#MEQAPI – Tweetchat Aug 17-2017 3:00ET Healthcare Star Ratings

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:

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.

Star Ratings

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.
      • 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
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
      • WIFI!
      • Analytical software
    • People
      • 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)
      • Values
      • Peer support
      • Friends and family
    • 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, 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
      • Data!
    • 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
      • Effectiveness of measurement
    • Environment
      • 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
      • Interuptions

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 enhance or impede Quality and Safety measurement
  2. What MACHINE factors enhance or impede Quality and Safety measurement
  3. What PEOPLE issues enhance or impede Quality and Safety measurement
  4. What MATERIALS enhance or impede Quality and Safety measurement
  5. What MEASUREMENT factors enhance or impede Quality and Safety measurement
  6. What ENVIRONMENTAL factors enhance or impede Quality and Safety measurement

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 Aug 17-2017 3:00ET Healthcare Star Ratings

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:

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.

Star Ratings

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.
      • 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
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
      • WIFI!
      • Analytical software
    • People
      • 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)
      • Values
      • Peer support
      • Friends and family
    • 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, 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
      • Data!
    • 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
      • Effectiveness of measurement
    • Environment
      • 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
      • Interuptions

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 enhance or impede Quality and Safety measurement
  2. What MACHINE factors enhance or impede Quality and Safety measurement
  3. What PEOPLE issues enhance or impede Quality and Safety measurement
  4. What MATERIALS enhance or impede Quality and Safety measurement
  5. What MEASUREMENT factors enhance or impede Quality and Safety measurement
  6. What ENVIRONMENTAL factors enhance or impede Quality and Safety measurement

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

PHR and Microsoft Healthvault Insights

This year, Microsoft Healthvault awoke from a fitful slumber and released “HealthVault Insights.”

Insights is a major step that includes hooks to Microsoft Cortana in order to provide some degree of analytics and access to diary etc. The most significant component in Insights is the ability of participating health care professionals (HCP) to build a Care Plan in their part of the application, and push it to the user (patient).

That is a pretty major step, because instead of a dim and clouded memory of the encounter to rely on, the patient now has an electronic record to work with. The record might involve excercise targets, dietary objectives, or precipitation schedules.

Great so far, and Microsoft deserves applause for taking personal health records (PHR) to the next level.

However, HealthVault developers and I have argued with regard to who should have the ability to initiate a Care Plan. Understandably, Microsoft are physician-centric, and see the Care Plan as starting its existence as the culmination of a medical encounter.

I see this as a workflow mistake.

To my mind, the vast majority of healthcare encounters will begin with a patient seeking an appointment for an injury, illness, or medication change. While it is certainly true that sometimes the physician initiates an encounter for a routine checkup or medication review, this is by far in the minority.

What Healthvault Insights doesn’t allow, is for the patient to initiate a Care Plan and push it to the provider. I believe this is a major gap, given the way most encounters are originated, and the need to enable activated patients to be self-managing.

Allowing the patient to create the Care Plan makes the process more patient-centered, encourages better encounter planning, and makes the patient more responsible for their health management.

The key elements should include:

  • Templates to guide the patient in listing signs and symptoms
  • Guides to help the patient select a tentative chief complaint
  • Diary and PHR hooks to develop a recent medical history of the complaint as a timeline
  • Prompts to help them develop a statement of health goals
  • Listing of their current PHCP or HCPs available with their current insurance
  • Means to push the resulting care plan to the HCP they selected as a care request with preferred dates and times

On receipt of the care request, the HCP could respond with an encounter at the most medically appropriate level of care, whether that is a Care Plan for self-care at home, encounter with a nurse, encounter with a physician, referral to a specialist, etc.

Currently, Microsoft agrees with the concept as I have described it here, but is relying on the HCP or other interested stakeholders to develop the functionality using the Healthvault software development kit. I think this is an unlikely scenario, and that the ability for patients to initiate, build, and push a care plan should be part of the core Insights functionality.

That’s my story, and I’m sticking to it.

#MEQAPI – Tweetchat Aug 10-2017 3:00ET 3D Printing in Healthcare

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

One of the most promising technologies in healthcare right now is 3D printing. 3D printing has seen application in many specialties, and has heralded innovations as a planning tool for complex surgery, in creation of custom prosthetics, and as a means to create bio-scaffolding for organ or tissue regrowth.

