Author Archives: mspin

Applying Systems Improvement to Patient Safety

IHI online open school optional assignment: Students complete the online curriculum and assessment for certificate program.  To provide greater detail and context for the material covered in class.  Recommended for students pursing a certificate in quality and safety.

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

  • Additional depth and detail regarding organizational culture, safety culture, high reliability organizations and reporting systems.
    • PS 101 (Lesson 1-3)
  • Discussion of Swiss cheese model, active and latent failures, unsafe acts and harm
    • PS 102 lesson 1-2
  • Discussion of human factors contributing to error and internal and external factors
    • PS 103 lesson 1

Population Health Panel

In this session, we will consider how organizations, including healthcare systems and public health institutions, promote the health and well-being of entire patient populations by addressing problems that impact large numbers of people. We will readdress topics that were introduced in week 1, including thinking broadly about what constitutes “health” and how we can address some of the social determinants of health. In order to do this, we need to define “population health” and understand what is meant by this term.

In addition, this session focuses on the “Triple Aim.” The Triple Aim involves three goals that are critical to improving the health of populations, whether here in the United States or elsewhere:

  1. Improving the individual experience of care.
  2. Reducing the per capita costs of care for populations.
  3. Improving the health of populations.

Activity 1:

Activity 2:

Key Take Home Points:

  1. Remember the World Health Organization definition of health we learned in Week 1: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
  2. Remember the definition of public health from Week 1: Public health is the science and the art of preventing disease, prolonging life, and organized community efforts to prevent, identify, preempt, and counter threats to the public’s health.
  3. Population health aims to address health disparities and improve health outcomes for the entire population of a specific geographic area.
  4. Population medicine aims to address health disparities and improve health outcomes for the population served by a given care provider (clinic, hospital, etc.).
  5. Both public and population health efforts rely on data that may often be limited; physicians can help improve public health data by reporting patient outcomes as required by law.
  6. All physicians can contribute in some way to health improvements at the population level by supporting public and population health programs

MD-MPH Joint Degree Programs at the University of Washington School of Public Health

UW School of Medicine Students who have a special interest in making social determinants of health and advocacy part of their medical careers are encouraged to explore information on the joint MD-MPH programs offered by the UW School of Public Health. Information on the different programs available can be found at: http://sph.washington.edu/mph/. The programs most relevant to social determinants of health are health services (focused on the US health system), global health (focused on health systems in resource-limited settings), environmental health (focused on climate change, worker health, etc.), and epidemiology (focused on the distribution and determinants of diseases and other health conditions). Interested students are encouraged to reach out to those programs for information on program structure and content and on the application process and deadlines.

Confronting institutionalized inequity in medicine

Activities

  1. Read: Taylor, A. (2004). Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure. NEJM, 351(20), 2049-2057.
    • Do not worry about details of biological mechanism, focus on big picture: what was studied, in whom, what were results and what’s the clinical application?
  2. Read: “The art of medicine. The short life of a race drug” by Sheldon Krimsky
    • Understand how and why BIDIL was able to be marketed as a race-specific treatment.
  3. Optional – Watch: Dorothy Roberts, The problem with race-based medicine (TEDMED 2015)

 

Improvement Methodology

Activity

These IHI modules are optional – IHI online open school.  Supplementary activity to provide greater detail and context for the material covered in lecture.  Recommended for students pursing a certificate in quality and safety. Improve understanding of aim statement by providing additional examples.

IHI Online Open School Modules – http://app.ihi.org/lms/home.aspx

  • QI 102 Lessons 3, 4, and 5 (optional) – Identify steps in the model of improvement framework for choosing measures, developing changes, and testing changes.
    • These lessons will introduce the steps in the model of improvement framework by providing knowledge regarding types of quality measures, change concept tools for developing changes, and methodology for testing changes.
  • QI 103 Lesson 2 (optional) –  Discover how to use data to learn about the impact of changes.
    • These lessons will inform the student on the purpose of data and how data may be organized, examined, and presented using a run chart.
  • QI 103 Lesson 1 and 3 (optional) – Determine how to collect quality measurement data and how to learn from data.
    • These lessons describe the planning process, data sampling, scale, and scope in data management.
  • QI 104 Lessons 1-3 (optional) – Recognize the use of charting tools for interpretation of data.
    • These lessons expand on interpretation of data using run charts, control charts, and other measurements.

