#MEQAPI – Tweetchat Nov 2-2017 3:00ET Complementary Modalities

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.

Firstly, some definition around what we mean by “complementary care” modalities.

We are distinguishing between care modalities that are “alternative” and those that are “complementary”. By alternative, we mean any care modality that is not Evidence Based Medicine (EBM) and which replaces EBM. Offering aromatherapy, yoga, or homeopathy instead of EBM, would be seen in this context as “alternative”.

In contrast, some of the same modalities may be seen as complementary where they are used in conjunction with EBM. Here there is a lot to say for modalities which enhance access or efficacy of EBM and which thereby lead to improved patient outcomes.

In looking at complementary modalities, we should perhaps examine them in the light of the MEQAPI standard – will they lead to care that is STEEEPA. Will the resulting care be Safe, Timely, Effective, Efficient, Equitable, Patient-Centered, and Affordable?

Consider this: while we might dismiss the use of aromatherapy as a replacement for drugs to treat cancer, what if the aromatherapy could help the patient to stick with their chemotherapy? What if art therapy didn’t replace clinical talk therapy and anti-psychotics, but enabled the patient to attend sessions and stay on their medication?

If a complementary care modality results in a patient achieving their health goals in a way that is STEEEPA, is there any reason to object? If their drumming sessions, acupuncture, or meditation puts them in a mental place from which they are more able to access, use, and stay with their EBM care plan, should it be encouraged?

There are obviously considerations and potential complications – will the complementary modality add any risks, affect dosages or create additional side effects, or lead to confusion in results of medical tests?

The potential downsides to complementary care are numerous: they are often unregulated and have wide variation is dosage and effect. Herbal and other potions, lotions, and products may containvery serious contaminants, including arsenic, lead, and mercury. Physical manipulations such as chiropractic have been linked to internal injuries, including broken bones, and may create a significant stroke risk.

Some “natural” remedies have very serious interactions with EBM drugs, and many cases have been listed of injury and death because the remedy either reduced the efficacy of a critical drug, or added to the effect in ways that resulted in harmful overdose.

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.

Complimentary Care

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, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • 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., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • 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
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

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.


  1. What METHODS increase or reduce risks related to use of Complementary Care Modalities
  2. What MACHINE factors increase or reduce risks related to use of Complementary Care Modalities
  3. What PEOPLE issues increase or reduce risks related to use of Complementary Care Modalities
  4. What MATERIALS increase or reduce risks related to use of Complementary Care Modalities
  5. What MEASUREMENT factors increase or reduce risks related to use of Complementary Care Modalities
  6. What ENVIRONMENTAL factors increase or reduce risks related to use of Complementary Care Modalities


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. We expand this to include Affordability, STEEEPA.

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.


The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.




Published by

Matthew Loxton

Healthcare Analyst using Lean Six Sigma, Knowledge Management, & Organizational Learning to improve healthcare http://linkedin.com/in/mloxton

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