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:
- Risk Factors in Six Areas Tied to Physician Burnout
- High-Volume NICUs See More Staff Burnout
- Vulnerability to burnout within the nursing workforce – the role of personality and interpersonal behaviour.
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).
- Dr Meredith Mealer – PTSD among ICU Nurses – and how to prevent
- Dr Sarra Nazem – preventing provider fatigue
- Compassion Fatigue and Burnout Amongst Clinicians: A Medical Exploratory Study
- CDC data by occupation and cause of death
- Physician and Medical Student Depression and Suicide Prevention
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.
Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:
- 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
- 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)
- Friends and family
- 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
- 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
- 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.
- What METHODS increase or reduce Burnout
- What MACHINE factors increase or reduce Burnout
- What PEOPLE issues increase or reduce Health Burnout
- What MATERIALS increase or reduce the risk of Burnout
- What MEASUREMENT factors increase or reduce Burnout
- What ENVIRONMENTAL factors increase or reduce Burnout
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.