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:
- 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
- What would you want to measure regarding the FUNCTIONALITY and PERFORMANCE of a Utilization Management tool for managing cases referred to external HCPs?
- What would you want to measure regarding the DEPLOYMENT of a Utilization Management tool for managing cases referred to external HCPs?
- What would you want to measure regarding the WORKFLOW of a Utilization Management tool for managing cases referred to external HCPs?
- What would you want to measure regarding the USER SATISFACTION of a Utilization Management tool for managing cases referred to external HCPs?
- 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.
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.