#MEQAPI – Tweetchat March 23rd 2017 3ET: Quality Improvement vs Proneness for Malpractice Claims

Next tweetchat: Thursday March 23rd, 2017 3:00-4:00 PM ET

Topic:  Quality Improvement vs Malpractice Claims

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

Malpractice claims are a disruptive nightmare for providers, and the chances are that every provider will experience this firsthand at some point in their career. However, the probability of a malpractice claim is not evenly distributed, and some providers are far more likely to have claims made against them for malpractice than others. Proneness to malpractice claims can be reduced, and we can take proactive steps through quality improvement to greatly reduce the likelihood of the nightmare of a claim.

This week the #MEQAPI topics are based on the Physicians’s Weekly article “Examining Proneness to Malpractice Claims” that reviews malpractice claims variation between physicians and specialties. We will look at proneness to malpractice claims for each of the typical arms of the basic Quality Improvement Ishikawa diagram that may look something like:

Ishikawa

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

  • Methods
    • Policies: either unit, office, organization, or national policies that might increase malpractice risks.
    • Workflow: how things are done that might increase risks of errors, or antagonize the patient, or create gaps in handoff, etc.
    • Standard work: Standard operating procedures that may increase risk
  • Machines
    • Medical or office equipment that might increase risk of malpractice claims, old, broken, poorly installed, etc.
    • Software systems (especially EHR?), that might lead to HIPAA issues, frustrate patients, cause medical errors like wrong pt, wrong site, wrong meds, failure to follow up, etc.
  • People
    • Staffing: insufficient or unqualified staff
    • Training: insufficient base training, incorrect training, insufficient CME, etc.
    • Attitudes: staff attitudes e.g. paternalism, rudeness, etc.
  • Materials
    • Forms: duplicative or incomplete forms
    • Supplies: medical or office, inferior fax paper, lack of coffee(!)
    • data? – sent to wrong recipient, not shared with pt or specialist, etc.
  • Measurement
    • KPIs: operational metrics that focus on the wrong things, or are poor measures, and that drive wrong behavior
    • Targets: improper or unachievable performance targets
    • Incentives: improper, biased, or discriminatory rewards
  • Environment
    • Noise: distracting noises, sound levels too high, etc.
    • Space: cramped, uncomfortable, slippery surfaces, etc.
    • Lighting: too dim, glare, poor contrast, etc.
    • Location: things not where they should be, too much movement of staff, pt, or equipment needed, etc.

The aim of this chat is look at each of these dimensions of cause, and discuss what we have seen before for that dimension that has been a risk or developed into a malpractice claim, or that we anticipate is likely to become an issue or end up as a malpractice claim.

Topics

  1. What Methods (policies, workflow, etc) have you seen or anticipate may increase risk or have led to malpractice claims
  2. What Machines (med/office equipment, EHR/SW) have you seen or anticipate may increase risk or have led to malpractice claims
  3. What People issues (staffing, training, attitudes) have you seen or anticipate may increase risk or have led to malpractice claims
  4. What Materials (forms, supplies, data?) have you seen or anticipate may increase risk or have led to malpractice claims
  5. What Measurements (KPIs, targets, incentives) have you seen or anticipate may increase risk or have led to malpractice claims
  6. What Environment issues (noise, space, lighting) have you seen or anticipate may increase risk or have led to malpractice claims

Background

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.

meqapi March 23

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#MEQAPI – Tweetchat March 16th 2017 3ET: Matching #Trumpcare (AHCA) to the IHI Triple Aim

Next tweetchat: Thursday March 16th, 2017 3:00-4:00 PM ET

Topic: Matching #Trumpcare (AHCA) to the IHI Triple Aim

This week the #MEQAPI topics are based on the Congressional Budget Office (CBO) report on the American Healthcare Act (AHCA) and the acts’ relationship to the Institute for Healthcare Improvement (IHI) Triple Aim.

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

Since MEQAPI looks at the quality and safety of healthcare policies in addition to technology deployment and workflow optimization, it seems like a good time to look at the AHCA through that lens.

