#MEQAPI – Tweetchat May 17-2018 3:00ET Women’s Health – A Quality Crisis

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

 

This is National Women’s Health Week #NWHW, so it is fitting to reflect on how women experience the healthcare system differently to men.

In many papers and articles, authors describe how healthcare policies, equipment, processes, measurements, etc. have been built (historically) by men, and one could say are custom-designed to suit the male experience of medicine. This would be fine if the two sexes experienced illness in the same way, had identical manifestations, and identical outcomes. However, there are significant differences between how men and women, for instance, experience heart failure. Because of historical male influence, the way heart failure is described, detected, treated, etc. have tended to under-diagnose heart failure in women, and have inferior outcomes.

Since the definition of quality is how well the outcomes fit the process customer’s goals the quality of medicine is lower for women than men if the outcomes are inferior.

Likewise, the access women have the health services, including OB/GYN, may be sub-optimal. In many states, there are entire zipcodes with no facilities offering OB/GYN services. Women may often encounter higher prices for the same healthcare products and services – the so-called “pink-tax”.

These factors may translate to lower healthcare quality, as seen from the perspective of women and the process-customer.

The major causes of death in women (figure 1)* are pretty much the same as men (figure 2)*, but there are differences in the rank order and rates, and perhaps more importantly, how the two sexes experience healthcare.

CoD WomenFigure 1. Leading causes of death in women 1999-2016 .

CoD MenFigure 2. Leading causes of death in men 1999-2016.

 

This chat will cover several aspects of healthcare as experienced by the female patient, and we look at several high-value areas of healthcare related to women’s health.

Some reading material from Physician’s Weekly and other sources:

 

 

Womens health

Topics

  1. Access: What assists and what hinders women’s access to care?
  2. Cost: What factors increase or decrease the cost of care to women? (“Pink Tax”?)
  3. Heart disease: What risks, issues, and missed opportunities exist in relation to Heart disease in women?
  4. Cancer: What risks, issues, and missed opportunities exist in relation to cancer in women?
  5. Stroke: What risks, issues, and missed opportunities exist in relation to cancer in women?
  6. Reproductive health: What risks, issues, and missed opportunities exist in relation to Reproductive health in women?

*Tables taken from Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on May 14, 2018

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.

 

 

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Upcoming #MEQAPI Chats

Here is the schedule for forthcoming #MEQAPI chats

  • May 17 – Women’s Health Week review of risks, issues, and missed opportunities
  • May 24 – Drug Costs
  • May 31 – Healthcare Resources
  • TBI & PTSD
  • Healthcare laws

Note: suggestions welcome! – Please DM @meqapi or use the #MEQAPI hashtag to pass on your ideas/

#MEQAPI – Tweetchat May 10-2018 3:00ET Loneliness

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

Loneliness is an unwelcome part of the experience of healthcare. From both sides of the care process, people frequently find themselves engulfed by a sense of loneliness – patients, carers, and clinicians alike have reported a wrenching sense of being alone, isolated, and vulnerable at times.

In this #MEQAPI chat, we will explore the topic of loneliness from the traditional Ishikawa cause & effect perspective, and see if we can cast some light on what causes are common for loneliness, and how it affects patient outcomes, and where it touches of the main quality aspects of healthcare – Safety, Timeliness, Effectiveness, Efficiency, Equitability, Patient-Centeredness, and Accessibility.

The health effects of loneliness and social isolation can be severe. The Campaign to End Loneliness puts it so:

… research shows that lacking social connections is as damaging to our health as smoking 15 cigarettes a day (Holt-Lunstad, 2015). Social networks and friendships not only have an impact on reducing the risk of mortality or developing certain diseases, but they also help individuals to recover when they do fall ill (Marmot, 2010

Loneliness and burnout are close cousins, and the two are often causally interrelated – burnout resulting in isolation and loneliness, and loneliness leading to increased stress, reduced resilience, and increased burnout. This crippling cycle can eat at clinicians, especially those in specialties and environments involving high emotional burden such as oncology, emergency medicine, and critical care, but can be seen across all specialties.

For patients, news of a positive diagnosis for a “dread illness”, an ongoing chronic illness, or suicidal feelings can spiral the person into isolation and loneliness – often at the very time that they most need social support. Some medical equipment and devices play a role in increasing isolation – ventilation equipment makes conversation difficult, stoma bags and devices may cause a patient to feel intensely self-conscious and be withdrawn, and many other visible or invisible barriers to socialization exist that may result in a patient becoming socially isolated.

