#MEQAPI – Tweetchat Nov-15 2018 8:00 PM ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc will be participating in a twitter-based Rapid Improvement Event (RIE)

Participants have carried out the following steps:

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants were encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants captured what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants ranked items in descending order of the rating

During the chat (Nov 1st) we will conduct QI cafe’

The chat will have six topics, following the Lean Six Sigma DMAIC process.

  • Define: Identify and refine the problem, the stakeholders, the critical to quality elements, the voice of the customer
    • Supplier
    • Inputs
    • Process
    • Outputs
    • Customers
  • Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results of any solution
    • Output metrics – what will measure the outcomes we want
    • Process metrics – what do we need to measure while things are being done and which will predict success of the outcomes metrics
    • Balancing metrics – how will be check that we aren’t making anything else worse. What do we need to measure to ensure that no untoward side effects are being caused
  • Analyze: Root cause analysis and analysis of alternatives
    • Policies & Procedures
    • Equipment & Technology
    • Measurement
    • Environment
    • People
    • Materials
  • Improve: Implement solutions
    • Plan
    • Do
    • Study
    • Act
  • Control: ongoing monitoring and evaluation to make the solutions stick and to ensure that the desired outcomes are realized.
    • M&E
    • Organizational Change Management (OCM)
    • Induction and Training
    • Ongoing process improvement

DMAIC+

Topics

  1. Define: What is the problem you want to solve, the stakeholders, the critical to quality elements, the voice of the customer, what is the future state?
  2. Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results?
  3. Analyze: What are the root causes and what alternatives do you have for Policies, Equipment, Measurement, Environment, People, Materials?
  4. Improve: What do you need to plan for, what will you do, how will you see what happened, what will you do to adopt?
  5. Control: How will you make it stick – what will you do iro M&E, OCM, Training, Ongoing process improvement?
  6. Next Steps:  What do you need to do next to get clear on what has to happen, get agreement, get started?

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 Nov-1 2018 8:00 PM ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc will be participating in a twitter-based Rapid Improvement Event (RIE)

Participants have carried out the following steps:

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants were encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants captured what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants ranked items in descending order of the rating

During the chat (Nov 1st) we will conduct QI cafe’

The chat will have six topics, following the Lean Six Sigma DMAIC process.

  • Define: Identify and refine the problem, the stakeholders, the critical to quality elements, the voice of the customer
    • Supplier
    • Inputs
    • Process
    • Outputs
    • Customers
  • Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results of any solution
    • Output metrics – what will measure the outcomes we want
    • Process metrics – what do we need to measure while things are being done and which will predict success of the outcomes metrics
    • Balancing metrics – how will be check that we aren’t making anything else worse. What do we need to measure to ensure that no untoward side effects are being caused
  • Analyze: Root cause analysis and analysis of alternatives
    • Policies & Procedures
    • Equipment & Technology
    • Measurement
    • Environment
    • People
    • Materials
  • Improve: Implement solutions
    • Plan
    • Do
    • Study
    • Act
  • Control: ongoing monitoring and evaluation to make the solutions stick and to ensure that the desired outcomes are realized.
    • M&E
    • Organizational Change Management (OCM)
    • Induction and Training
    • Ongoing process improvement

DMAIC+

Topics

  1. Define: What is the problem you want to solve, the stakeholders, the critical to quality elements, the voice of the customer, what is the future state?
  2. Measure: How will success be measured, how will the current as-is state be measured, how will we measure the to-be results?
  3. Analyze: What are the root causes and what alternatives do you have for Policies, Equipment, Measurement, Environment, People, Materials?
  4. Improve: What do you need to plan for, what will you do, how will you see what happened, what will you do to adopt?
  5. Control: How will you make it stick – what will you do iro M&E, OCM, Training, Ongoing process improvement?
  6. Next Steps:  What do you need to do next to get clear on what has to happen, get agreement, get started?

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 Oct-18 2018 3:00ET QI Workshop

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

This chat is a working session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc are going to try their own QI discovery using the following steps. This chat will be to mull through questions and issues in getting started.

Before the chat, participants will have carried out the following steps

  • For three days, kept a diary of everything in the work or care environment that
    1. Were Surprising
    2. Were Frustrating
    3. Were Confusing
  • To maximize recall, participants are encouraged to make the diary note as soon as possible after it happened. Experience has shown, they tend to evaporate from memory pretty fast, so the idea is to grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Participants will capture what the issue was, what effect it had on what they were trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max what impact (or potential impact) it had
  • At the end of the three days, participants will rank items in descending order of the rating

During the chat (Oct 18th) we will conduct a speed-dating form of QI cafe’

For each of the main bones of the fishbone, get ready to attack your issue and Tweet two things. What do you think is a cause, and what do you think might be a fix. Usually we would do these apart, but it’s an hour, its Twitter, so we are doing them together. PLUS, you are going to comment or question what the other players in the game put out as their causes and solutions.

