#MEQAPI – Tweetchat May 10-2018 3:00ET Loneliness

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

Loneliness is an unwelcome part of the experience of healthcare. From both sides of the care process, people frequently find themselves engulfed by a sense of loneliness – patients, carers, and clinicians alike have reported a wrenching sense of being alone, isolated, and vulnerable at times.

In this #MEQAPI chat, we will explore the topic of loneliness from the traditional Ishikawa cause & effect perspective, and see if we can cast some light on what causes are common for loneliness, and how it affects patient outcomes, and where it touches of the main quality aspects of healthcare – Safety, Timeliness, Effectiveness, Efficiency, Equitability, Patient-Centeredness, and Accessibility.

The health effects of loneliness and social isolation can be severe. The Campaign to End Loneliness puts it so:

… research shows that lacking social connections is as damaging to our health as smoking 15 cigarettes a day (Holt-Lunstad, 2015). Social networks and friendships not only have an impact on reducing the risk of mortality or developing certain diseases, but they also help individuals to recover when they do fall ill (Marmot, 2010

Loneliness and burnout are close cousins, and the two are often causally interrelated – burnout resulting in isolation and loneliness, and loneliness leading to increased stress, reduced resilience, and increased burnout. This crippling cycle can eat at clinicians, especially those in specialties and environments involving high emotional burden such as oncology, emergency medicine, and critical care, but can be seen across all specialties.

For patients, news of a positive diagnosis for a “dread illness”, an ongoing chronic illness, or suicidal feelings can spiral the person into isolation and loneliness – often at the very time that they most need social support. Some medical equipment and devices play a role in increasing isolation – ventilation equipment makes conversation difficult, stoma bags and devices may cause a patient to feel intensely self-conscious and be withdrawn, and many other visible or invisible barriers to socialization exist that may result in a patient becoming socially isolated.

Likewise, some conditions themselves make social situations and contact more difficult and result in increased loneliness and isolation. Often the stigma associated with a condition can force isolation on a patient.

Some reading material from Physician’s Weekly and other sources:

 

 

Loneliness

Topics

  1. Methods: What policies and procedures increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  2. Machines: What equipment or devices increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  3. Measurement: What measurement or surveillance increases or mitigates clinician or patient loneliness or social isolation – What effect does this have?
  4. Environment: What social, built, or clinical environmental factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  5. People: What people factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
  6. Materials: What materials increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?

 

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 expand this to include Accessibility, 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

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

Advertisements

#MEQAPI – Tweetchat May 3-2018 3:00ET MH Crisis Quality & Safety

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

Physician’s Weekly held a tweet chat titled “The Mental Healthcare Crisis in the US” in which several features of ongoing and emerging problems in healthcare planning and delivery for mental health were discussed.

In this chat, we will use five of the #PWChat topics and think of the causes and potential remedies from the QI model of general dimensions of Quality & Safety: Methods, Machines, Measurement, Environment, People, and Materials. This will potentially guide our talk about how the MH crisis manifests in your experience, and explore the issues and opportunities from a QI perspective.

MH Crisis

Topics

  1. Thinking of the six arms of the QI model: What hinders or helps public education on how to address emergency situations among patients with mental disorders?
  2. What is causing mental illness to be treated as less important than physical illness?
  3. What is causing or what will help address patients who aren’t willing to accept that they have a mental disorder?
  4. What is causing health insurance companies to differentiate mental health disorders from others, what would change that?
  5. When a patient who needs specialized care from a psychiatrist and/or psychologist is left waiting for months, what is causing the delay and what could reduce it?

 

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 expand this to include Affordability, 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

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

#MEQAPI – Tweetchat April 19-2018 3:00ET Toxic Bosses

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

I vividly remember a conference session about 30 years ago in which the speaker fulminated over the poor quality of managerial skills in the workforce. The problem, the speaker explained energetically, was that we were thrusting people into managerial roles for which they had little training, almost no understanding, and very few practical skills. As a result, safety, quality, and cost took continual hits, worker satisfaction was deplorable, and customers were inflamed.

The solution, he suggested, was threefold:

  1. View management as a specific occupation, not as a hobby or sideline.
  2. Establish management training at a graduate study level to prepare managers for their roles.
  3. Split management roles from subject matter expert (SME) or individual contributor roles.

