Upcoming #MEQAPI Chats

Here is the schedule for forthcoming #MEQAPI chats

  • Aug 3 “Improving Joy in Work” – based on IHI Whitepaper and related to physician burnout
  • Aug 10 “3D Printing in Healthcare” with the indomitable @wareflo
  • Aug 17 “Healthcare Star Ratings”
  • Aug 24 “Workplace Safety”
  • Aug 31 “Veterans Health, Triumphs and Opportunities” with @nxtstop1 and @VATBIdoc

Unscheduled but planned:

#MEQAPI – Tweetchat July 27-2017 3:00ET The Opioid Epidemic

Topic:  “The Opioid Epidemic”, QI perspective

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

News articles sketch a chilling picture: Opioid-related death is quickly becoming the “modern plague” and surpassing cancer, heart disease, and motor vehicle accidents in those under 50 years. As a result, drug related deaths are now the number one cause of death in people under 50 in America.

We are expecting 59,000 deaths from opioid overdose this year, a 10% climb over 2016. Rural areas and low SES populations groups are the hardest hit, but the epidemic is spreading to all demographics. Opioid dependence is now seen as a leading risk factor in all surgeries (risk factor of 6%).

Physician’s Weekly have kindly shared the following pertinent articles (some with CME credits):

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.

Opioid Epidemic

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including HIPAA, Physician assisted death policies, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
      • Incompatible drug and pain policies
      • Ability to navigate drug laws, policies, and processes
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Drug access
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
      • Management styles
      • Malpractice litigation
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
      • Discharge info packets
      • Explanation of Benefits sheets
      • Opioid alternatives
    • Measurement
      • Health outcomes, morbidity and mortality, birth defects
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
      • Patient goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc. Gender segregated space
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Architecture: location of work areas, gathering places, shared areas
      • Ability to navigate the healthcare facility

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences, and offer their insights and observations.

Topics

  1. What METHODS influence the Opioid Epidemic
  2. What MACHINE factors influence the Opioid Epidemic
  3. What PEOPLE issues and expectations influence the Opioid Epidemic
  4. What MATERIALS influence the Opioid Epidemic
  5. What MEASUREMENT factors influence the Opioid Epidemic
  6. What ENVIRONMENTAL factors influence the Opioid Epidemic

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 add “Affordable” to this – 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

 

 

 

#MEQAPI – Tweetchat July 20-2017 3:00ET The Quadruple Aim

Topic:  “The Quadruple Aim”, QI perspective

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

This week we are discussing “Quadruple Aim: Care of the Physician“- the IHI Triple Aim, plus caring for the physician. Our guests are Dr. Bernadette Keefe, M.D. (@nxtstop1) and Dr. Matthew Katz, M.D. (@subatomicdoc).

They will be speaking about physician needs for effective practice, how that’s bound up with patient’s needs, and how the bond between making optimal doctoring, practice of medicine for both.

 

The classic ‘triple aim’ for healthcare is a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. IHI asserts 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

Numerous publications suggest that the list be expanded to a ‘Quadruple Aim’ to include: Improving the Care of and Experience of The Provider (ie MDs/other HCPs).

The concept of a quadruple aim is supported by several industry quality leaders, including the Agency for Healthcare Research and Quality (AHRQ), the British Medical Journal (BMJ), and the Institute for Healthcare Improvement (IHI)

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.

Quadruple Aim

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including HIPAA, Physician assisted death policies, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
      • Incompatible policies
      • Ability to navigate laws, policies, and processes
      • MOC, Accreditation, Licensing, etc.
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Interoperability
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
      • Management styles
      • Malpractice litigation
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
      • Discharge info packets
      • Explanation of Benefits sheets
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
      • Patient goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc. Gender segregated space
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Architecture: location of work areas, gathering places, shared areas
      • Ability to navigate the healthcare facility

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences, and offer their insights and observations.

Topics

  1. What METHODS influence the Quadruple Aim
  2. What MACHINE factors influence the Quadruple Aim
  3. What PEOPLE issues and expectations influence the Quadruple Aim
  4. What MATERIALS influence the Quadruple Aim
  5. What MEASUREMENT factors influence the Quadruple Aim
  6. What ENVIRONMENTAL factors influence the Quadruple Aim

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.

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

 

 

 

#MEQAPI – Tweetchat July 13-2017 3:00ET End of Life Planning

Topic:  “End of Life Planning”, QI perspective

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

End of life planning is a topic that few people find comfortable. Perhaps excepting patients themselves, it is a topic that all stakeholders find uncomfortable, including governments, politicians, and even physicians. As a result, patients and carers facing an inevitable pathway of a terminal illness find obstacles to effective end of life planning.

This week we are discussing end of life planning with Andrea J. Wilson of Blue Faery. the Adrienne Wilson Liver Cancer Association. Andrea tweets using as @BlueFaeryLiver.

