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 cover a fascinating and complex question – Patient Rehabilitation, and then we make it even more complex by placing it in the context of Post Traumatic Stress Disorder (PTSD).
Once a patient has been stabilized after injury, there is typically a period (however brief) of recovery that includes re-adaptation to their lived environment. This applies whether we are thinking of a hernia repair and not making beds or pushing a broom for a few days, or the far more complex process of learning to cope with Activities of daily living (ADL) following an amputation, or if we are thinking of the extensive and often incomplete recovery from events such as brain injury (including surgery) that will require a hierarchical and far more comprehensive process to regain mastery of elements of Instrumental activities of daily living (IADLs).
Rehabilitation covers a broad terrain that can be as simple as getting around with an eye patch, a bandage, or a sling for a day or so, to lifelong coping with barriers and challenges from a Traumatic Brain Injury (TBI).
Seen in this hierarchical way, coping involves dealing with both physical and mental shocks, as well as the physical and mental effects of the shocks. A physical injury resulting in amputation, blindness, or loss of cognitive capacity or capability will often have mental effects such as anxiety, depression, or even complex syndromic outcomes such as PTSD.
In this context, we explore patient rehabilitation, and what helps or hinders rehabilitation.
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 related to workplace safety
- Workflow: how things are done including transportation, care, drug prescription and fulfillment, and laboratory work
- Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
- Unofficial workarounds
- Safety and quality training
- Rehabilitative and accommodative funding, policies, laws, and training
- Quality Improvement and incident reporting policies
- Machines (equipment including 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 planning systems
- Ergonomics (right size, shape, location, etc)
- Habilitative and accomodative tools and equipment
- 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
- Fatigue (especially alert fatigue)
- Organizational, specialty, and personal values
- Peer support and role models
- Friends and family
- Helpful Societies
- 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
- Checklists, SoPs
- Uniforms, footwear, personal protective equipment
- 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 and incident reporting
- Effectiveness of measurement
- 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
- Interruptions or interference
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 enhance or impede rehabilitation
- What MACHINE factors enhance or impede rehabilitation
- What PEOPLE issues enhance or impede rehabilitation
- What MATERIALS enhance or impede rehabilitation
- What MEASUREMENT factors enhance or impede rehabilitation
- What ENVIRONMENTAL factors enhance or impede rehabilitation
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. To this model, we add “Affordability”, since perfect care that is umaffordable is as beyond reach as though it were far in the future.
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.