Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.
One cannot do effective healthcare improvement without valid and reliable quality and performance metrics to guide ones actions. Likewise, without some basis by which to judge quality and safety, prospective patients have no way to compare physicians.
However, although there are plenty of organizations dedicated to quality and safety in healthcare and many published metrics, there is little standardization and very few of the metrics are focused on patient outcomes or cost of care.
As a result, the enormous burden of collection and analysis is not having the desired effect on care quality, safety, and cost, and comparing physicians, techniques, and facilities is typically an arduous and technically challenging task.
Creating “star ratings” for providers and facilities is an attempt to standardize and simplify comparison by aggregating a number of metric into a single performance indicator. Used by the entertainment, accommodation, and other service industries, ratings of five stars indicated superlative vendors or services, while ratings of one or no stars might suggest poor quality or value.
There are many criticisms of these ratings, including that they mush together metrics in a way that reduces validity, that they hide the rating drivers, and that they trivialize medical quality in a harmful way.
Pertinent articles provided courtesy of Physician’s Weekly:
- Linking clinical quality indicators to research evidence – a case study in asthma management for children
- Does adoption of electronic health records improve organizational performances of hospital surgical units? Results from the French e-SI (PREPS-SIPS) study.
- Effects of perceptions of care, medical advice, and hospital quality on patient satisfaction after primary total knee replacement: A cross-sectional study
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.
Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:
- 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.
- Insurance Models, payer systems
- Vendor policies and processes
- Machines (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
- Medication dispensing systems
- Personal Health Record and encounter planning systems
- Ergonomics (right size, shape, location, etc)
- Analytical software
- Staffing: sufficient and qualified staff
- Training: base training, ongoing training, CME, and patient or carer training
- Attitudes: staff attitudes to technology, adoption vs resistance, bullying
- Fatigue (especially alert fatigue)
- Peer support
- Friends and family
- 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, inferior fax paper,
- Data: ability to securely share with correct patient, specialist, lab, etc
- Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
- Internet sources
- Checklists, SoPs
- Uniforms, footwear, personal protective equipment
- 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
- Effectiveness of measurement
- Noise: distracting noises, sound levels too high, etc. due to computer systems
- Space: Cramped, uncomfortable work space etc.
- 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
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.
- What METHODS enhance or impede Quality and Safety measurement
- What MACHINE factors enhance or impede Quality and Safety measurement
- What PEOPLE issues enhance or impede Quality and Safety measurement
- What MATERIALS enhance or impede Quality and Safety measurement
- What MEASUREMENT factors enhance or impede Quality and Safety measurement
- What ENVIRONMENTAL factors enhance or impede Quality and Safety measurement
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.