It’s going to be hectic.

You will do this with your primary issue, but maybe as time goes on and the chat is coming near, you think the secondary or tertiary issue are actually better, you can switch.

Issue

Topics

  1. Policy: What laws, policies, rules, regulations, etc. cause your issue, what are potential solutions to your issue?
  2. Equipment: What equipment and device factors cause your issue, what are potential solutions to your issue?
  3. Measurement: What quality, safety, and performance metrics cause your issue, what are potential solutions to your issue?
  4. Environment: What environmental factors cause your issue, what are potential solutions to your issue?
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc cause your issue, what are potential solutions to your issue?
  6. Materials: What “medical stuff” that patients need cause your issue, what are potential solutions to your issue?

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 Oct-11 2018 3:00ET QI Prep Workshop

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

This chat is a prep session for a small-scale DIY Lean Six Sigma targeting process. A number of people in healthcare – patient’s, caregivers, nurses, physicians, etc are going to try their own QI discovery using the following steps. This chat will be to mull through questions and issues in getting started.

We will discuss the following steps

  • For three days, keep a diary of everything in your work or care environment that
    1. Surprised you
    2. Frustrated you
    3. Confused you
  • Try to keep as near to real-time capture as possible. Experience has shown, they tend to evaporate from memory pretty fast, so grab them while they are hot. Immediately is good, end of day is ok, more than that is going to be less than half as effective
  • Capture what it was, what effect it has on what you are trying to do, and on a scale of 1-5, rate each. 1=Min 5=Max
  • At the end of the three days, rank them in descending order of the rating you gave. Tweak any that in retrospect you feel MORE strongly about
  • Pick one of the top five to be your primary target
  • Pick another top five as a secondary
  • Pick another as a tertiary

You are now ready for the main chat.

During the chat (Oct 18th?) we will conduct a speed-dating form of QI cafe’

For each of the main bones of the fishbone, get ready to attack your issue and Tweet two things. What do you think is a cause, and what do you think might be a fix. Usually we would do these apart, but it’s an hour, its Twitter, so we are doing them together. PLUS, you are going to comment or question what the other players in the game put out as their causes and solutions. It’s going to be hectic.

You will do this with your primary issue, but maybe as time goes on and the chat is coming near, you think the secondary or tertiary issue are actually better, you can switch.

Issue

Topics

  1. Policy: What laws, policies, rules, regulations, etc. cause your issue, are a potential solution to your issue?
  2. Equipment: What equipment and device factors cause your issue, are a potential solution to your issue?
  3. Measurement: What quality, safety, and performance metrics cause your issue, are a potential solution to your issue?
  4. Environment: What environmental factors cause your issue, are a potential solution to your issue?
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc cause your issue, are a potential solution to your issue?
  6. Materials: What “medical stuff” that patients need cause your issue, are a potential solution to your issue?

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 Oct-4 2018 3:00ET Manterrupting

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

The phenomenon of one person interrupting the speech of another is fairly commonplace, but in high-risk situations is a cause for greater concern. There are striking asymmetries in who interrupts whom, and how often. Men interrupt others more than women do, and men interrupt women far more than that.

While much has been said of the causes, it is perhaps useful to consider the quality cost of interruption, and the cost of the asymmetry of interruption.

These can be seen in five areas:

  1. Patient and Staff Safety
  2. Quality & Efficiency
  3. Innovation & Problem-Solving
  4. Organizational Velocity
  5. Staff Burnout

Interruptions cause reduced message integrity and informational survival, resulting in higher error rates and increased unmet needs. In simpler terms, when someone’s message is interrupted, there is a high probability that the meaning of what they were conveying will be degraded or lost, and there is an increased likelihood of the message not being acted on or understood. In a healthcare setting this can have fatal outcomes.

Interrupted speech results in higher rates of error, and lower quality execution of work, with more things being missed and greater execution gaps.

Interruptions depress creativity, increase guarded thinking, and increase the amount of knowledge hoarding and knowledge hiding. This results in reduced innovation, and less effective problem solving

As a result of the combination of all those above, the organization spends more time and effort per achieved work outcome, and has less velocity in achieving strategic goals.

Perhaps the largest impact is in the effect that ubiquitous and frequent interruption has on people. It reduces a sense of organizational attachment, increases stress, and drives up the probability of burnout. People who are frequently interrupted are less committed to organizational goals, less likely to share ideas, and less likely to participate.

High interruption rates are a risk factor for low achievement, high cost, and high turnover.

We will discuss the various dimensions of interrupting using a structured approach.

