healthcare
  6. What ENVIRONMENTAL factors influence the experience of women in healthcare

Numbers for this chat

meqapi numbers Jun 15 2017

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.

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

 

 

 

#MEQAPI – Tweetchat June 8th 2017 3:00ET: Tribes and Silos in Healthcare

Topic:  “Tribes and Silos, and, Tribes VS Tribes 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.

 

This week we are discussing silos and tribalism in healthcare. The chat is based on the excellent blog “Tribes and Silos, and, Tribes VS Tribes in Healthcare” by Dr. Bernadette Keefe, MD.

Bernadette describes how tribal and siloed behavior plays out in healthcare:

… many errors and misunderstandings in healthcare are, at their core, communication issues  arising from stakeholders speaking and acting from isolated positions.

Since this often leads to waste and error, it is important that we address tribal or siloed behavior and structures in healthcare.

Bernadette covers a wide range of the causes, processes, and effects of siloed and tribal behaviors and structures, but I would like to dwell on one specific area, the patient perspective.

Here is what Bernadette states about the patient experience:

Patients

Patients are experiencing multiple pain points, including:

  • Often limited access to data
  • Inadequately represented in research endeavors
  • Lack of time with and incomplete communication with physicians
  • Not enough shared decision making or, often patients are not given enough data or tools to make effective shared decisions. This results in incomplete buy-in and, what is inaccurately termed, non-adherence.

How to improve?

  • Release data from data silos
  • Involve patients in more research AND have transparency of their data and study results.
  • Provide better educational materials for patients online to enable more effective self care between healthcare provider contacts.
  • Create patient care teams to expand the healthcare provider network on behalf of patients, as described in, “Cowboys and Pit Crews” – Atul Gawande MD.
  • Additionally both patients and physicians might appreciate this post.

From a quality point of view this is critical, since we must shape all processes and workflow with the customer outcome in mind. If the structures and processes are not leading to quality and value as seen from the perspective of the patient, then we have failed.

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.

silos

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 MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies
      • Traditions and memes
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Access Control
      • Interoperability
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance, bullying, supporting
      • Fatigue (especially alert fatigue)
      • Values and traditions
      • Friends and family
      • Role Models
    • 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
      • Internet sources
      • Employment Handbook
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
    • 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
      • Architecture: location of work areas, gathering places, shared areas

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 silos or tribal behavior
  2. What MACHINE factors increase or reduce silos or tribal behavior
  3. What PEOPLE issues increase or reduce silos or tribal behavior
  4. What MATERIALS increase or reduce silos or tribal behavior
  5. What MEASUREMENT factors increase or reduce silos or tribal behavior
  6. What ENVIRONMENTAL factors increase or reduce silos or tribal behavior

Numbers

meqapi numbers jun 8 2o17

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.

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

 

 

 

#MEQAPI – Tweetchat June 1st 2017 3:00ET: Speaking Up

Topic:  “Speaking Up” vs unprofessional behavior

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

Fear of repercussions and scapegoating is a major impediment to safety, and frequently results in increased waste and lost lives.

A basic principle of quality improvement is the establishment of a “no-blame” culture in which every stakeholder feels an obligation to report quality risks or issues, but also knows that the response will be to focus on the problem and a solution rather than on blaming the individuals.

The need for “Speaking Up” is applicable to every healthcare facility and specialty, regardless of whether they are public or private institutions. The idea that if you “see something, say something” is very important no matter your “position” at the facility. Advocating for the patients is very important, and often times people will keep quiet because they are afraid of repercussions if they do speak up.

Deming included “Drive out fear” in his list of 14 Points for quality. He exhorted organizations to encourage effective two way communication as a means  to drive out fear throughout an organization. This enables everybody to work effectively, productively, and safely.

This chat is based largely on the BMJ paper by Martinez et al “Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents

Recent articles from Physician’s Weekly on unprofessional behavior in healthcare:

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.

Speaking Up

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 MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Access Control
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance, bullying, supporting
      • Fatigue (especially alert fatigue)
      • Values and traditions
      • Friends and family
      • Role Models
    • 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
      • Internet sources
      • Employment Handbook
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
    • 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
      • Traditions

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 unprofessional behavior or ability to speak up
  2. What MACHINE factors increase or reduce unprofessional behavior or ability to speak up
  3. What PEOPLE issues increase or reduce unprofessional behavior or ability to speak up
  4. What MATERIALS increase or reduce unprofessional behavior or ability to speak up
  5. What MEASUREMENT factors increase or reduce unprofessional behavior or ability to speak up
  6. What ENVIRONMENTAL factors increase or reduce unprofessional behavior or ability to speak up

… and the numbers:

June 1 MEQAPI numbers

Attendees:

MEQAPI Participants June 1

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.

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

 

 

 

#MEQAPI – Tweetchat May 25th 2017 3:00ET: Burnout

Topic:  Quality Improvement vs Care Burnout

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 March 30th MEQAPI we discussed the serious and growing problem of Clinician Burnout. Since then, even more papers and articles have been written, and even more harm has emerged – For example, burnout has been shown to be leading to a sharp increase in physician suicide.

