#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

 

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#MEQAPI – Tweetchat Feb 2nd 2017 3ET

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

Topic: Administrative and Clinical Workflow 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 include physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

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

  1. What does care workflow mean to you, and where does care workflow start and end
  2. What care workflow risks and issues have you experienced, what harm or missed opportunity did you see
  3. How is poor care workflow contributing to the high rate of medical mistakes
  4. What role does/should technology play in improving care workflow
  5. How can providers and patients drive improvements in care workflow

Here’s some of those who attended the session:

 

meqapi-ppl

… and the Symplur analysis of the activity:

meqapi-perf

 

#MEQAPI – Tweetchat Jan 26 2017 3ET

#MEQAPI – Tweetchat Jan 26 2017 3ET

Next tweetchat: Thursday January 26th, 2017 3:00-4:00 PM ET

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 will include everyone from administrators to zoologists, and include physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.

Three healthcare domains in which we might want to pay close attention are Care Policies, Care technologies, and care flow.

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

  1. What successes are there in Health IT – what is working well and how does that manifest
  2. What Health IT failed at least one element of Safety, Timely, Efficiency, Effectiveness, Equitability, Patient Centered – how
  3. What role should the government play in making Health IT improve healthcare cost, quality, and accessibility
  4. What role do the medical NGOs, journals, and professional bodies play in improving Health IT
  5. How can providers and patients drive improvements in Health IT

 

#MEQAPI TweetChat

On an average year, the estimates are that between 90,000 and 400,000 patients in America die untimely deaths due to medical error and missed opportunities. (The earlier IHI studies estimated 90,000, and more recent research hints at 400,000). The toll of injury related to medical error runs into the millions, and the financial cost of waste, medically unnecessary care, and dealing with sequelae of mistakes runs into the billions of dollars.

While we may object to various technical aspects of the research papers, find fault with elements of the methodology, or just plan balk at the thought of physicians killing patients, clearly healthcare is in need of quality improvement.

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

The format will follow a similar structure to the famous and well-loved examples of #HITSM, #HCLDR, and #IrishMed – guest moderators will pose 4-6 topics in sequence, aimed at igniting discussion and interaction.

If you would like to moderate a #MEQAPI tweetchat or suggest some topics, please contact us at @MEQAPI, or email mloxton@meqapi.org.

Oh, and the first #MEQAPI chat will take place on Thursday 12th Jan at 15:00-16:00 ET

See you there!

BPM & CM – My takeaway from the Global Summit

Thanks to Dr. Charles Webster (@wareflo), I attended the 2015 BPM & CM global summit in Pentagon City last month.
During the three-day summit, Dr. Webster interviewed me and several other attendees, and broadcast live over Periscope.
His intention was to find out what we each hoped to get out of the sessions, and then to follow up afterwards to find out what we saw as the major takeaways.

It has taken me nearly a month to settle on what I took away from the seminar, but here is my answer to his question:

  1. There was an elephant in the room
  2. The field has achieved a great deal of progress, but still has a long way to go
  3. There is a huge opportunity to improve healthcare

Before I talk about those, here are my top three favorite sessions

  1. Chuck Webster’s session on wearable workflow featuring @MrRimp. (It’s not every day you get that level of geekiness crammed into a presentation)
  2. Anne Rozinat’s session on process mining using Disco
  3. Aaron Drew, U.S. Department of Veterans Affairs & Business Architecture Leadership Panel, who spoke about the future of the VA’s VistA EHR design

Chuck thrilled us all with MrRimp, and hinted at a future in which wearable technology would form part of seamless workflow. From door to doc and beyond, wearables are going to play a major role in healthcare, and will shift the patient to the center of a care team, rather than simply being the topic of clinician discussions. Wearable workflow also has the promise of having adaptive business processes in which the currently error-prone activities of basic data capture are shifted from clinicians to machines. Shifting this burden will free up hours per day per clinician, while increasing data reliability.