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 can look at the law, the analysis thus far, and the CBO evaluation, and ask how this may influence quality and safety, and to ask ourselves if it would be a positive influencer of care that is STEEEP.

The aim of this chat is thus to bump the Triple Aim up against the AHCA, and in the context of the CBO and other analyses of how the AHCA will work, discuss our views on a number of dimensions.

We are expecting @TheIHI to attend, and to participate in the discussion.

 

Topics

The following topics will be covered during the chat:

  1. What WAS IN the #AHCA you think will have a bearing on the IHI Triple Aim
  2. What was NOT in the #AHCA you think will have a bearing on the IHI Triple Aim?
  3. In relation to the Triple Aim and #AHCA, what do you expect to see personally/professionally?
  4. What do you think HC Quality orgs like @theihi @nqf and @AHRQNews should do about #AHCA?
  5. What do you think yourself, patients, and providers should do about #AHCA to drive care that is STEEEP?

 

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.

 

#MEQAPI – Tweetchat March 9th 2017 3ET: Patient-Participative Questions To Improve Clinical Decision Making

Next tweetchat: Thursday March 9th, 2017 3:00-4:00 PM ET

Topic: Patient-Participative Questions To Improve Clinical Decision Making

MEQAPITweetChat.png

This week the #MEQAPI topics are based on a @physicianswkly article on preoperative questions by Dr.Schwarze MD. The article “Improving Surgical Decision Making” is available on the Physician’s Weekly website.

Co-hosting the chat is Chris Cole of @physicianswkly, and we hope to have Dr. Schwarze @GretchenSchwa10 to provide details, so please watch for their tweets during the chat. Dr. Schwarze is affiliated with the University of Wisconsin School of Medicine and Public Health (@uwsmph) and UW Health (@uwhealth)

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

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 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.

In this chat, we will focus on safety and patient-centeredness, in the context of the Schwarze article.

To reduce the high number of medical errors resulting in missed opportunities, injury, and premature death, healthcare providers need to use basic quality improvement principles. Likewise, quality improvement techniques can help align patient expectations and most probable medical outcomes. A core principle of Lean Six Sigma is the inclusion of the Voice of the Customer (VoC).

In healthcare, VoC implies inclusion of the patient, their caregivers, and patient families in the development and execution of the careflow, and in making medical decisions. Various studies have shown that including patients in the overall quality processes increased patient satisfaction, and reduced cost and risk.

Participation by patients in the treatment decision-making process can reduce risk of errors, increase patient understanding of medicaloutcomes, and avoid patient dissatisfaction with results

Topics

The following topics will be covered during the chat:

  1. What risks/opportunities do you see in involving pts in clinical decisions by using standardized question prompt lists (QPL)
  2. Who should lead an initiative to involve patients in developing or using QPLs – Nursing/Physicians/QM/Case-Managers/Other
  3. Are there HIPAA risks in involving patients in developing or using QPLs
  4. How can we build patient involvement in QPLs into the careflow
  5. How would we tell if patient involvement in QPLs is working – what benefits would we be able to measure

and the numbers

meqapi mar 9 2017

#MEQAPI – Tweetchat March 2nd 2017 3ET – HSPI Conference #SHS2017

Next tweetchat: Thursday March 2nd, 2017 3:00-4:00 PM ET

Topic: Healthcare Systems Process Improvement Conference 2017 #SHS2017

This week we will be co-hosting with the Healthcare Systems Process Improvement Conference 2017 #SHS2017 chat along with Dr. Chuck Webster.

MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

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 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.

MEQAPI therefore wants to look at healthcare policy implementation, technology deployment, and workflow optimization in terms of how to monitor them, and how to evaluate if they have (a) achieved what they sought to do, (b) don’t cause unexpected harm, (c) do not cost more than anticipated,  or (d) do not take much longer than planned. During and after implementation, MEQAPI seeks to rapidly identify risks, issues, and opportunities, and to use quality assurance and process improvement methods and tools to reduce risk and waste, increase efficiency, and improve outcomes for all stakeholders.

