#MEQAPI – Tweetchat June 29-2017 3:00ET: Patient Advocacy

Topic:  “Patient Advocacy”, 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.

In a perfect healthcare world, patient advocacy would perhaps be unnecessary – the processes would place patients at the center, patient goals would automatically be prioritized, and no patient would be subject to care that was not Safe, Timely, Efficient, Effective, Equitable, Patient Centered, and Affordable. No patient would wait unnecessarily, and every illness would attract the right level of funding.

However, that is not the world in which patients actually find themselves.

The world in which they navigate has information gaps and gradients, power dynamics, misleading information, and a hugely complex process that typically prioritizes many other stakeholder’s interests above those of the patient. What the patient encounters is  nightmare. Some illnesses take the lion’s share of funding, research, and care, while others languish for want of attention. Very often attention is rationed according to the estimated profitability of treatment, degree to which the condition is emotionally appealing, or just random luck.

Strong patient advocacy can help rectify, mitigate, or avoid the many obstacles, detours, and traps  that can prevent a patient from getting necessary care and support.

This week we are discussing patient advocacy with Andrea J. Wilson of Blue Faery. the Adrienne Wilson Liver Cancer Association. Andrea tweets using as @BlueFaeryLiver.

The Adrienne Wilson Liver Cancer Association is writing a Blue Faery Patient Advocacy eBook for cancer patients by cancer patients. The goal of the eBook is to answer commonly asked questions by cancer patients. A writer and editor, President Andrea Wilson is writing the book using personal stories to illustrate specific points. By conducting polls, collecting feedback, and interviewing cancer patients, Andrea is gathering content for the eBook that will be free on Blue Faery’s new website.

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

The topic of patient advocacy includes patient/physician partnership, and some medical journals have encouraged research that is done in partnership with patients. The British Medical Journal, for example, maintains a “Partnering with Patients” page.:

The BMJ launched an innovative strategy to promote patient partnership in 2014. It took this step because it sees partnering with patients, their families, carers and support communities, and the public as an ethical imperative, which is essential to improving the quality, safety, value, and sustainability of health systems.

The strategy has seen the journal move to co-produce its content with patients and advancing international debate on how to embed meaningful partnership with patients in clinical practice, service delivery, research, education, and policy. The strategy was drawn up with and continues to be informed by a dedicated international patient advisory panel.f\

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.

Patient Advocacy

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
      • Ability to navigate laws, policies, and processes
    • 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
    • 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
      • Discharge info packets
      • Explanation of Benefits sheets
    • 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
      • Patient goals
    • 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
      • Ability to navigate the healthcare facility

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences, and offer their insights and observations.

Topics

  1. What METHODS influence Patient Advocacy
  2. What MACHINE factors influence Patient Advocacy
  3. What PEOPLE issues and expectations influence Patient Advocacy
  4. What MATERIALS influence Patient Advocacy
  5. What MEASUREMENT factors influence Patient Advocacy
  6. What ENVIRONMENTAL factors influence Patient Advocacy

Numbers for last week

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

 

 

 

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#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:

  • July 6 “ETOH & Fireworks” inviting all our Emergency Medicine and Primary Care collegues to relate their insights of 4th of July combination of booze and gunpowder
  • July 13 “End of Life Planning” with Andrea J. Wilson of Blue Faery  @BlueFaeryLiver
  • July 20 “Physician Wellness & the Quadruple Aim” with @nxtstop1 and @subatomicdoc #crazysocks4docs
  • July 27 “Opioid Epidemic” – now the leading cause of death in <55 yr old white males

#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