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:
- Sexual Harassment & Discrimination Among Doctors
- Sexual Harassment Experienced by One-Third of Female Doctors
- Gender Gap Found in Evaluations of Emergency Medicine Residents
- Women Underrepresented Among Grand Rounds Speakers
- More Women Than Men Leaving Practice of Medicine
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.
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.
- 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
- 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
- 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
- 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
- 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.
- What METHODS influence the experience of women in healthcare
- What MACHINE factors influence the experience of women in healthcare
- What PEOPLE issues and expectations influence the experience of women in healthcare
- What MATERIALS influence the experience of women in healthcare
- What MEASUREMENT factors influence the experience of women in healthcare
- What ENVIRONMENTAL factors influence the experience of women in healthcare
Numbers for this chat
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.