MBA training blossomed in the subsequent decades, and many industries split roles so that taking a management position meant a conscious decision to distance oneself from being an SME or individual contributor, and becoming a professional manager.

However, this has not turned into great success in healthcare.

Firstly, the MBA programs have apparently done very little to prepare anyone for a management role, and some researchers have even suggested that the sole measurable outcome of the millions of dollars spent on MBA programs, has been a reduction in ethics. That’s right, MBA graduates tend to have lower business ethics than when they started. If that wasn’t bad enough, in healthcare, a boss (Chief, director, chair, etc) tends to retain patient duties and have parallel lives in which they are still a researcher or physician, as well as trying to manage and lead team(s) of SMEs.

This has not been optimal, and we can see it in the burnout of both bosses and staff, and few bosses have the time to work on basic managerial tasks such as developing staff careers, being proactive on customer satisfaction, or developing and advancing the strategic business operation. Another outcome is that bosses range in ability as bosses and we get many “types” of bad boss (which will be discussed in a Physician’s Weekly blog).

For example, some bosses “kiss up and kick down”, ingratiating themselves to their bosses, and waging a tyranny against their staff, other bad bosses hide away (in meetings, conferences, and their own work) and are just MIA when staff need them, and still others are the sweetest people ever, but let other managers pillage and destroy, and never seem to stand up to support their staff.

In this chat, we will talk about how this manifests in your experience – the signs, symptoms, and situations of “bad bossing”.

Topics

  1. Think of the BEST boss you ever saw- department head, chief, director, or just a team lead. What was special about them, what they did, how they acted?
  2. Think of the WORST boss you ever had – department head, chief, director, or just a team lead. What was special about them, what they did, how they acted?
  3. What did the bad bosses do to your sanity, safety, productivity, and how did this manifest itself?
  4. What did the bad bosses do to patient safety, satisfaction, and outcomes, and how did this manifest itself?
  5. What effect does good or bad management or leadership have on care Safety, Timeliness, Effectiveness, Efficiency, Equitability, Patient-Centeredness, or Affordability?

 

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 expand this to include Affordability, 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

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

#MEQAPI – Tweetchat April 5-2018 3:00ET Patient Collaboration in QI

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

Patient voice is a critical component of quality improvement (QI) and has been a neglected area in healthcare. While clinicians and healthcare workers strive to be patient-centered and to do their best for patients, this does not often manifest in including patients when it comes to planning changes, making decisions, or developing policies. As a result, patients are often a neglected voice in healthcare improvement, even when they are the central goal.

In their British Medical Journal (BMJ) paper titled “What can patients tell us about the quality and safety of hospital care? Findings from a UK multicentre survey study“, O’Hara et al discuss a study of patient experience of safety. The study analyzed data from 2,471 patients across 33 wards in three English NHS Trusts, between May 2013 and September 2014.

O’Hara et al found a high rate of patient-reported incidents, but perhaps the most eye-opening finding was that 10% of the patients identified a patient safety issue (boldface added)

Of the 2471 inpatients recruited, 579 provided 1155 patient-reported incident reports. 14 categories were developed for classification of reports, with communication the most frequently occurring (22%), followed by staffing issues (13%) and problems with the care environment (12%). 406 of the total 1155 patient incident reports (35%) were classified by clinicians as a patient safety incident according to the standard definition. 1 in 10 patients (264 patients) identified a patient safety incident, with medication errors the most frequently reported incident.

To put this number into perspective, CDC figures for 2015, show that 83.6% of the U.S. adult population had at least one healthcare encounter in the preceding year, translating into 125.7 million hospital visits, and 990.8 million physician office visits. If 10% of patients discovered and reported a safety issue in that year, millions of additional opportunities for improvement would result.

From a Lean Six Sigma and QI view,  one must take the “workpiece’s” perspective going through the workflow, and the definition of “quality” must derive from the objectives and goals of the “customer”. In healthcare, we typically don’t do this – for workflow we typically look at life through the lens of the physician or capital equipment (that’s why patients sit in waiting rooms queued up waiting on physicians and MRI scanners), and at best, we have somewhat shoddy proxies for whether the patients goals were met.