Likewise, some conditions themselves make social situations and contact more difficult and result in increased loneliness and isolation. Often the stigma associated with a condition can force isolation on a patient.

Some reading material from Physician’s Weekly and other sources:

 

 

Loneliness

Topics

  1. Methods: What policies and procedures increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  2. Machines: What equipment or devices increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  3. Measurement: What measurement or surveillance increases or mitigates clinician or patient loneliness or social isolation – What effect does this have?
  4. Environment: What social, built, or clinical environmental factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  5. People: What people factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  6. Materials: What materials increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?

 

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 May 3-2018 3:00ET MH Crisis Quality & Safety

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

Physician’s Weekly held a tweet chat titled “The Mental Healthcare Crisis in the US” in which several features of ongoing and emerging problems in healthcare planning and delivery for mental health were discussed.

In this chat, we will use five of the #PWChat topics and think of the causes and potential remedies from the QI model of general dimensions of Quality & Safety: Methods, Machines, Measurement, Environment, People, and Materials. This will potentially guide our talk about how the MH crisis manifests in your experience, and explore the issues and opportunities from a QI perspective.

MH Crisis

Topics

  1. Thinking of the six arms of the QI model: What hinders or helps public education on how to address emergency situations among patients with mental disorders?
  2. What is causing mental illness to be treated as less important than physical illness?
  3. What is causing or what will help address patients who aren’t willing to accept that they have a mental disorder?
  4. What is causing health insurance companies to differentiate mental health disorders from others, what would change that?
  5. When a patient who needs specialized care from a psychiatrist and/or psychologist is left waiting for months, what is causing the delay and what could reduce it?

 

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 Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

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 April 19-2018 3:00ET Toxic Bosses

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

I vividly remember a conference session about 30 years ago in which the speaker fulminated over the poor quality of managerial skills in the workforce. The problem, the speaker explained energetically, was that we were thrusting people into managerial roles for which they had little training, almost no understanding, and very few practical skills. As a result, safety, quality, and cost took continual hits, worker satisfaction was deplorable, and customers were inflamed.

The solution, he suggested, was threefold:

  1. View management as a specific occupation, not as a hobby or sideline.
  2. Establish management training at a graduate study level to prepare managers for their roles.
  3. Split management roles from subject matter expert (SME) or individual contributor roles.

MBA training blossomed in the subsequent decades, and many industries split roles so that taking a management position meant a conscious decision to distance oneself from being an SME or individual contributor, and becoming a professional manager.

However, this has not turned into great success in healthcare.

Firstly, the MBA programs have apparently done very little to prepare anyone for a management role, and some researchers have even suggested that the sole measurable outcome of the millions of dollars spent on MBA programs, has been a reduction in ethics. That’s right, MBA graduates tend to have lower business ethics than when they started. If that wasn’t bad enough, in healthcare, a boss (Chief, director, chair, etc) tends to retain patient duties and have parallel lives in which they are still a researcher or physician, as well as trying to manage and lead team(s) of SMEs.

This has not been optimal, and we can see it in the burnout of both bosses and staff, and few bosses have the time to work on basic managerial tasks such as developing staff careers, being proactive on customer satisfaction, or developing and advancing the strategic business operation. Another outcome is that bosses range in ability as bosses and we get many “types” of bad boss (which will be discussed in a Physician’s Weekly blog).

For example, some bosses “kiss up and kick down”, ingratiating themselves to their bosses, and waging a tyranny against their staff, other bad bosses hide away (in meetings, conferences, and their own work) and are just MIA when staff need them, and still others are the sweetest people ever, but let other managers pillage and destroy, and never seem to stand up to support their staff.

In this chat, we will talk about how this manifests in your experience – the signs, symptoms, and situations of “bad bossing”.

Topics

  1. Think of the BEST boss you ever saw- department head, chief, director, or just a team lead. What was special about them, what they did, how they acted?
  2. Think of the WORST boss you ever had – department head, chief, director, or just a team lead. What was special about them, what they did, how they acted?
  3. What did the bad bosses do to your sanity, safety, productivity, and how did this manifest itself?
  4. What did the bad bosses do to patient safety, satisfaction, and outcomes, and how did this manifest itself?
  5. What effect does good or bad management or leadership have on care Safety, Timeliness, Effectiveness, Efficiency, Equitability, Patient-Centeredness, or Affordability?

 

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 Affordability, STEEEPA.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

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.