Recent articles from Physician’s Weekly:

The effects of burnout can be seen in decreased physicians job satisfaction, increased numbers of clinicians leaving healthcare, and increased physicians suicide. It also Negatively Affects Quality, Safety.

Burnout is also happening all across the different roles in healthcare. At a very fundamental level, the combination of burnout and low wages is driving a shortage of home health workers. Without sufficient and motivated home health workers, fewer patients can be safely discharged from hospitals, more will find themselves in the ED or readmitted, and the mortality rate after discharge will climb.

Some additional materials courtesy of the Rocky Mountain Mental Illness Research, Education and Clinical Centers (MIRECC).

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.

MEQAPI burnout

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 MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Home visit support
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Medication dispensing systems
      • Personal Health Record and encounter ploanning systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance
      • Fatigue (especially alert fatigue)
      • Values
      • Friends and family
    • 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
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • Internet sources
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
    • 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

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 Burnout
  2. What MACHINE factors increase or reduce Burnout
  3. What PEOPLE issues increase or reduce Health Burnout
  4. What MATERIALS increase or reduce the risk of Burnout
  5. What MEASUREMENT factors increase or reduce Burnout
  6. What ENVIRONMENTAL factors increase or reduce Burnout

The Numbers

meqapi number May 25

Participants May 25Background

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.

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

 

 

 

#MEQAPI – Tweetchat May 18th 2017 3:00ET: Health Literacy

Topic:  Quality Improvement vs Health Literacy

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

A core and foundational part of moving from fee-for-service to value-based care, reducing healthcare costs, and reducing medical errors, is the idea that patients can become active players in their own care. That includes the self-management that goes hand in hand with “architecting” a healthy lifestyle, reducing health risks, and accessing healthcare services in a selective and judicious manner. It also implies that the average, or at least many, healthcare consumers will play an active role in medical decisions, and be partners with their (many) providers in order to prioritize and select the goals and components of their care plan.

A key assumption in achieving this activated patient role, is that the person has a high degree of health literacy – that they understand the concepts, are familiar with the terrain, and can speak the language of healthcare. They will know what HbA1c, BP, Resting Heart Rate, BMI, HDL, LDL, Triglycerides, etc are, what they mean, where they stand on each, and what they need to do about them.

It is by no means clear that we are anywhere near having most people in a position where the terminology is familiar, where they understand the implications, and where they have clear health goals prioritized to lead them to the healthiest life that they can afford, are willing to maintain, and is feasible given their history, health status, and environment.

In fact, Health.gov paints a fairly dismal picture:

Only 12 percent of adults have Proficient health literacy, according to the National Assessment of Adult Literacy.  In other words, nearly nine out of ten adults may lack the skills needed to manage their health and prevent disease.  Fourteen percent of adults (30 million people) have Below Basic health literacy.  These adults were more likely to report their health as poor (42 percent) and are more likely to lack health insurance (28 percent) than adults with Proficient health literacy.6

Health.gov describes health literacy dependencies and implications thus:

Health literacy is dependent on individual and systemic factors:

  • Communication skills of lay persons and professionals
  • Lay and professional knowledge of health topics
  • Culture
  • Demands of the healthcare and public health systems
  • Demands of the situation/context

Health literacy affects people’s ability to:

  • Navigate the healthcare system, including filling out complex forms and locating providers and services
  • Share personal information, such as health history, with providers
  • Engage in self-care and chronic-disease management
  • Understand mathematical concepts such as probability and risk

Low health literacy can result in many sub-optimal outcomes, including reduced ability to comply with treatment plans, poorer healthcare choices, and ineffective or expensive utilization.

Health.gov again:

Low literacy has been linked to poor health outcomes such as higher rates of hospitalization and less frequent use of preventive services (see Fact Sheet: Health Literacy and Health Outcomes). Both of these outcomes are associated with higher healthcare costs.

Some supporting reading for the chat comes from Physician’s Weekly and the Leapfrog Group.

Educational materials from Leapfrog:

Articles from Physician’s Weekly:

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. Unlike most Ishikawa diagrams we have used in past chats, Healthcare Literacy feeds itself – Low health literacy causes continued low literacy, while high health literacy can cause greater health literacy.

MEQAPI Health Literacy

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 MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Home visit support
    • Machines (equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Medication dispensing systems
      • Personal Health Record and encounter ploanning systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes to technology, adoption vs resistance
      • Fatigue (especially alert fatigue)
      • Celebrities
      • Friends and family
    • 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
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • Drug information sheets
      • Self-care guides
      • Internet sources
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Monitoring of home-care
      • Adverse Effects reporting
      • Home monitoring
    • 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

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 Health Literacy
  2. What MACHINE factors increase or reduce Health Literacy
  3. What PEOPLE issues increase or reduce Health Literacy
  4. What MATERIALS increase or reduce the risk of Health Literacy
  5. What MEASUREMENT factors increase or reduce Health Literacy
  6. What ENVIRONMENTAL factors increase or reduce Health Literacy

meqapi numbers may 18 2017

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.

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