Likewise, we often nod toward patient goals, but subordinate them to other priorities such as profit, standards of care, purchasing policies, and physician preferences when we think of quality improvement. One egregious example is caesarean section births, which are often used and timed to be convenient to physicians and how the facility operates, rather than what the patient desires or prioritizes. Same often happens with end-of-life care, in which very often the patient’s goals are subordinated to a host of other considerations. Sometimes the lack of patient voice can be as mundane as what medications are prescribed and in what form – again, often the choice has little to do with what the patient wanted most.

So, to be truly patient-centered, healthcare would need to change to prioritize the patients goals, and eliminate waste and waiting as seen from the patient’s eyes – the identification of quality and safety risks, issues, and missed opportunities being one area in which patient-collaboration can help us to make significant improvements.

Some additional sources for this chat:

  1. Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention
  2. How might health services capture patient-reported safety concerns in a hospital setting? An exploratory pilot study of three mechanisms
  3. The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study
  4. Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation
  5. The Patient Feedback Response Framework – Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study

Topics

  1. What is your first reaction to the idea of collaborating with patients in healthcare improvement? – What other thoughts occur to you?
  2. What obstacles and opportunities do you see in collaborating with patients for quality & safety improvement
  3. How can we amplify the voices of underrepresented patient subgroups such as women, LGBTQ, and people of color when collaborating with patients for quality & safety improvement?
  4. Who will support and who will oppose collaborating with patients for quality & safety improvement?
  5. What policy, people, materials, measurement, environment, and equipment changes would need to take place to collaborate with patients for quality & safety improvement?

 

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 expand this to include Affordability, 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

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

#MEQAPI – Tweetchat April 5-2018 3:00ET Patient Collaboration in QI

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

Patient voice is a critical component of quality improvement (QI) and has been a neglected area in healthcare. While clinicians and healthcare workers strive to be patient-centered and to do their best for patients, this does not often manifest in including patients when it comes to planning changes, making decisions, or developing policies. As a result, patients are often a neglected voice in healthcare improvement, even when they are the central goal.

In their British Medical Journal (BMJ) paper titled “What can patients tell us about the quality and safety of hospital care? Findings from a UK multicentre survey study“, O’Hara et al discuss a study of patient experience of safety. The study analyzed data from 2,471 patients across 33 wards in three English NHS Trusts, between May 2013 and September 2014.

O’Hara et al found a high rate of patient-reported incidents, but perhaps the most eye-opening finding was that 10% of the patients identified a patient safety issue (boldface added)

Of the 2471 inpatients recruited, 579 provided 1155 patient-reported incident reports. 14 categories were developed for classification of reports, with communication the most frequently occurring (22%), followed by staffing issues (13%) and problems with the care environment (12%). 406 of the total 1155 patient incident reports (35%) were classified by clinicians as a patient safety incident according to the standard definition. 1 in 10 patients (264 patients) identified a patient safety incident, with medication errors the most frequently reported incident.

To put this number into perspective, CDC figures for 2015, show that 83.6% of the U.S. adult population had at least one healthcare encounter in the preceding year, translating into 125.7 million hospital visits, and 990.8 million physician office visits. If 10% of patients discovered and reported a safety issue in that year, millions of additional opportunities for improvement would result.

From a Lean Six Sigma and QI view,  one must take the “workpiece’s” perspective going through the workflow, and the definition of “quality” must derive from the objectives and goals of the “customer”. In healthcare, we typically don’t do this – for workflow we typically look at life through the lens of the physician or capital equipment (that’s why patients sit in waiting rooms queued up waiting on physicians and MRI scanners), and at best, we have somewhat shoddy proxies for whether the patients goals were met.

Likewise, we often nod toward patient goals, but subordinate them to other priorities such as profit, standards of care, purchasing policies, and physician preferences when we think of quality improvement. One egregious example is caesarean section births, which are often used and timed to be convenient to physicians and how the facility operates, rather than what the patient desires or prioritizes. Same often happens with end-of-life care, in which very often the patient’s goals are subordinated to a host of other considerations. Sometimes the lack of patient voice can be as mundane as what medications are prescribed and in what form – again, often the choice has little to do with what the patient wanted most.

