#MEQAPI – Tweetchat June 21-2018 3:00ET #STEEEPA: A Closer Look at Care

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

 

Care is all about processes and outcomes. Care processes and outcomes can be glorious, uplifting, emancipatory, or they can be shattering, debilitating, and dehumanizing. This is true for the clinicians, researchers, and carers, just as much as for the patients.

We are seeing record numbers of clinicians burned out and driven to suicide by the processes and outcomes of care, and we see patients and their families left crippled, destitute, or dead.

Using a Ishikawa fishbone structure, we will chat about seven dimensions of care.

  • Safety
    Unsafe care is of little benefit to the patient, and soaks up both time and resources, while creating downstream risks and costs. Medical errors, including drug-drug interactions and overdoses may be the third leading cause of death in America, and workplace injuries among healthcare workers is one of the highest, if not the highest, of all industries and occupations.
  • Timeliness
    If care comes too late, it may be of no use to patients, regardless of how otherwise beneficial it may have been. Likewise, care that prevents a condition is often of far more value to the patient than treating florid diseases.
  • Effectiveness
    It may seem like a somewhat pointless thing to say that care should be better than doing nothing. Yet in far too many cases, the difference between drugs or treatments (often with significant risks and side-effects), and placebo (doing nothing), is essentially zero. We want care that is potent and which targets a disease with precision, accuracy, and reliability, and causes the least harm.
  • Efficiency
    Many care processes are very efficient when viewed from cash-collection perspectives, but highly wasteful and inefficient when viewed through the patient’s eyes. We want care that has the minimum waste and delay, and which addresses the patient’s risks, issues, and opportunities with the least cost for the best outcome.
  • Equitability
    Care should be mediated by need, not bias. Research spending and focus, healthcare processes, and care provided should not be variable according to the demographics of the patient. Women’s issues, for example, should be researched according to the same prioritization scales as those of men, people of colour or from vulnerable population groups should receive the same level of care as those whose fortunes make them whiter, wealthier, or more politically powerful. To paraphrase: care should be provided the same to the prince and the pauper.
  • Accessibility
    The most miraculous treatment is of little use if the patient experiences insurmountable barriers to actually getting it in practice. Whether this be because it is unknown to the patient or their physician, too expensive for the patient to buy, or is only offered at places or times that are out of reach of the patient.

STEEEPA Care

Topics

  1. Safe: what risks, issues, and missed opportunities do you see regarding SAFETY of giving or receiving medical care?
  2. Timely: what risks, issues, and missed opportunities do you see regarding TIMELINESS of giving or receiving medical care?
  3. Effective: what risks, issues, and missed opportunities do you see regarding EFFECTIVENESS of giving or receiving medical care?
  4. Efficient: what risks, issues, and missed opportunities do you see regarding EFFECTIVENESS of giving or receiving medical care?
  5. Equitable: what risks, issues, and missed opportunities do you see regarding EQUATIBILITY of giving or receiving medical care?
  6. Patient-Centered: what risks, issues, and missed opportunities do you see regarding PATIENT-CENTEREDNESS of giving or receiving medical care?
  7. Accessible: what risks, issues, and missed opportunities do you see regarding ACCESSIBILITY of giving or receiving medical care?

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 Accessibility, 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 and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

Advertisements

#MEQAPI – Tweetchat June 14-2018 3:00ET #WrapRage: Getting a Grip on Rx

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

Accessibility goes beyond simply being able to see a physician or pay for a prescription. After all, what use is seeing a physician, getting a diagnosis, and filling a prescription, if one can’t get the pill bottle open or liberate the tablet from the seemingly indestructible blister pack?

For many people with chronic diseases, the child-proof bottles, blister packs, and other packaging systems can present very real barriers to access. This may be especially so when flares or acute episodes make dexterity, visual acuity, or coordination problematic. As one person put it “.. do you really want me using a knife during a migraine?”.

IMG_20180612_113710

I can’t use the fold-n-peel (which never peels) kind of blister pack when I have a migraine. My migraine medicine is packaged in a fold-n-peel blister pack. Clumsiness is a common problem with migraines. Using a sharp object to slice it open is a bad idea but it’s what i do!

I am blessed with a 6’2″ adequately-muscled body with above average grip strength, but at times I have experienced #WrapRage and resorted to brute force and tool-enhanced violence to get at a tiny pill lurking in a blister pack. If, I have wondered aloud, I need a dissection knife and locking forceps to break through the blister pack defenses, what on earth will it be like when I am 8o, and have weakened grip, less dexterity, reduced visual acuity, and more likely to gouge a trough in my hand than get at the pill?

20180612_103922
Tools to Defeat Blister Packs

There is a sense that child-safety features are understandable, but surely there are ways to achieve acceptable security without burdening the patient with barrier to access at the time and place of need? In the same vein, it is often rather obvious that the medication and packaging designers have not acquainted themselves overmuch with the environment in which the product is used. Some medication presentation and packaging and dosages are not very well suited to the real-world in which a sick person is trying to get the medication into their body – tablets that are too large, hard to swallow, difficult to grip, or just too tiny, fragile, or nondescript to handle.

A core concept in quality management is that value and quality are measurement according to how well a product meets the requirements of the “process customer” – the patient. If a medication doesn’t get into the bloodstream of the patient in the right dose, at the right time, then one can scarcely see it as a quality product – regardless of how clever the formulation.

Giving the patient a stroke (figuratively) due to #WrapRage is not a strong value proposition.

 

Using a Ishikawa fishbone structure, we will chat about several dimensions of #WrapRage.

WrapRage

Topics

  1. Policies: How do national, state, or organizational  policies, laws, and processes cause or reduce medication usability and #WrapRage?
  2. Environment: What environmental factors influence medication #WrapRage?
  3. People: What people factors cause or reduce medication usability and #WrapRage?
  4. Modality: What aspects of the treatment modality e.g. liquid, tablet, IM, IV, etc. cause or reduce medication usability and #WrapRage
  5. Materials: What medical materials cause or reduce medication usability and #WrapRage?
  6. Ergonomics: What aspects of the usability, handling characteristics, weight, spillage, etc. cause or reduce medication usability and #WrapRage

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 Accessibility, 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 and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

#MEQAPI – Tweetchat June 7-2018 3:00ET Partnering with Patients

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

Many healthcare conferences these days feature at least one session on “patient empowerment”, and pretty much everyone talks about “partnership”. However, in few cases are those two threads combined – partnership with patients. Typically, the “partnership” being discussed is between insurers, researchers, manufacturers, government, or provider networks.

During a Live Streamed panel discussion at the Inaugural Healthcare IT Expo in New Orleans (#HITExpo), I called for us to flip the focus, and look at healthcare systems through the eyes of patients. The “Going Beyond EHR’s” session touched on many of the issues, but it is worth looking specifically at partnership from the patient’s point of view, and unpacking some of the dimensions involved.

Using a Ishikawa fishbone structure, we will chat about several dimensions of partnership with patients.

Patient partnership

Topics

  1. Policies: How do national, state, or organizational  policies, laws, and processes improve or degrade PATIENT PARTNERSHIP?
  2. Equipment: What risks, issues, and missed opportunities relate to medical equipment and PATIENT PARTNERSHIP?
  3. Measurement: What measurements serve as early warnings of issues, or can affect PATIENT PARTNERSHIP?
  4. Environment: What environmental factors influence PATIENT PARTNERSHIP?
  5. People: What people factors improve or degrade PATIENT PARTNERSHIP?
  6. Materials: What medical materials improve or degrade PATIENT PARTNERSHIP?

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 Accessibility, 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 and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.