Upcoming #MEQAPI Chats

Here is the schedule for forthcoming #MEQAPI chats

  • Sep 21 – Social Determinants of Health
  • Sep 28 – Antibiotic resistance

Unscheduled but planned:

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

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#MEQAPI – Tweetchat Sep 14-2017 3:00ET Rural Hospital Closures

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

For many years there has been a steady reduction in rural hospitals and healthcare professionals (HCP) serving rural areas. This leveled off somewhat after the introduction of the Affordable Care Act (ACA), but did not stop altogether. Although it is too early to claim a trend, there are some signs that the process of depletion has resumed, and that we may be seeing an acceleration in closures of rural facilities.

In some zip codes in rural areas, there are now specialties with zero HCPs, and some services are simply not available inb that zip code. This is mainly specialty treatment, but even some primary care services, for women’s health especially, are no longer available in some places.

Hospital closures and service terminations have serious health implications for rural patients, and there are large health gradients and differences in morbidity and mortality rates if one sorts locations by how rural or urban they are. Rural populations have higher rates of preventable illness and death compared to their urban counterparts, and the less choice of facilities and fewer specialties on offer in a location, the higher the health gradient becomes.

The following interesting article has been provided by Physician’s Weekly:

This is an example of one of the many ripple effects of any closure, but in rural areas where the next facility may be some distance away, any closure has large downstream effects.

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.

Rural Closures

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
      • Subsidies and programs to retain HCPs
    • Machines (incl 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 planning systems
      • Transportation systems, incl. wheelchairs, lifts, ambulances, etc.
      • Access control
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
      • WIFI and internet
      • Analytical software
      • Patient identification
      • HCP Identification
    • 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
      • Fatigue (especially alert fatigue)
      • Values
      • Peer support
      • 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
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Cost
    • 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 Eventss reporting
      • Effectiveness of measurement
    • 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
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Tax revenues

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 of Rural Hospital Closures or Service Termination
  2. What MACHINE factors increase or reduce risks of Rural Hospital Closures or Service Termination
  3. What PEOPLE issues increase or reduce risks of Rural Hospital Closures or Service Termination
  4. What MATERIALS increase or reduce risks of Rural Hospital Closures or Service Termination
  5. What MEASUREMENT factors increase or reduce risks of Rural Hospital Closures or Service Termination
  6. What ENVIRONMENTAL factors increase or reduce risks of Rural Hospital Closures or Service Termination

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 Sep 7-2017 3:00ET Surgical Adverse Events

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

Generally speaking, if somebody slices into you with a knife, burns holes in your body, or sticks something into you with the aim of tearing parts of you out, there would be a just cause to call the police, pick up a weapon, or run like heck. Yet every day, thousands of people are very happy that a surgeon is going to wield a scalpel, laser, or endoscope because there is goodwill and good odds that one will be better off as a result.

However, surgery is still a kind of violent assault on the body, and there is always a risk, a price to pay, and an off-chance of things going very wrong. There are many ways in which adverse surgical events can occur, many ways in which they manifest, and the effects can range from negligible to death.

We can usefully talk of an adverse event in which there was a risk or near miss, but in which the patient wasn’t reached. If the patient was reached, we can talk of an adverse incident, which may or may not result in harm. However, not everyone uses these terms in the same way, and the AHRQ talks ofNever Events as those errors that pose serious and unnecessary risk of great harm.

The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable. The NQF initially defined 27 such events in 2002. The list has been revised since then, most recently in 2011, and now consists of 29 events grouped into 7 categories: surgical, product or device, patient protection, care management, environmental, radiologic, and criminal.

The general idea then, is to stop risks from becoming events, keep events from ever reaching a person, and keeping those that do from resulting in harm to the person.

The following pertinent articles have been provided by 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.

Adverse Surgical Events

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
    • Machines (incl 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 planning systems
      • Transportation systems, incl. wheelchairs, lifts, ambulances, etc.
      • Access control
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
      • WIFI!
      • Analytical software
      • Patient identification
      • HCP Identification
    • 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
      • Fatigue (especially alert fatigue)
      • Values
      • Peer support
      • 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
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
    • 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 Eventss reporting
      • Effectiveness of measurement
    • 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
      • Temperature: too cold, too hot, too variable
      • Interuptions

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 of Adverse Surgical Events
  2. What MACHINE factors increase or reduce risks of Adverse Surgical Events
  3. What PEOPLE issues increase or reduce risks of Adverse Surgical Events
  4. What MATERIALS increase or reduce risks of Adverse Surgical Events
  5. What MEASUREMENT factors increase or reduce risks of Adverse Surgical Events
  6. What ENVIRONMENTAL factors increase or reduce risks of Adverse Surgical Events

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 Aug 31-2017 3:00ET Rehab and PTSD

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 cover a fascinating and complex question – Patient Rehabilitation, and then we make it even more complex by placing it in the context of Post Traumatic Stress Disorder (PTSD).

