#MEQAPI – Tweetchat Feb 15-2018 3:00ET Amplifying Women’s Voices

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

It is a fact that women in science and medicine have less voice than men. This manifests in women being interrupted more, being asked for opinion less, being on fewer expert panels, etc. It is seen when a female physician is assumed to be a nurse, the male nurse is assumed to be a physician, and patients, families, and clinicians alike will turn to the male in the discussion to corroborate what the woman says.

These are facts.

In one thin slice of this unfortunate pie, women use social media such as Twitter less than men (47% vs 53%), get retweeted less frequently, have few followers, and are again, often spoken over in conversations.

This is, quite naturally, very irritating and demoralizing to  the women involved, but it shadows a more dangerous threat – it harms quality and safety. Undersampling, ignoring, and failing to engage women’s voices in medicine degrades quality, increases risk, and worsens the health outcomes of patients. Everything runs slower, has more errors, and costs more when we mute the voice of half the healthcare workforce.

This chat will look at several dimensions pertinent to the problem, and ask how to improve the situation.

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 Voice

 

  • Policies
    • Facility or work unit policies, practices, rules
    • Specialty-specific policies
    • Human Resource guidelines, policies, etc.
    • Workflow and standard practices
    • Training
  • Work
    • Projects in which women are selected, lead, initiate, etc
    • Consultation of women for input, expert opinion, etc.
    • Recognition for achievement, effort, support, etc.
    • Plagiarism, theft or unattributed use of ideas, work, etc.
    • Sabotage of women’s work
    • Space, physical, time, and mental space to do creative work
    • Built environment, situation of toilets, parking, change rooms, rest areas, etc.
    • Time
  • Social Media
    • Follows
    • Retweets and Likes
    • Online bullying
    • Interruptions
    • Shunning
  • Conferences
    • Selection of speakers, panel members, judges, etc.
    • Seating
    • Interruptions
    • Questions
    • Disruptions
    • Post-conference follow up
  • People
    • Patients
    • Providers/HCP
    • Role Models
    • Sexualization
    • Diminishment
    • Peer support
    • Attitudes and bullying
  • Other
    • Environment
    • Pay
    • Equipment
    • Measurement
    • Recruitment
    • Other

Topics

  1. What POLICIES increase or reduce the ability of Women to be Heard in Medicine and Science
  2. What WORK factors increase or reduce the ability of Women to be Heard in Medicine and Science
  3. What SOCIAL MEDIA issues increase or reduce the ability of Women to be Heard in Medicine and Science
  4. What CONFERENCE issues increase or reduce the ability of Women to be Heard in Medicine and Science
  5. What PEOPLE factors increase or reduce the ability of Women to be Heard in Medicine and Science
  6. What OTHER factors increase or reduce the ability of Women to be Heard in Medicine and Science

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. 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.

http://www.meqapi.org

The Author and Moderator: Matthew is a Principal Analyst at Whitney, Bradley, and Brown Inc. focused on healthcare improvement, and serves on the board of directors of the Blue Faery Liver Cancer Association. Matthew is the founder of the Monitoring & Evaluation, Quality Assurance, and Process Improvement (MEQAPI) organization, and is a KM and quality improvement author, and regularly blogs for Physician’s Weekly. Matthew’s pro bono roles have included support for the Queensland Emergency Medicine Research Foundation and the St. Andrew’s Medical Research Institute. Matthew is active on social media related to healthcare improvement and hosts the weekly #MEQAPI chat. Matthew also trains others in the use of MAXQDA. You can find his contact info in his MAXQDA professional trainer profile

 

 

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#MEQAPI – Tweetchat Feb 8-2018 3:00ET Choosing Metrics #1

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

This is another installment in the discussion of “perfection in healthcare”, in which we will continue down a practice-based QI journey. Previously, we identified a few important parts of healthcare and asked what they would look like if they were perfect. This technique is discussed in a recent Physician’s Weekly blog titled “Three Effective Ways to Pick Quality Improvement Targets“.

In this process, we  first chatted about perfection, and now we will look for outliers (positive and negative), and then later we will go through a root cause analysis on a few selected items to see if we can solve them to a degree.

Previously, we  discussed the following elements in terms of what perfection would look like:

  • Patients
  • Physicians
  • Nurses
  • Specialists
  • Environment
  • Training
  • Diagnostics
  • Scheduling
  • Medication
  • Emergency Care

This time, we are going to look for metrics that reflect the positive outliers – the best we have ever done – because we know that technically these results are possible. If we can shift our processes to performing on average what we previously did atour best, then we will have made a great stride in quality.

However, before we can pick “best ever achievement” for metrics (as described in @physicianswkly blog), we need to think about which ones to pick … and how metrics are created. If we start with a specific case, we can illustrate how this works.

So let’s imagine you are assessing a key part of the careflow – referrals to outside services like specialists, overflow physicians, outsourced services, etc. How would you track what happens to the patient, and if the care meets your standards? If we start by looking at problems – the risks, issues, or opportunities that are conceivably going to occur, we have a starting place to think about metric. The problems for this scenario include:

  • patient coordination is harder
  • services may not be what you asked for (more, less, different)
  • services may be below the standards you set for yourself

Maybe you want to use some kind of Utilization Management (UM) tool that tracks where the patients went, and whether the care met your UM criteria – such as, was the pt at the right level of care, was the Tx appropriate. Was the care STEEEPA?

How would you measure that this is all happening, and how would you measure that the tool is doing what you want? (two problems) . Maybe we would measure something like these:

  • Time taken to adjudicate cases for referral to external HCPs
  • Utilization of the UM tool (are staff actually using the tool)
  • Post-care review notes and evaluation (is the care satisfactory)
  • User satisfaction with the tool – do they like using it
  • User satisfaction with the tool implementation – did we give them enough warning, did it install easily, etc.
  • User satisfaction with the tool training and documentation – are they easy to use, do they apply to the real world, etc.
  • User satisfaction with the process and workflow

Topics

  1. What would you want to measure regarding the FUNCTIONALITY and PERFORMANCE of a Utilization Management tool for managing cases referred to external HCPs?
  2. What would you want to measure regarding the DEPLOYMENT of a Utilization Management tool for managing cases referred to external HCPs?
  3. What would you want to measure regarding the WORKFLOW of a Utilization Management tool for managing cases referred to external HCPs?
  4. What would you want to measure regarding the USER SATISFACTION of a Utilization Management tool for managing cases referred to external HCPs?
  5. What else would you want to measure regarding a Utilization Management tool for managing cases referred to external HCPs?

In the  #MEQAPI chat following this one, we will start using examples of regular chat members, and help identify what they would measure for their specific situations.

 

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. 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.

http://www.meqapi.org

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.