#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.

 

 

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#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.

 

 

#MEQAPI – Tweetchat Jan 25-2018 3:00ET Perfection 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

This is part 2 in the discussion of “perfection in healthcare”, in which we will continue down a practice-based QI journey. First we identify a few important parts of healthcare and ask what they would look like if they were perfect. This technique is also discussed in a recent Physician’s Weekly blog titled “Three Effective Ways to Pick Quality Improvement Targets“.

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

In the previous blog on “Perfection in Healthcare”, I described a quality improvement method in which we reflect on a specific operation, and explore what it would look like if it were “perfect”. I defined what we would mean by “perfect”, thus:

QI poses a more practical, but still distant and largely unavailable level of perfection. This is the Theoretical Capacity, and is an expression of what a process could theoretically yield if everything was running at 100% performance and there were no defects. This is the level of perfection that will be the topic of the next few #MEQAPI chats.

Last time, we discussed the following elements:

  • Patients
  • Physicians
  • Nurses
  • Specialists
  • Environment

For this chat, we are going to run headlong through five components of the overall healthcare workflow:

  1. Training
  2. Diagnostics
  3. Scheduling
  4. Medication
  5. Emergency Care

For each of these, we are going to reflect of what it would look like if were perfect- what would the perfect patient be like, the perfect physician, the perfect nurse, etc. In future chats, we will take the input and explore more deeply.

Perfection 2

For example, is, does perfect training mean it must be timely, reflect real world needs, and not select students in a way that results in inequities?
What about medications would perfection reflect? – would they be safe, effective, affordable? Would reconciliation be an integral part?
How about emergency care? – Do we know when to head for the ED and when we can wait for the next available primary care appointment, do we know when to use an urgent care facility, when to call an ambulance, and when to DIY?

 

 

Topics

  1. What features, properties, or behavior does “Perfect Training” have
  2. What features, properties, or behavior does “Perfect Diagnostics” have
  3. What features, properties, or behavior does “Perfect Scheduling” have
  4. What features, properties, or behavior does “Perfect Medication” have
  5. What features, properties, or structure does “Perfect Emergency Care” have

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, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • 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., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • 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
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

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.

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.

 

 

#MEQAPI – Tweetchat Jan 4-2018 3:00ET Perfection 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

In the previous blog on “Perfection in Healthcare”, I described a quality improvement method in which we reflect on a specific operation, and explore what it would look like if it were “perfect”. I defined what we would mean by “perfect”, thus:

QI poses a more practical, but still distant and largely unavailable level of perfection. This is the Theoretical Capacity, and is an expression of what a process could theoretically yield if everything was running at 100% performance and there were no defects. This is the level of perfection that will be the topic of the next few #MEQAPI chats.

For this chat, we are going to run headlong through five components of the overall healthcare workflow:

  1. Patients
  2. Physicians
  3. Nurses
  4. Specialists
  5. Environment

For each of these, we are going to reflect of what it would look like if were perfect- what would the perfect patient be like, the perfect physician, the perfect nurse, etc. In future chats, we will take the input and explore more deeply.

Perfection I

For example, if we listed “timeliness” as feature of the “perfect patient”, in a future session we may a scan the six arms of the QI framework, and discuss what challenges are encountered patient’s ability to be timely. For instance, are there policies that make timeliness more or less likely? Are there machine factors that influence timeliness, environmental factors, measurement aspects, materials, etc.

Patient Timeliness

 

Topics

  1. What features, properties, or behavior does the “Perfect Patient” have
  2. What features, properties, or behavior does the “Perfect Physician” have
  3. What features, properties, or behavior does the “Perfect Nurse” have
  4. What features, properties, or behavior does the “Perfect Specialist” have
  5. What features, properties, or structure does the “Perfect Care Environment” have

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, etc
      • Workflow: how things are done including new patient onboarding, care provision, care coordination, ordering/prescribing, billing, patient transfer, etc.
      • Quality Improvement Policies
      • Subsidies and funding
      • Facility Policies
      • Specialty Policies
      • Employment policies
      • National and State Laws
      • Training
      • Navigable processes and policies
      • Patient Centeredness
      • Evidence Based Medicine standards
      • Value-based Care
    • Machines (incl equipment, EHR)
      • Personal Safety Equipment
      • Real Time Locator Systems (RTLS)
      • Med Equipment
      • Test and scanning equipment
      • Equip Ergonomics
      • Interoperability
      • EHR/Software
      • TeleHealth
      • Home Equipment
      • Access Control
      • Office Equipment
      • Product tracking
      • Outcomes tracking
    • People
      • Staffing: sufficient and qualified staff
      • Patients – objectives, attitudes, ability to cope, beliefs, power-distance, health literacy
      • Subject Experts
      • Malpractice suits
      • Role Models, celebrity influence
      • Peer support/conflict
      • Training
      • Vendors
      • Friends/Family
      • Patient participation
      • Attitudes/Bullying
    • 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., and Access to Information
      • Patient self-care materials including checklists and how-to instructions, contact information for questions, and self-care consumables
      • OTC and home remedies and drugs
      • Impurities and variances in product strength and effect
      • Internet sources and access
      • Checklists, SoPs
      • Uniforms, footwear, personal protective equipment
      • Costed consumables
    • Measurement
      • Health outcomes
      • KPIs: operational metrics required by practice, local government, state, federal
      • Quality and safety metrics
      • Adverse effects reporting and metrics
      • Targets: set by practice, insurer, etc. as well as patient goals
      • Gini Index
      • Incentives and rewards
      • Adverse Event reporting
      • Effectiveness of measurement
      • Productivity Metrics
      • Patient Goals
    • 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
      • Contamination and impurities
      • Temperature: too cold, too hot, too variable
      • Interruptions
      • Political climate
      • Social norms and group identity
      • Electrical Power
      • Climate and weather
      • Income inequality
      • Time
      • Direct marketing to patients

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.

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.