So, to be truly patient-centered, healthcare would need to change to prioritize the patients goals, and eliminate waste and waiting as seen from the patient’s eyes – the identification of quality and safety risks, issues, and missed opportunities being one area in which patient-collaboration can help us to make significant improvements.

Some additional sources for this chat:

  1. Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention
  2. How might health services capture patient-reported safety concerns in a hospital setting? An exploratory pilot study of three mechanisms
  3. The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study
  4. Exploring how ward staff engage with the implementation of a patient safety intervention: a UK-based qualitative process evaluation
  5. The Patient Feedback Response Framework – Understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study

Topics

  1. What is your first reaction to the idea of collaborating with patients in healthcare improvement? – What other thoughts occur to you?
  2. What obstacles and opportunities do you see in collaborating with patients for quality & safety improvement
  3. How can we amplify the voices of underrepresented patient subgroups such as women, LGBTQ, and people of color when collaborating with patients for quality & safety improvement?
  4. Who will support and who will oppose collaborating with patients for quality & safety improvement?
  5. What policy, people, materials, measurement, environment, and equipment changes would need to take place to collaborate with patients for quality & safety improvement?

 

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 expand this to include Affordability, 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

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser and board member at the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and blogs regularly for Physician’s Weekly.

 

 

#MEQAPI – Tweetchat Feb 15-2018 3:00ET Amplifying Women’s Voices

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

It is a fact that women in science and medicine have less voice than men. This manifests in women being interrupted more, being asked for opinion less, being on fewer expert panels, etc. It is seen when a female physician is assumed to be a nurse, the male nurse is assumed to be a physician, and patients, families, and clinicians alike will turn to the male in the discussion to corroborate what the woman says.

These are facts.

In one thin slice of this unfortunate pie, women use social media such as Twitter less than men (47% vs 53%), get retweeted less frequently, have few followers, and are again, often spoken over in conversations.

This is, quite naturally, very irritating and demoralizing to  the women involved, but it shadows a more dangerous threat – it harms quality and safety. Undersampling, ignoring, and failing to engage women’s voices in medicine degrades quality, increases risk, and worsens the health outcomes of patients. Everything runs slower, has more errors, and costs more when we mute the voice of half the healthcare workforce.

This chat will look at several dimensions pertinent to the problem, and ask how to improve the situation.

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.

Women Voice

 

  • Policies
    • Facility or work unit policies, practices, rules
    • Specialty-specific policies
    • Human Resource guidelines, policies, etc.
    • Workflow and standard practices
    • Training
  • Work
    • Projects in which women are selected, lead, initiate, etc
    • Consultation of women for input, expert opinion, etc.
    • Recognition for achievement, effort, support, etc.
    • Plagiarism, theft or unattributed use of ideas, work, etc.
    • Sabotage of women’s work
    • Space, physical, time, and mental space to do creative work
    • Built environment, situation of toilets, parking, change rooms, rest areas, etc.
    • Time
  • Social Media
    • Follows
    • Retweets and Likes
    • Online bullying
    • Interruptions
    • Shunning
  • Conferences
    • Selection of speakers, panel members, judges, etc.
    • Seating
    • Interruptions
    • Questions
    • Disruptions
    • Post-conference follow up
  • People
    • Patients
    • Providers/HCP
    • Role Models
    • Sexualization
    • Diminishment
    • Peer support
    • Attitudes and bullying
  • Other
    • Environment
    • Pay
    • Equipment
    • Measurement
    • Recruitment
    • Other

Topics

  1. What POLICIES increase or reduce the ability of Women to be Heard in Medicine and Science
  2. What WORK factors increase or reduce the ability of Women to be Heard in Medicine and Science
  3. What SOCIAL MEDIA issues increase or reduce the ability of Women to be Heard in Medicine and Science
  4. What CONFERENCE issues increase or reduce the ability of Women to be Heard in Medicine and Science
  5. What PEOPLE factors increase or reduce the ability of Women to be Heard in Medicine and Science
  6. What OTHER factors increase or reduce the ability of Women to be Heard in Medicine and Science

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 expand this to include Affordability, 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

