#MEQAPI – Tweetchat March 30th 2017 3ET: Quality Improvement vs Clinician Burnout

Next tweetchat: Thursday March 30th, 2017 3:00-4:00 PM ET

Topic:  Quality Improvement vs Clinician Burnout

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

This week the #MEQAPI topics are based on the Physicians’s Weekly articles on clinician burnout. (Thanks to @DermHAG, Dr. Howard Green for the suggestion).

Clinician burnout has climbed over time, and yet we act surprised that it is happening, when we can see burnout even in medical training. Burnout is robbing clinicians of satisfaction in their work, and has serious implications in terms of access to care, care quality, and clinician and patient safety. Amongst other things, burnout Erodes the Sense of Calling, it is widespread and prevalent among Pediatric Residents and across all specialties, and negatively affects Quality and Safety.

Could better collaboration help reduce burnout?

We will take a QI approach, and discuss clinician burnout using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram for clinician burnout may look something like this:

MEQAPI Burnout 2

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

  • Methods
    • Policies: either unit, office, organization, or national policies that might increase frustration and burnout risks.
    • Workflow: how things are done that might increase risks of errors, or antagonize the patient, or create gaps in handoff, etc.
    • Insurance Models: Clinicians face billing and criteria issues and typically deal with several insurance providers, each with their own criteria, payment models, and processes. This may result in copious paperwork, slow payment, low payment, and the denial of payment even when there are compelling medical reasons.
  • Machines (equipment, EHR)
    • Medical or office equipment that might increase risk of malpractice claims, old, broken, poorly installed, etc.
    • Software systems (especially EHR?), that might lead to duplicate work, frustration, cause medical errors like wrong pt, wrong site, wrong meds, and create hours of extra work per day.
  • People
    • Staffing: insufficient or unqualified staff
    • Training: insufficient base training, incorrect training, insufficient CME, etc.
    • Attitudes: staff attitudes e.g. paternalism, rudeness, and workplace bullying.
  • Materials
    • Patients: as the “raw material” of the medical process, patients are both the joy and the anguish of medical practice. 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, lack of coffee(!)
    • Data? – sent to wrong recipient, not shared with pt or specialist, etc.
  • Measurement
    • KPIs: operational metrics that focus on the wrong things, or are poor measures, and that drive wrong behavior
    • Targets: improper or unachievable performance targets
    • Incentives: improper, biased, or discriminatory rewards, conflicting or perverse
  • Environment
    • Noise: distracting noises, sound levels too high, etc.
    • Space: cramped, uncomfortable, slippery surfaces, etc.
    • Time: Too little time per patient, too little time in a day, too many demands
    • Location: things not where they should be, too much movement of staff, pt, or equipment needed, etc.

The aim of this chat is look at each of these dimensions of causation, and discuss what we have seen before that has been a risk or developed into burnout, or that we anticipate is likely to become an issue or end up with clinician burnout.

Topics

  1. What Methods (policies, workflow, etc) have you seen or anticipate may increase risk or have led to burnout
  2. What Machines (med/office equipment, EHR/SW) have you seen or anticipate may increase risk or have led to burnout
  3. What People issues (staffing, training, bullying) have you seen or anticipate may increase risk or have led to burnout
  4. What Materials (forms, supplies, data?) have you seen or anticipate may increase risk or have led to burnout
  5. What Measurements (KPIs, targets, incentives) have you seen or anticipate may increase risk or have led to burnout
  6. What Environment issues (noise, space, time) have you seen or anticipate may increase risk or have led to burnout

Background

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.

 

meqapi stats march 30 2017

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#MEQAPI – Tweetchat March 23rd 2017 3ET: Quality Improvement vs Proneness for Malpractice Claims

Next tweetchat: Thursday March 23rd, 2017 3:00-4:00 PM ET

Topic:  Quality Improvement vs Malpractice Claims

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

Malpractice claims are a disruptive nightmare for providers, and the chances are that every provider will experience this firsthand at some point in their career. However, the probability of a malpractice claim is not evenly distributed, and some providers are far more likely to have claims made against them for malpractice than others. Proneness to malpractice claims can be reduced, and we can take proactive steps through quality improvement to greatly reduce the likelihood of the nightmare of a claim.

This week the #MEQAPI topics are based on the Physicians’s Weekly article “Examining Proneness to Malpractice Claims” that reviews malpractice claims variation between physicians and specialties. We will look at proneness to malpractice claims for each of the typical arms of the basic Quality Improvement Ishikawa diagram that may look something like:

Ishikawa

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

  • Methods
    • Policies: either unit, office, organization, or national policies that might increase malpractice risks.
    • Workflow: how things are done that might increase risks of errors, or antagonize the patient, or create gaps in handoff, etc.
    • Standard work: Standard operating procedures that may increase risk
  • Machines
    • Medical or office equipment that might increase risk of malpractice claims, old, broken, poorly installed, etc.
    • Software systems (especially EHR?), that might lead to HIPAA issues, frustrate patients, cause medical errors like wrong pt, wrong site, wrong meds, failure to follow up, etc.
  • People
    • Staffing: insufficient or unqualified staff
    • Training: insufficient base training, incorrect training, insufficient CME, etc.
    • Attitudes: staff attitudes e.g. paternalism, rudeness, etc.
  • Materials
    • Forms: duplicative or incomplete forms
    • Supplies: medical or office, inferior fax paper, lack of coffee(!)
    • data? – sent to wrong recipient, not shared with pt or specialist, etc.
  • Measurement
    • KPIs: operational metrics that focus on the wrong things, or are poor measures, and that drive wrong behavior
    • Targets: improper or unachievable performance targets
    • Incentives: improper, biased, or discriminatory rewards
  • Environment
    • Noise: distracting noises, sound levels too high, etc.
    • Space: cramped, uncomfortable, slippery surfaces, etc.
    • Lighting: too dim, glare, poor contrast, etc.
    • Location: things not where they should be, too much movement of staff, pt, or equipment needed, etc.

