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makes conversation difficult, stoma bags and devices may cause a patient to feel intensely self-conscious and be withdrawn, and many other visible or invisible barriers to socialization exist that may result in a patient becoming socially isolated.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:
- Social Isolation, Loneliness May Increase AMI, Stroke Risk
- Patients With Thyroid CA Who Choose No Rx Report Isolation
- Social Isolation Can Adversely Affect Breast Cancer Survival
- To Combat Loneliness, Promote Social Health
- What Loneliness Does to the Human Body
- The Impact of Loneliness on Health Care Utilization Among Older Adults
- Why A Giant Health Insurer Is Diagnosing America With Loneliness
- Methods: What policies and procedures increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
- Machines: What equipment or devices increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
- Measurement: What measurement or surveillance increases or mitigates clinician or patient loneliness or social isolation – What effect does this have?
- Environment: What social, built, or clinical environmental factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
- People: What people factors increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
- Materials: What materials increase or mitigate clinician or patient loneliness or social isolation – What effect does this have?
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.
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.