Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement, and you can visit us at http://www.meqapi.org.
While the public, and even most healthcare professionals, are easily agog over the latest wonder drug, the new surgical robot, or the big-data analytical Watson thingamajig, we all know that actually, the biggest needle-movers in healthcare are typically far less flashy.
Soap, clean water, sewage disposal, vaccines, food purity, road markings, etc. have each saved more lives, and made a bigger contribution to quality of life than all the wonder drugs or the all the flashy gadgets put together (maybe except for penicillin).
Likewise, we can all hammer on about the fancy stuff in the hospital, but deep down we know that the social determinants of health (#SDoH) are by far the biggest obstacles and opportunities. Low socio-economic status (SES), income inequality, female education, and beliefs are worth more than all the telemetry beds and surgical robots put together. Tobacco, ETOH, opioids, are deeply entangled with the social environment, and so too are root causes and contributory factors for cancer, stroke, and heart disease. #SDoH predict and drive obesity, T2D, and most things that put us in the hospital bed or the morgue.
Unless healthcare addresses #SDoH and faces the issues, we can never get beyond faint victories and lukewarm improvements.
The following pertinent articles have been provided by Physician’s Weekly: (Please note the CME)
- Social Determinants of HIV Disparities in the Southern United States and in Counties with Historically Black Colleges and Universities (HBCUs), 2013-2014
- CME – CVD: Social Determinants of Risks & Outcomes
- Social disadvantage and the black-white disparity in spontaneous preterm delivery among California births
- Mediating Effects of Social Support and Internalized Homonegativity on the Association Between Population Density and Mental Health Among Gay and Bisexual Men
- Depression, Hopelessness and Social Support among Breast Cancer Patients: in Highly Endogamous Population
- Social support, stress coping strategies, resilience and posttraumatic growth in a Polish sample of HIV-infected individuals: results of a 1 year longitudinal 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.
- Quality Improvement Policies
- Subsidies and funding
- Facility Policies
- Specialty Policies
- Employment policies
- National and State Laws
- Navigable processes and policies
- Machines (incl equipment, EHR)
- Personal Safety Equipment
- Real Time Locator Systems (RTLS)
- Med Equipment
- Equip Ergonomics
- Home Equipment
- Access Control
- Office Equipment
- Staffing: sufficient and qualified staff
- Patients – objectives, attitudes, ability to cope, beliefs, power-distance
- Subject Experts
- Malpractice suits
- Role Models
- Peer support/conflict
- Crime and safety
- 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., and Access to Information
- Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
- Internet sources and access
- Checklists, SoPs
- Uniforms, footwear, personal protective equipment
- Costed consumables
- 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
- Gini Index
- Incentives and rewards
- Adverse Eventss reporting
- Effectiveness of measurement
- Productivity Metrics
- Patient Goals
- 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
- Temperature: too cold, too hot, too variable
- Political climate
- Social norms and group identity
- Electrical Power
- Climate and weather
- Income inequality
- Potable water
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 increase or reduce risks related to Social Determinants of Health #SDoH
- What MACHINE factors increase or reduce risks related to Social Determinants of Health #SDoH
- What PEOPLE issues increase or reduce risks related to Social Determinants of Health #SDoH
- What MATERIALS increase or reduce risks related to Social Determinants of Health #SDoH
- What MEASUREMENT factors increase or reduce risks related to Social Determinants of Health #SDoH
- What ENVIRONMENTAL factors increase or reduce risks related to Social Determinants of Health #SDoH
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.