Andrea is the president and founder of Blue Faery: The Adrienne Wilson Liver Cancer Association. She became passionate about End-Of-Life (EOL) choices and planning after losing her younger sister to liver cancer. Andrea went against doctors’ recommendations to put her sister on a respirator and keep her in the hospital. Instead, Andrea took her sister Adrienne home where she died peacefully in her own bed surrounded by people who loved her.

Later, Andrea worked as the Greater Los Angeles Development Manager for Compassion & Choices, the nation’s oldest, largest and most active nonprofit organization committed to improving care and expanding EOL options. In that role, she created, produced, and presented Advance Directive workshops to various audiences including NASA’s JPL and Pasadena Village.

Physician’s Weekly have kindly shared the following pertinent articles:

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.

EOL Planning

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including HIPAA, Physician assisted death policies, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
      • Incompatible policies
      • Ability to navigate laws, policies, and processes
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Interoperability
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
      • Management styles
      • Malpractice litigation
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
      • Discharge info packets
      • Explanation of Benefits sheets
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
      • Patient goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc. Gender segregated space
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Architecture: location of work areas, gathering places, shared areas
      • Ability to navigate the healthcare facility

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences, and offer their insights and observations.

Topics

  1. What METHODS influence End of Life Planning
  2. What MACHINE factors influence End of Life Planning
  3. What PEOPLE issues and expectations influence End of Life Planning
  4. What MATERIALS influence End of Life Planning
  5. What MEASUREMENT factors influence End of Life Planning
  6. What ENVIRONMENTAL factors influence End of Life Planning

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.

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

 

 

 

#MEQAPI – Tweetchat July 6-2017 3:00ET: Fireworks & ETOH

Topic:  “Fireworks & ETOH”, QI perspective

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

Besides the “normal” issues resulting from consumption of ETOH, and from playing with fire, many national holidays, religious days, and social events put the two together. As a result, primary care (PC) providers and Emergency Departments (ED) see a sudden spike in injuries. The injuries range from a blister on a little finger to profound burns and trauma.

With the July 4th celebrations fresh in memory, we discuss from a healthcare point of view and a quality improvement perspective what happens when ETOH and fireworks are brought together.

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.

Fireworks

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: local, regional, or national policies regarding sale and use of fireworks, Hospital or clinic protocols on treating ETOH or firework injuries. Insurance coverage for them
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Fireworks design and manufacture, storage and transportation  systems, tools and usage systems
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Instructions for use of fireworks
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
      • Patient goals
    • Environment
      • Noise: distracting noises, sound levels too high,
      • Space: Cramped, uncomfortable work space etc.  Highly populated areas
      • Time: Too little time per patient or order, too little time in a day, too many demands. Pressure on using fireworks within a short period
      • Location: availability of spaces to use fireworks. Combustable matierials in the environment
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Architecture: location of work areas, gathering places, shared areas

Participants are invited to describe their experiences, and offer their insights and observations.

Topics

  1. What METHODS influence Fireworks and ETOH use
  2. What MACHINE factors influence Fireworks and ETOH use
  3. What PEOPLE issues and expectations influence Fireworks and ETOH use
  4. What MATERIALS influence Fireworks and ETOH use
  5. What MEASUREMENT factors influence Fireworks and ETOH use
  6. What ENVIRONMENTAL factors influence  Fireworks and ETOH use

MEQAPI 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.

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

 

 

 

#MEQAPI – Tweetchat June 29-2017 3:00ET: Patient Advocacy

Topic:  “Patient Advocacy”, QI perspective

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

In a perfect healthcare world, patient advocacy would perhaps be unnecessary – the processes would place patients at the center, patient goals would automatically be prioritized, and no patient would be subject to care that was not Safe, Timely, Efficient, Effective, Equitable, Patient Centered, and Affordable. No patient would wait unnecessarily, and every illness would attract the right level of funding.

However, that is not the world in which patients actually find themselves.

The world in which they navigate has information gaps and gradients, power dynamics, misleading information, and a hugely complex process that typically prioritizes many other stakeholder’s interests above those of the patient. What the patient encounters is  nightmare. Some illnesses take the lion’s share of funding, research, and care, while others languish for want of attention. Very often attention is rationed according to the estimated profitability of treatment, degree to which the condition is emotionally appealing, or just random luck.

Strong patient advocacy can help rectify, mitigate, or avoid the many obstacles, detours, and traps  that can prevent a patient from getting necessary care and support.

This week we are discussing patient advocacy with Andrea J. Wilson of Blue Faery. the Adrienne Wilson Liver Cancer Association. Andrea tweets using as @BlueFaeryLiver.

The Adrienne Wilson Liver Cancer Association is writing a Blue Faery Patient Advocacy eBook for cancer patients by cancer patients. The goal of the eBook is to answer commonly asked questions by cancer patients. A writer and editor, President Andrea Wilson is writing the book using personal stories to illustrate specific points. By conducting polls, collecting feedback, and interviewing cancer patients, Andrea is gathering content for the eBook that will be free on Blue Faery’s new website.

