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.
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:
- Care Transitions Common at End of Life for Medicare Recipients
- Health Policy Impacts End-of-Life Care – Video Highlight
- PCP Involvement Tied to End-of-Life Care Patterns
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 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
- 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
- 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
- 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
- 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.
- What METHODS influence End of Life Planning
- What MACHINE factors influence End of Life Planning
- What PEOPLE issues and expectations influence End of Life Planning
- What MATERIALS influence End of Life Planning
- What MEASUREMENT factors influence End of Life Planning
- What ENVIRONMENTAL factors influence End of Life Planning
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.