Anne eloquently stepped us through the concepts and technology behind process mining, and gave examples that were clear and compelling. Process mining is a big deal in healthcare, as I discuss in a whitepaper on process discovery in quality improvement. The big deal is that current methods to discover the as-is workflow are resource intensive and slow. Variation in healthcare settings is high, and processes may vary not just from hospital to hospital, but ward to ward, and even shift to shift.

If you have a healthcare system with dozens or hundreds of care facilities, scaling this is close to impossible, and even in a single facility with a small number of wards, can be daunting and expensive. Process mining does not entirely overlap with observational methods of process discovery, but it comes close enough to bring real-time process discovery within the reach of small and large healthcare systems alike.

Aaron described a future in which BPM is built into the EHR, and where patient centered care teams could interoperate seamlessly without the EHR creating obstacles and pitfalls. The original VHA EHR was built to solve the problem of running a single medical facility and managing diverse treating specialties within a single environment. Since then it has been pressed into service as a means to do care and bed management across the nation as well as handle medication ordering, medical imaging, and disaster planning.

This venerable but dated EHR has architectural limitations that are no longer up to the challenges and demands of the modern care environment. The VistA Evolution project details a ground-up rebuild of the architecture and technology, and will put VHA back in the lead with a groundbreaking EHR.

That’s my top-three picks for sessions.

Now for the elephant

During one of the sessions, the presenter was explaining how he wished that US management and C-Suite were as tuned into the need for efficient and effective BPM as the executives he encountered in Germany. What followed was, from my perspective, a remarkable response from the audience. As a qualitative researcher and quality improvement practitioner in healthcare, whenever an audience is animated it’s important to pay attention.

Nowhere on the agenda was a discussion related to management itself, none of the sessions involved management best practices, and no speaker directly addressed the topic of executive sponsorship and behavior. Governing policies regarding process improvement and quality weren’t a listed topic. However, what came thick and fast, in raised voices, were accounts and agreements that US business practices were a major impediment to improving processes.

One person gave an account of how short-term focus and lack of forward vision was crippling attempts to improve workflow in the business operation. Another described how quarterly metrics resulted in punitive reactions to improvements, and that improving a process for long-term success were often cancelled by management because of a short-term focus. Somebody else gave a personal account of management cancelling projects that were designed to improve quality and efficiency. The projects couldn’t deliver within a financial quarter, and so they were terminated.

Whether the specific projects were viable or not, is something we can never know. What was clear is that the tone and degree of participation in this session, and on this specific topic, were remarkable. The topic evoked a far higher degree of audience participation, and the degree of vociferous agreement stood out. The thing that nobody was talking about, but was evidently on everyone’s mind, was that US business models are a significant cause of bad business processes.

That bears some thinking, especially in the US healthcare market, where the cost of bad processes is paid in blood and death.

BPM & CM advancement

With the release of BPMN v2.0, and the advent of DMN v1.0, the field now has an accepted set of standards that can be used to model business processes. This is great news for fields that include quality improvement, business reengineering, and business design. This means that a wide variety of workflow and process design tools will produce interoperable if not entirely interchangeable process models. It also opens the door to being able to build processes that can be directly embodied in business logic in the workplace.

What is less stellar is that while over 80% of all process models are created and reside in Microsoft Visio, the model you created in Visio only pretends to be a BPMN model. It’s like a picture of a dollar bill – it looks like one, and it can be named “dollar bill”, but you can’t buy anything with it. You can’t just flow your business data through the Visio diagram to see if something is wrong.

Perhaps with time that will change, but it isn’t a pretty picture right now.

Opportunities in Healthcare

Putting this together, if there is one industry where wearable workflow, process mining, and BPM standards could benefit operations, it is healthcare.

  1. Healthcare costs in the US, account for up to 60% of bankruptcies
  2. Preventable medical mistakes are the third highest source of untimely death
  3. Incompatible processes are the daily reality for patients and providers alike

 

Improving the performance and conformance of business processes, placing patients at the center of their care team, engineering humans out of data entry, and standardizing processes across points of care could save lives and money. It could shift US healthcare from being the most expensive in the world to being at least on par with the OECD averages. It could move US healthcare outcomes from the doldrums to being in the top five percentile.

That’s my story, and I’m sticking to it!