In comparison, the HSPI conference focuses on some topics that are very dear to MEQAPI:

  • Process Improvement
  • Leadership and Change Management
  • Operations Research
  • Quality and Safety
  • Human Factors

 

Topics

To mine the experiences of HSPI conference attendees, MEQAPI regulars, and other stakeholders and interested parties, the following topics will be presented during the tweetchat:

  1. Healthcare process improvement increasingly relies on software tools: your favorites?
  2. Is “process” different from “workflow”? If so, how? If not, why do people seem to insist on using both?
  3. Is Healthcare Management/Industrial Engineering” an obsolete phrase? If so, what should replace it?
  4. Health IT increasingly *IS* healthcare workflow. What HIT applications hold greatest promise to improve workflow?
  5. How can we bridge the chasm between process improvement & health IT creation & use?
  6. Bonus question: Quick! Make up a question & tweet it out right now!

… and the numbers

 

meqapi-stats-3-mar-2017

#MEQAPI – Tweetchat Feb 16th 2017 3ET

Next tweetchat: Thursday February 16th, 2017 3:00-4:00 PM ET

Topic: Patient Involvement in Healthcare Improvement

MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare quality, and includes everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

We have selected a mini case study based on the BMJ paper by Lawton et al concerning a Patient Reporting and Action for a Safe Environment (PRASE) intervention.

Paper: “Can patient involvement improve patient safety? A cluster randomised control trial of the Patient Reporting and Action for a Safe Environment (PRASE) intervention

Url: http://qualitysafety.bmj.com/content/early/2017/02/03/bmjqs-2016-005570

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. A central focus of Lean Six Sigma is the need for all quality efforts to be aligned to the Voice of the Customer (VoC).

In healthcare, this means the patient’s voice, yet few quality measure in the National Quality Measures Clearinghouse (NQMC) are proxies for patient outcome, and fewer still are obtained from patient input. The lack of patient involvement in developing measures, collecting quality data, and understanding cost of noncompliance has led to missed opportunities and increased risk and waste. Lawton et al describe the use of the Patient Reporting and Action for a Safe Environment (PRASE) intervention at 33 hospital wards.

The intervention demonstrated a repeatable modality for patient involvement and participation in healthcare improvement.

Topics

  1. Have you seen opportunities for patient involvement in healthcare improvement, what were they
  2. What risks do you foresee in using patient input and participation in quality initiatives
  3. How would patient participation be kept within HIPAA boundaries
  4. What role does/should technology play in patient participation in healthcare improvement
  5. How can providers and patients work together to improve healthcare

 

thu-16-meqapi

#MEQAPI – Tweetchat Feb 9th 2017 3ET

Next tweetchat: Thursday February 9th, 2017 3:00-4:00 PM ET

Topic: Emergency Department Congestion – Patient flow and Healthcare Improvement

MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare quality, and includes everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

The following topics will be posed this week related to patient flow and how it relates to healthcare improvement and quality:

We have selected a mini case study based on ED physician tweets about ED crowding.
Process and quality issues are often seen first in the ED, so a good place to start when looking at improving healthcare. ED crowding is very common, with over half of EDs reporting frequent boarding.

ED is also a very busy and hazardous place, you want to spend as little time in the ED in your life as possible. ED boarding creates additional patient safety risks.

For this discussion, we are defining Boarding as a length of stay (LOS) of over 2hrs for acuity 1-2, or over 6hrs for acuity 3-5. ACEP takes a more functional view of boarding

  1. In a 90 bed ED, 80 beds are boarded, and the ED census is 120. What questions would you ask, and of whom
  2. What risks do you foresee in ED crowding, what risks, issues, and missed opportunities have you experienced
  3. What opportunities do you see for reducing ED crowding, and who should grasp them
  4. What role does/should technology play in improving care workflow
  5. How can providers and patients drive reduction in ED crowding

… and the numbers

meqapi-feb-9