The aim of this chat is look at each of these dimensions of cause, and discuss what we have seen before for that dimension that has been a risk or developed into a malpractice claim, or that we anticipate is likely to become an issue or end up as a malpractice claim.

Topics

  1. What Methods (policies, workflow, etc) have you seen or anticipate may increase risk or have led to malpractice claims
  2. What Machines (med/office equipment, EHR/SW) have you seen or anticipate may increase risk or have led to malpractice claims
  3. What People issues (staffing, training, attitudes) have you seen or anticipate may increase risk or have led to malpractice claims
  4. What Materials (forms, supplies, data?) have you seen or anticipate may increase risk or have led to malpractice claims
  5. What Measurements (KPIs, targets, incentives) have you seen or anticipate may increase risk or have led to malpractice claims
  6. What Environment issues (noise, space, lighting) have you seen or anticipate may increase risk or have led to malpractice claims

Background

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.

meqapi March 23

#MEQAPI – Tweetchat March 16th 2017 3ET: Matching #Trumpcare (AHCA) to the IHI Triple Aim

Next tweetchat: Thursday March 16th, 2017 3:00-4:00 PM ET

Topic: Matching #Trumpcare (AHCA) to the IHI Triple Aim

This week the #MEQAPI topics are based on the Congressional Budget Office (CBO) report on the American Healthcare Act (AHCA) and the acts’ relationship to the Institute for Healthcare Improvement (IHI) Triple Aim.

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

Since MEQAPI looks at the quality and safety of healthcare policies in addition to technology deployment and workflow optimization, it seems like a good time to look at the AHCA through that lens.

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 can look at the law, the analysis thus far, and the CBO evaluation, and ask how this may influence quality and safety, and to ask ourselves if it would be a positive influencer of care that is STEEEP.

The aim of this chat is thus to bump the Triple Aim up against the AHCA, and in the context of the CBO and other analyses of how the AHCA will work, discuss our views on a number of dimensions.

We are expecting @TheIHI to attend, and to participate in the discussion.

 

Topics

The following topics will be covered during the chat:

  1. What WAS IN the #AHCA you think will have a bearing on the IHI Triple Aim
  2. What was NOT in the #AHCA you think will have a bearing on the IHI Triple Aim?
  3. In relation to the Triple Aim and #AHCA, what do you expect to see personally/professionally?
  4. What do you think HC Quality orgs like @theihi @nqf and @AHRQNews should do about #AHCA?
  5. What do you think yourself, patients, and providers should do about #AHCA to drive care that is STEEEP?

 

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.

 

#MEQAPI – Tweetchat March 9th 2017 3ET: Patient-Participative Questions To Improve Clinical Decision Making

Next tweetchat: Thursday March 9th, 2017 3:00-4:00 PM ET

Topic: Patient-Participative Questions To Improve Clinical Decision Making

MEQAPITweetChat.png

This week the #MEQAPI topics are based on a @physicianswkly article on preoperative questions by Dr.Schwarze MD. The article “Improving Surgical Decision Making” is available on the Physician’s Weekly website.

Co-hosting the chat is Chris Cole of @physicianswkly, and we hope to have Dr. Schwarze @GretchenSchwa10 to provide details, so please watch for their tweets during the chat. Dr. Schwarze is affiliated with the University of Wisconsin School of Medicine and Public Health (@uwsmph) and UW Health (@uwhealth)

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

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

The 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.

In this chat, we will focus on safety and patient-centeredness, in the context of the Schwarze article.

To reduce the high number of medical errors resulting in missed opportunities, injury, and premature death, healthcare providers need to use basic quality improvement principles. Likewise, quality improvement techniques can help align patient expectations and most probable medical outcomes. A core principle of Lean Six Sigma is the inclusion of the Voice of the Customer (VoC).

In healthcare, VoC implies inclusion of the patient, their caregivers, and patient families in the development and execution of the careflow, and in making medical decisions. Various studies have shown that including patients in the overall quality processes increased patient satisfaction, and reduced cost and risk.

Participation by patients in the treatment decision-making process can reduce risk of errors, increase patient understanding of medicaloutcomes, and avoid patient dissatisfaction with results

Topics

The following topics will be covered during the chat:

  1. What risks/opportunities do you see in involving pts in clinical decisions by using standardized question prompt lists (QPL)
  2. Who should lead an initiative to involve patients in developing or using QPLs – Nursing/Physicians/QM/Case-Managers/Other
  3. Are there HIPAA risks in involving patients in developing or using QPLs
  4. How can we build patient involvement in QPLs into the careflow
  5. How would we tell if patient involvement in QPLs is working – what benefits would we be able to measure

and the numbers

meqapi mar 9 2017