Conflict of interest

Activities:

  1. READ: Fromme E. Requests for Care from Family Members. Virtual Mentor.May 2012, Volume 14, Number 5: 368-372
    • Goal: Explain the ethical conflicts involved in deciding if and when to provide medical care for family members.
    • Instructions/context for reading:  Almost all medical students and physicians will receive requests for medical advice from family or friends at some point in their career. These requests can range from simple questions about routine medical care to complex inquiries about serious health issues or medications. Read this article about handling a request for medical care from a family member and consider how you might respond as a medical professional.
  1. READ: AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members.
    • Goal: Explain the implications of the policy statements from the AMA Board of Ethics and explore the ramifications of providing medical care for family and friends
    • Instructions/context for reading:  Responding to requests for medical care from family and friends in a manner that maintains professional integrity without compromising a personal relationship takes introspection and practice. Participating in class discussion will help students begin to analyze the nuances of these interactions and the ethical dilemmas involved in approaching requests from family and friends.

Optional readings:

Social Determinants of Health in US Populations

Required:

  • Link and Phelan. 1995. “Social Conditions as Fundamental Causes of Disease” Journal of Health and Social Behavior pp.80-94
    • In this foundational article, social epidemiologists Bruce Link and Jo Phelan argue three main points:
      1.  social conditions (e.g., SES, inequality, racism, segregation) have a causal effect on health and well-being,
      2. to understand patterns of disease prevalence and incidence, we need to contextualize risk factors and understand what conditions put people “at risks of risks” (i.e., people in poor neighborhoods have an elevated risk of exposure to crime which increases the risk of stress accumulation), and
      3. researchers need to acknowledge that social conditions are not just distal causes of disease, they are FUNDAMENTAL causes, meaning that the relationship between the social conditions (e.g., SES) and health is robust and will remain present even as the risk factors for disease and the leading causes of disease/death change.
    • This is because high SES individuals are afforded flexible resources that they can use to avoid risks and minimize the consequences of disease.
  • Frieda, Misha. 2016. “For Native Americans, Health Care Is a Long, Hard Road Away”.
    • NPR : https://www.npr.org/2016/04/13/473264076/for-native-americans-health-care-is-a-long-hard-road-away
  • Social Determinants of Health PPT

White Fragility

Activities 1-3

  1. Read pages 54-58 (stop before the section Factors that Inculcate White Fragility) in the article White Fragility, by Robin DiAngelo
    • Discussions about race and racism can be inherently uncomfortable. Acts of racism can take all forms and it is important to consider intent versus impact when racist behavior is exhibited. Much of this is driven by societal norms and socialization.
  2. Review In-class handout: The Art of Mindful Inquiry and Health Ways to Communicate
    • In order to have a deeper discussion please review recommendations for inquiring about difficult topics and look over the discussion points that will be discussed.
  3. Watch the video clip Just Be American from the film Color of Fear.
    • This video in an excerpt from the 1994 film The Color of Fear. Eight men of different backgrounds, races and ethnicities were gathered by director Lee Mun Wah, for a dialog about the state of race relations in America as seen through their eyes. This is a response by David C. after hearing about experienced racism from other members of the group.

Your goal for each activity

  1. Create a personal definition of white fragility.
  2. Understand how societal norms can lead to power differentials that exist between racial groups.
  3. Create a framework for discussions that may be difficult or challenging.
  4. Create a framework for understanding why talking about racism may be more difficult for some than others.

 

Race and Racism in Medicine

Watch “The Biology of Race in the absence of Biological Races” by Dr. Rick Kittles

Watch video or read transcript:

Race: The Power of an Illusion – Episode 2

Read:

Goal for these activities:

  1. Recognize why using race in biomedical studies can be problematic.
  2. Recognize how and why race is a social and political construct and its current function in society.
  3. Recognize how race is still used in medicine, and “pros” and “cons” to using race as a social identifier.