This chat will be preceded at 2:00 ET by a 3D Printing FireTalk chat with Dr. Charles Webster (@wareflo), who is a 3D printing expert and enthusiast! Please make time to join the FireTalk if you can.

Pertinent articles provided courtesy of Physician’s Weekly:

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.

3D Printing

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.
      • 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
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
      • WIFI!
    • People
      • 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)
      • Values
      • Peer support
      • Friends and family
    • 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, 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
      • Printing materials
    • 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
    • Environment
      • 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
      • Interuptions

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 enhance or impede 3D Printing
  2. What MACHINE factors enhance or impede 3D Printing
  3. What PEOPLE issues enhance or impede 3D Printing
  4. What MATERIALS enhance or impede 3D Printing
  5. What MEASUREMENT factors enhance or impede 3D Printing
  6. What ENVIRONMENTAL factors enhance or impede 3D Printing

 

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 Aug 3-2017 3:00ET Joy in Work

Topic:  Quality Improvement vs “Joy in Work” 

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

In the March 30th MEQAPI we discussed the serious and growing problem of Clinician Burnout. The Institute for Healthcare Improvement (IHI) has initiated a “Joy in Work” theme, and this week we will be posing what improves joy in healthcare work.

The IHI explains their approach thus:

Clinician burnout has been well-documented and is at record highs. The same issues that drive burnout also diminish joy in work for the health care workforce.

Health care leaders need to understand what factors are diminishing joy in work, nurture their workforce, and address the issues that drive burnout and sap joy in work.

The most joyful, productive, engaged staff feel both physically and psychologically safe, appreciate the meaning and purpose of their work, have some choice and control over their time, experience camaraderie with others at work, and perceive their work life to be fair and equitable.

There are proven methods for creating a positive work environment that creates these conditions and ensures the commitment to deliver high-quality care to patients, even in stressful times.

Pertinent articles provided courtesy of Physician’s Weekly:

 

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.

Joy in Work

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.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Accreditation/MOC
      • Rotations & shifts
    • 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
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
    • People
      • 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)
      • Values
      • Peer support
      • Friends and family
    • 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, 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
    • 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
    • Environment
      • 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
      • Interuptions

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 increase or reduce Joy in Work
  2. What MACHINE factors increase or reduce Joy in Work
  3. What PEOPLE issues increase or reduce Joy in Work
  4. What MATERIALS increase or reduce Joy in Work
  5. What MEASUREMENT factors increase or reduce Joy in Work
  6. What ENVIRONMENTAL factors increase or reduce Joy in Work

 

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 Aug 3-2017 3:00ET Joy in Work

Topic:  Quality Improvement vs “Joy in Work”

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

In the March 30th MEQAPI we discussed the serious and growing problem of Clinician Burnout. The Institute for Healthcare Improvement (IHI) has initiated a “Joy in Work” theme, and this week we will be posing what improves joy in healthcare work.

The IHI explains their approach thus:

Clinician burnout has been well-documented and is at record highs. The same issues that drive burnout also diminish joy in work for the health care workforce.

Health care leaders need to understand what factors are diminishing joy in work, nurture their workforce, and address the issues that drive burnout and sap joy in work.

The most joyful, productive, engaged staff feel both physically and psychologically safe, appreciate the meaning and purpose of their work, have some choice and control over their time, experience camaraderie with others at work, and perceive their work life to be fair and equitable.

There are proven methods for creating a positive work environment that creates these conditions and ensures the commitment to deliver high-quality care to patients, even in stressful times.

Pertinent articles provided courtesy of Physician’s Weekly:

 

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.

Joy in Work

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.
      • Insurance Models, payer systems
      • Vendor policies and processes
      • Accreditation/MOC
      • Rotations & shifts
    • 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
      • Telehealth
      • Ergonomics (right size, shape, location, etc)
    • People
      • 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)
      • Values
      • Peer support
      • Friends and family
    • 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, 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
    • 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
    • Environment
      • 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
      • Interuptions

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 increase or reduce Joy in Work
  2. What MACHINE factors increase or reduce Joy in Work
  3. What PEOPLE issues increase or reduce Joy in Work
  4. What MATERIALS increase or reduce Joy in Work
  5. What MEASUREMENT factors increase or reduce Joy in Work
  6. What ENVIRONMENTAL factors increase or reduce Joy in Work

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 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