Topic: “The Quadruple Aim”, 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 “Quadruple Aim: Care of the Physician“- the IHI Triple Aim, plus caring for the physician. Our guests are Dr. Bernadette Keefe, M.D. (@nxtstop1) and Dr. Matthew Katz, M.D. (@subatomicdoc).
They will be speaking about physician needs for effective practice, how that’s bound up with patient’s needs, and how the bond between making optimal doctoring, practice of medicine for both.
The classic ‘triple aim’ for healthcare is a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. IHI asserts 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
Numerous publications suggest that the list be expanded to a ‘Quadruple Aim’ to include: Improving the Care of and Experience of The Provider (ie MDs/other HCPs).
The concept of a quadruple aim is supported by several industry quality leaders, including the Agency for Healthcare Research and Quality (AHRQ), the British Medical Journal (BMJ), and the Institute for Healthcare Improvement (IHI)
- Quadruple Aim Proposed to Address Workforce Burnout
- WIHI: Moving Upstream to Address the Quadruple Aim
- The Quadruple Aim: care, health, cost and meaning in work
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 HIPAA, Physician assisted death policies, 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
- MOC, Accreditation, Licensing, etc.
- 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
- 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
- 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
- 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
- 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.
- What METHODS influence the Quadruple Aim
- What MACHINE factors influence the Quadruple Aim
- What PEOPLE issues and expectations influence the Quadruple Aim
- What MATERIALS influence the Quadruple Aim
- What MEASUREMENT factors influence the Quadruple Aim
- What ENVIRONMENTAL factors influence the Quadruple Aim
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.