Once a patient has been stabilized after injury, there is typically a period (however brief) of recovery that includes re-adaptation to their lived environment. This applies whether we are thinking of a hernia repair and not making beds or pushing a broom for a few days, or the far more complex process of learning to cope with Activities of daily living (ADL) following an amputation, or if we are thinking of the extensive and often incomplete recovery from events such as brain injury (including surgery) that will require a hierarchical and far more comprehensive process to regain mastery of elements of Instrumental activities of daily living (IADLs).

Rehabilitation covers a broad terrain that can be as simple as getting around with an eye patch, a bandage, or a sling for a day or so, to lifelong coping with barriers and challenges from a Traumatic Brain Injury (TBI).

Seen in this hierarchical way, coping involves dealing with both physical and mental shocks, as well as the physical and mental effects of the shocks. A physical injury resulting in amputation, blindness, or loss of cognitive capacity or capability will often have mental effects such as anxiety, depression, or even complex syndromic outcomes such as PTSD.

In this context, we explore patient rehabilitation, and what helps or hinders rehabilitation.

 

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.

Rehab

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 related to workplace safety
      • Workflow: how things are done including transportation, care, drug prescription and fulfillment, and laboratory work
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Unofficial workarounds
      • Safety and quality training
      • Rehabilitative and accommodative funding, policies, laws, and training
      • Quality Improvement and incident reporting policies
    • Machines (equipment including 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 planning systems
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
      • WIFI!
      • Habilitative and accomodative tools and equipment
    • 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
      • Fatigue (especially alert fatigue)
      • Organizational, specialty, and personal values
      • Peer support and role models
      • Friends and family
      • Helpful Societies
    • 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
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Data!
    • 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 and incident reporting
      • Effectiveness of measurement
    • 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
      • Interruptions or interference

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 enhance or impede rehabilitation
  2. What MACHINE factors enhance or impede rehabilitation
  3. What PEOPLE issues enhance or impede rehabilitation
  4. What MATERIALS enhance or impede rehabilitation
  5. What MEASUREMENT factors enhance or impede rehabilitation
  6. What ENVIRONMENTAL factors enhance or impede rehabilitation

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. To this model, we add “Affordability”, since perfect care that is umaffordable is as beyond reach as though it were far in the future.

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 Aug 24-2017 3:00ET Workplace Safety

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

Why are we talking about workplace safety?

Firstly, because of the large number of workers and the high rate of injury, the healthcare and social assistance industry has the highest number of injuries of any industry. In the last OSHA report (2010), the healthcare industry reported 653,900 cases of injury (152,000 more than manufacturing). In context, the industry had a non-fatal injury rate of 139.9 per 10,000 workers, compared to the national average of 107.7.

Healthcare workers face a broad array of health risks, ranging from materials they handle and the pathogens they are exposed to, to the patients they see, and even other healthcare workers.

Health care workers face a wide range of hazards on the job, including sharps injuries, harmful exposures to chemicals and hazardous drugs, back injuries, latex allergy, violence, and stress. Although it is possible to prevent or reduce healthcare worker exposure to these hazards, healthcare workers continue to experience injuries and illnesses in the workplace. Cases of nonfatal occupational injury and illness with healthcare workers are among the highest of any industry sector. (CDC-NIOSH)

Occupational Safety and Health Administration (OSHA) expands on this with more specific risks, as follows.

Healthcare workers face a number of serious safety and health hazards. They include bloodborne pathogens and biological hazards, potential chemical and drug exposures, waste anesthetic gas exposures, respiratory hazards, ergonomic hazards from lifting and repetitive tasks, laser hazards, workplace violence, hazards associated with laboratories, and radioactive material and x-ray hazards. Some of the potential chemical exposures include formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde, and paracetic acid used for sterilization; and numerous other chemicals used in healthcare laboratories. (OSHA)

Some injuries cluster by role. For example, nursing aides, orderlies, and attendants had the highest rates of musculoskeletal injury, with an injury rate of 249 injuries per 10,000 workers compared to a national average of 34.

The following graphs were sourced from the OSHA “Facts About Hospital Worker Safety” fact-sheet. From these one can see that sprains, strains, and bruises are the most frequent injury causing days off work. The leading causes were patients, floors, and other workers, with transportation and violence being the most frequent context of injury (with falls and exposure tied in third place).

nature of injury

source of inj

cause of inj

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.

Workplace safety

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 related to workplace safety
      • Workflow: how things are done including transportation, care, drug prescription and fulfillment, and laboratory work
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Unofficial workarounds
      • Safety and quality training
      • Quality Improvement and incident reporting policies
    • Machines (equipment including 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 planning systems
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
      • WIFI!
      • Analytical software
      • Incident reporting 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, bullying
      • Fatigue (especially alert fatigue)
      • Organizational, specialty, and personal values
      • Peer support and role models
      • Friends and family
      • Unit management
    • 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
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Data!
    • 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 and incident reporting
      • Effectiveness of measurement
    • 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
      • Interruptions or interference

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 enhance or impede workplace safety
  2. What MACHINE factors enhance or impede workplace safety
  3. What PEOPLE issues enhance or impede workplace safety
  4. What MATERIALS enhance or impede workplace safety
  5. What MEASUREMENT factors enhance or impede workplace safety
  6. What ENVIRONMENTAL factors enhance or impede workplace safety

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