The Author and Moderator: Matthew is a Principal Analyst at Whitney, Bradley, and Brown Inc. focused on healthcare improvement, and serves on the board of directors of the Blue Faery Liver Cancer Association. Matthew is the founder of the Monitoring & Evaluation, Quality Assurance, and Process Improvement (MEQAPI) organization, and is a KM and quality improvement author, and regularly blogs for Physician’s Weekly. Matthew’s pro bono roles have included support for the Queensland Emergency Medicine Research Foundation and the St. Andrew’s Medical Research Institute. Matthew is active on social media related to healthcare improvement and hosts the weekly #MEQAPI chat. Matthew also trains others in the use of MAXQDA. You can find his contact info in his MAXQDA professional trainer profile

 

 

#MEQAPI – Tweetchat Feb 8-2018 3:00ET Choosing Metrics #1

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

This is another installment in the discussion of “perfection in healthcare”, in which we will continue down a practice-based QI journey. Previously, we identified a few important parts of healthcare and asked what they would look like if they were perfect. This technique is discussed in a recent Physician’s Weekly blog titled “Three Effective Ways to Pick Quality Improvement Targets“.

In this process, we  first chatted about perfection, and now we will look for outliers (positive and negative), and then later we will go through a root cause analysis on a few selected items to see if we can solve them to a degree.

Previously, we  discussed the following elements in terms of what perfection would look like:

  • Patients
  • Physicians
  • Nurses
  • Specialists
  • Environment
  • Training
  • Diagnostics
  • Scheduling
  • Medication
  • Emergency Care

This time, we are going to look for metrics that reflect the positive outliers – the best we have ever done – because we know that technically these results are possible. If we can shift our processes to performing on average what we previously did atour best, then we will have made a great stride in quality.

However, before we can pick “best ever achievement” for metrics (as described in @physicianswkly blog), we need to think about which ones to pick … and how metrics are created. If we start with a specific case, we can illustrate how this works.

So let’s imagine you are assessing a key part of the careflow – referrals to outside services like specialists, overflow physicians, outsourced services, etc. How would you track what happens to the patient, and if the care meets your standards? If we start by looking at problems – the risks, issues, or opportunities that are conceivably going to occur, we have a starting place to think about metric. The problems for this scenario include:

  • patient coordination is harder
  • services may not be what you asked for (more, less, different)
  • services may be below the standards you set for yourself

Maybe you want to use some kind of Utilization Management (UM) tool that tracks where the patients went, and whether the care met your UM criteria – such as, was the pt at the right level of care, was the Tx appropriate. Was the care STEEEPA?

How would you measure that this is all happening, and how would you measure that the tool is doing what you want? (two problems) . Maybe we would measure something like these:

  • Time taken to adjudicate cases for referral to external HCPs
  • Utilization of the UM tool (are staff actually using the tool)
  • Post-care review notes and evaluation (is the care satisfactory)
  • User satisfaction with the tool – do they like using it
  • User satisfaction with the tool implementation – did we give them enough warning, did it install easily, etc.
  • User satisfaction with the tool training and documentation – are they easy to use, do they apply to the real world, etc.
  • User satisfaction with the process and workflow

Topics

  1. What would you want to measure regarding the FUNCTIONALITY and PERFORMANCE of a Utilization Management tool for managing cases referred to external HCPs?
  2. What would you want to measure regarding the DEPLOYMENT of a Utilization Management tool for managing cases referred to external HCPs?
  3. What would you want to measure regarding the WORKFLOW of a Utilization Management tool for managing cases referred to external HCPs?
  4. What would you want to measure regarding the USER SATISFACTION of a Utilization Management tool for managing cases referred to external HCPs?
  5. What else would you want to measure regarding a Utilization Management tool for managing cases referred to external HCPs?

In the  #MEQAPI chat following this one, we will start using examples of regular chat members, and help identify what they would measure for their specific situations.

 

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 expand this to include Affordability, 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

The Author and Moderator: Matthew is a principal analyst for healthcare improvement at the Washington D.C. based firm of Whitney, Bradley, and Brown (WBB), and is a strategic adviser to the Blue Faery Liver Cancer Association. Matthew is a peer reviewer for the international journal of Knowledge Management Research and Practice, and writes on topics related to healthcare quality improvement and knowledge management.