Physician’s Weekly have kindly shared the following pertinent articles:

The topic of patient advocacy includes patient/physician partnership, and some medical journals have encouraged research that is done in partnership with patients. The British Medical Journal, for example, maintains a “Partnering with Patients” page.:

The BMJ launched an innovative strategy to promote patient partnership in 2014. It took this step because it sees partnering with patients, their families, carers and support communities, and the public as an ethical imperative, which is essential to improving the quality, safety, value, and sustainability of health systems.

The strategy has seen the journal move to co-produce its content with patients and advancing international debate on how to embed meaningful partnership with patients in clinical practice, service delivery, research, education, and policy. The strategy was drawn up with and continues to be informed by a dedicated international patient advisory panel.f\

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.

Patient Advocacy

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
      • Incompatible policies
      • Ability to navigate laws, policies, and processes
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Access Control
      • Interoperability
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
      • Management styles
      • Malpractice litigation
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
      • Discharge info packets
      • Explanation of Benefits sheets
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
      • Patient goals
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc. Gender segregated space
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Architecture: location of work areas, gathering places, shared areas
      • Ability to navigate the healthcare facility

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences, and offer their insights and observations.

Topics

  1. What METHODS influence Patient Advocacy
  2. What MACHINE factors influence Patient Advocacy
  3. What PEOPLE issues and expectations influence Patient Advocacy
  4. What MATERIALS influence Patient Advocacy
  5. What MEASUREMENT factors influence Patient Advocacy
  6. What ENVIRONMENTAL factors influence Patient Advocacy

Numbers for last week

meqapi numbers june 22 2017

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.

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

 

 

 

#MEQAPI – Tweetchat June 22nd 2017 3:00ET: Physician Suicide

Topic:  “Physician Suicide”, QI perspective

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

Although the general public may not be aware of it, Dr. Danielle Ofri reminds us in a Slate article, “Doctors have the highest suicide rates of any professional group.” Although physicians tend to be healthier than the general public, they suicide at a far higher rate.

This week we are discussing physician suicide with Dr. Meredith Mealer of the Rocky Mountain chapter of the  VA Mental Illness Research, Education and Clinical Centers (MIRECC).

Meredith Mealer PhD is a registered nurse and an Assistant Professor of Physical Medicine and Rehabilitation (PM&R) at the University of Colorado, Anschutz School of Medicine and the Director of the Colorado Multiple Institutional Review Board (COMIRB). Her primary area of research interest is resilience training in healthcare professionals as a mechanism to mitigate psychological distress that results from the work environment.

Dr. Mealer will be attending the #MEQAPI chat, and taking questions related to clinician suicide and approaches to suicide reduction, such as resilience training. Some additional materials by Dr. Mealer include:

Physician’s Weekly have kindly shared the following highly pertinent articles:

 

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.

Physician Suicide

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

    • Methods
      • Policies: office, organization, or national policies, including MU, HIPAA, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Workload: demands of the job, and whether they exceed the resources and ability to meet the demand.
      • Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
      • Traditions and memes
      • Incompatible policies
    • Machines (e.g. equipment, EHR)
      • Medical or office equipment
      • Home equipment specific to the patient condition
      • Integration/interoperation with other office or medical systems, or user personal health records
      • Access Control
      • Interoperability
    • People
      • Staffing: sufficient and qualified staff
      • Training: base training, ongoing training, CME, and patient or carer training
      • Attitudes: staff attitudes
      • Fatigue and stress
      • Values and traditions
      • Friends and family
      • Role Models
      • Management styles
      • Malpractice litigation and threats of litigation
    • Materials
      • Patients: as the “raw material” of the medical process. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
      • Supplies: medical or office,  or self-provided materials, uniforms, personal safety equipment.
      • Data: ability to securely share with correct patient, specialist, lab, etc
      • Internet sources
      • Employment Handbook
      • Means of suicide
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Incentives and rewards
      • Adverse Effects reporting
      • Disruptive Incidents reporting
      • Productivity metrics
    • Environment
      • Noise: distracting noises, sound levels too high, etc. due to computer systems
      • Space: Cramped, uncomfortable work space etc. Gender segregated space
      • Time: Too little time per patient or order, too little time in a day, too many demands
      • Location: things where they should be on the screen, click distance, and location of workstation relative to point of care and patient
      • Control: the degree to which the individual can control their workload and how to accomplish it
      • Fairness: the perception that the burdens and rewards, the effort and outcomes are spread amongst stakeholders in an equitable way
      • Architecture: location of work areas, gathering places, shared areas

Some of the authors of the works cited above may be responding to the following topics, and participants are invited to describe their experiences of medication errors, and offer their insights and observations.

Topics

  1. What METHODS influence physician suicide
  2. What MACHINE factors influence physician suicide
  3. What PEOPLE issues and expectations influence physician suicide
  4. What MATERIALS influence physician suicide
  5. What MEASUREMENT factors influence physician suicide
  6. What ENVIRONMENTAL factors influence physician suicide

Numbers for this chat

meqapi numbers june 22 2017

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.

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