Manterrupting

Topics

  1. Policy: What laws, policies, rules, regulations, etc. increase or decrease the frequency and degree to which men interrupt women at work?
  2. Equipment: How do equipment and devices increase or decrease the frequency and degree to which men interrupt women at work? Everything from speaker phones to messaging systems.
  3. Measurement: How do quality, safety, and performance metrics increase or decrease the frequency and degree to which men interrupt women at work?
  4. Environment: What environmental factors increase or decrease the frequency and degree to which men interrupt women at work?Everything from the room where care is provided, facility location, privacy, etc.
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc increase or decrease the frequency and degree to which men interrupt women at work?
  6. Materials: What effect does the “medical stuff” patients need increase or decrease the frequency and degree to which men interrupt women at work? – the medications, instruction sheets, information, medications, test results, etc

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 Sep-27 2018 3:00ET Compliance Shaming

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

There is an unfortunate holdover from the old days of medical paternalism that continues to bear a rancid fruit of mistrust and anger among patients and physicians – the label of “non-compliance”.

Here is how Stephen Brunton, editor in chief at the journal of clinical; diabetes puts it:

Medicine has a history of paternalistic and top-down approaches to patient care; patients had to follow our instructions, and if they did not, we labeled them “noncompliant.” (How dare they ignore our erudite advice?) More recently, as we have become more enlightened in our recognition that input from our patients needs to at least be considered, we began using a term many of us thought of as more politically correct: “adherence.” However, this term also suggests a power differential, and although we may believe it to be less offensive, it, too, misses the mark. We have simply slapped a new label (“nonadherent”) over the old “noncompliant” label, but we are still blaming and shaming our patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391811/

The term “non-compliant patient” conjures up images of an intransigent know-it-all patient who “thinks they know better than the doctor”, and who digs in their heel for no other reason than to be bull-headed and contrary. However,  more typical reasons that patients do not follow doctors’ orders are social determinants of health such as lack of money, lack of accessibility, and impracticality in the context of the lived environment. Physicians often do not know how much prescribed medications cost, nor what practical difficulties the patient may experience in their lived environment.

When a patient must choose between the brand-name medication and buying food, or when getting the prescription filled will require two buses and a stiff walk, they may simply not be able to stay in compliance with doctor’s orders. Likewise, an instruction to use an ice pack and have bed rest may be good advice, but impractical when missing a day’s work means risking the rent or losing a job, and the nearest ice machine is a bus trip away.

Part of escaping the blame and frustration cycle is to make sure that care plans are developed with patient participation, and will therefore be more closely aligned to the patient’s goals, priorities, and capabilities. Quality, let’s not forget, is a function of how well the outcomes meet patient’s goals.

We will discuss the various dimensions of compliance shaming

Compliance Shaming

Topics

  1. Policy: What laws, policies, rules, regulations, etc. enhance or degrade patient ability or willingness to adhere to  a care plan?
  2. Equipment: How do equipment and devices enhance or degrade patient ability or willingness to adhere to  a care plan? Everything from transport to gowns with no back.
  3. Measurement: How do quality, safety, and performance metrics enhance or degrade patient ability or willingness to adhere to  a care plan?
  4. Environment: What environmental factors enhance or degrade patient ability or willingness to adhere to  a care plan? Everything from the room where care is provided, facility location, privacy, etc.
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc enhance or degrade patient ability or willingness to adhere to  a care plan?
  6. Materials: What effect does the “medical stuff” patients need enhance or degrade patient ability or willingness to adhere to  a care plan? – the medications, instruction sheets, information, medications, test results, etc

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 Sep-13 2018 3:00ET Shared Decision Making

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

One of the rallying cries around patient empowerment and increased patient self-management, is the concept of shared decision-making. Shared decision-making is also a central component of pateint-centered care – after all, how can a situation be “patient-centered” if the patient has no say in the goals, priorities, and approaches taken in the care plan?

HealthIT.gov argues that there are seven beneficial outcomes to shared decision-making, and that patients are more likely to:

  1. learn about their health and understand their
    health conditions
  2. recognize that a decision needs to be made
    and are informed about the options
  3. understand the pros and cons of
    different options
  4. have the information and tools needed
    to evaluate their options
  5. are better prepared to talk with their health
    care provider
  6. collaborate with their health care team
    to make a decision right for them
  7. are more likely to follow through on
    their decision

We will discuss the various dimensions of shared decision-making

Shared Decision Making

Topics

  1. Policy: What laws, policies, rules, regulations, etc. enhance or degrade patient participation in shared decision-making?
  2. Equipment: How do equipment and devices enhance or degrade patient participation in shared decision-making? Everything from transport to gowns with no back.
  3. Measurement: How do quality, safety, and performance metrics enhance or degrade patient participation in shared decision-making?
  4. Environment: What environmental factors enhance or degrade patient participation in shared decision-making? Everything from the room where care is provided, facility location, privacy, etc.
  5. People: How do the people in healthcare – the staff, cleaners, technicians, clinicians, researchers, public, media, friends, family, etc enhance or degrade patient participation in shared decision-making?
  6. Materials: What effect does the “medical stuff” patients need enhance or degrade patient participation in shared decision-making? – the medications, instruction sheets, information, medications, test results, etc

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.