Topic: “Physician Suicide”, 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.
Although the general public may not be aware of it, Dr. Danielle Ofri reminds us in a Slate article, “Doctors have the highest suicide rates of any professional group.” Although physicians tend to be healthier than the general public, they suicide at a far higher rate.
Meredith Mealer PhD is a registered nurse and an Assistant Professor of Physical Medicine and Rehabilitation (PM&R) at the University of Colorado, Anschutz School of Medicine and the Director of the Colorado Multiple Institutional Review Board (COMIRB). Her primary area of research interest is resilience training in healthcare professionals as a mechanism to mitigate psychological distress that results from the work environment.
Dr. Mealer will be attending the #MEQAPI chat, and taking questions related to clinician suicide and approaches to suicide reduction, such as resilience training. Some additional materials by Dr. Mealer include:
- Feasibility and acceptability of a resilience training program for intensive care unit nurses
- A qualitative study of resilience and posttraumatic stress disorder in United States ICU nurses
- The prevalence and impact of post traumatic stress disorder and burnout syndrome in nurses
Physician’s Weekly have kindly shared the following highly pertinent articles:
- High Expectations & Physician Suicide
- A Look at Suicide Among Physicians
- Depression, Suicide Ideation Prevalent in Medical Students
- New AMA Module Helps Identify Physician Distress
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.
- Human Resources Policies, and variation in expectations regarding women and men in the work setting and career progression
- Traditions and memes
- Incompatible policies
- 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
- Access Control
- 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 and threats of 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
- Means of suicide
- 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
- 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
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 influence physician suicide
- What MACHINE factors influence physician suicide
- What PEOPLE issues and expectations influence physician suicide
- What MATERIALS influence physician suicide
- What MEASUREMENT factors influence physician suicide
- What ENVIRONMENTAL factors influence physician suicide
Numbers for this chat
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.