#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.



  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?


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.


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.




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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