Category Archives: Communities

Patient Safety and Systems Engineering

OPTIONAL:

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

These IHI modules are optional – IHI online open school.  Supplementary activity to provide greater detail and context for the material covered in class.  Recommended for students pursing a certificate in quality and safety.

  • PS 101
    • This module provides additional detail regarding organization culture, safety culture, high reliability organizations, and reporting systems.
  • PS 102 Lessons 1- 3
    • This module provides additional discussion of the Swiss Cheese Model, active and latent failures, unsafe acts, and harm.
  • PS 103 Lesson 1
    • This module describes human factors contributing to error and distinguishes between internal and external human factors.

These modules are intended for students working to complete the certificate program.

Community Visit

Complete the readings

Watch: Entering and Exiting Communities

  • Whether you’re working with a partner, conducting a site visit, doing research, or getting to know folks in a community, it helps to think through the before, during, and after to create a comfortable, safe, and reciprocal experience

READ: Collins, Janet, and Jeffrey P. Koplan. “Health impact assessment: a step toward health in all policies.” Jama 302.3 (2009): 315-317.

  • Instructions: Review social and structural determinants of health and how they apply to communities and health outcomes.

Review Community Visit Materials on Canvas

Supplemental readings and resources (not required)

Creating A Culture of Safety

1) Watch the video: “Building a psychologically safe workplace” (TED talk by Amy Edmonson).

GOAL: Develop awareness of psychological safety and its importance in teamwork.

In high-functioning teams, every member feels able to disclose errors, near-misses, or unsafe situations without fear of punishment or retaliation. Creating this culture of safety requires openness, trust, and leadership. As you watch this video, consider situations that you have witnessed in your clinical experiences. How would you characterize the psychological safety in these environments?

The Medical Safety Net with Health Policy

1. READ: The “Executive Summary” for Community Health Centers: Recent Growth and the Role of the ACA

  • NOTE: the longer “Issue Brief” contains additional details but is NOT required reading
  • GOAL: Provide additional data regarding community health centers, populations served, and funding received.
  • INSTRUCTIONS: Read the following summary for basic introductory information regarding community health centers. Pay particular attention to the mechanisms for funding and access.

 

Optional Video

 

Optional additional references

Adverse childhood experiences and trauma informed care

Activities:

  1. WATCH: Nadine Burke Harris’s TED talk that introduces key concepts about Adverse Childhood Experiences and how they impact health.

GOAL: Define the scope and frequency of adverse childhood experiences (ACE) and toxic stress, the connection to illness across the lifespan, and opportunities for clinician intervention.

Dr. Nadine Burke Harris explains how incorporating an understanding of the frequency and effects of adverse childhood experiences (ACES) can impact medical practice.

Reflect: How can a physician’s understanding of ACEs impact their clinical practice and outcomes?

 

2. READ: Original ACEs study: Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine. 1998;14(4):245–258. doi:10.1016/s0749-3797(98)00017-8. 

GOAL: Define and provide examples of Adverse Childhood Experiences.  Review the relationship between various forms of trauma/violence/ACEs and health status or health care outcomes throughout the life course.

This massive prospective study is the original research that described the prevalence of certain “adverse childhood events” in a managed care population and provided evidence for the strong correlation with morbidity and mortality later in life. Please note: A caveat that some language in this original paper (“family dysfunction”) would not be used in the trauma informed care environment that this work ultimately produced.

REFLECT: How does this information change the way you think about chronic diseases such as diabetes?  In what way does the study population (white, employed, insured, middle class) affect your reading of this article?

4. DISCUSS: Please respond to the following prompt in the discussion board on Canvas:

In reflecting on the data and concepts presented by Dr. Burke , and by the Felliti and Anda study, please consider a patient you have seen in PCP or tutorial who was or may have been affected by toxic stress or adverse childhood experiences.

  • How might an understanding of the effect of toxic stress across the lifespan changed your interaction with or your understanding of this patient?
  • As a medical student, what actions can you personally take as you interact with patients that could contribute to a family’s resilience or reduce the risk of re-traumatization during the medical visit?

OPTIONAL PRE-CLASS READING

1. READ (OPTIONAL): NYT article on WA state resilient community success story

GOAL: Apply concepts of resilience to responding to and preventing ACEs.

WA state was a leader in community level interventions to reduce ACEs and mitigate their outcomes.  Ready about some of these projects and outcomes.

REFLECT: How might physicians be involved in such projects?

2. READ (OPTIONAL): The Lifelong Effects of Early Childhood Adversity and Toxic Stress, Shonkoff et al, Pediatrics Jan 2012, 129 (1) , focusing on pages e235-238, and figure 2 on page e23

GOAL: Describe the proposed pathophysiologic mechanisms of toxic stress’ effect on health across the lifespan and the mediating effect of known resilience factors.

In this Pediatrics article, Shonkoff et al, delve into the science of toxic stress on the developing brain and the moderating effect of resilience factors.  Based on this science, they propose an “ecobiodevelopmental framework” from which the clinicians of the future should approach primary care.

REFLECT: What potential roles can clinicians take in responding to and preventing toxic stress?

3. READ (OPTIONAL): American Family Physician Curbside Consultation: Providing Trauma-Informed Care, Ravi A, Little, V.  May 2017https://www.aafp.org/afp/2017/0515/p655.html

GOAL: With deepened understanding of the prevalence and effects of childhood trauma, describe universal concrete actions that can be taken during the interview and exam to maximize emotional safety for patients.

This article was also provided in Immersion; it is provided here for clinical correlation.  Ravi and Little discuss trauma-informed care as a “…universal precaution to optimally address patient’s health care needs while decreasing the risk of traumatization.”

REFLECT: Have you seen these precautions taken in your clinical settings?

Additional Resources:

Community Engagement in Population Health

1. Read Cultures of engagement: The organizational foundations of advancing health in immigrant and low-income communities of color. Bloemraad I, Terriquez V. Soc Sci Med. 2016;165:214-222. PMID: 26898114.

This article presents an overview of the mechanisms by which community-based organizations can contribute to community well-being. Consider the implications for local communities you have worked in, and think about questions you’d like to ask panel members about their work.

Relational Ethics

This module will focus on ethical reasoning that relies on Social Relations:

1) Review Ethics Key Terms

GOAL: Familiarize yourself with and review these key ethics terms before turning to the video and reading:

  1. Care Ethics
  2. Communitarianism
  3. Interdependency

2) Watch video of Carol Gilligan on Moral Development and Care Ethics.

GOAL: Understand the basics of care ethics and how it might apply to the clinical setting.

Consider what is different about the approach that Gilligan is suggesting (i.e. a relational or Care Ethics based approach) from what you typically think of in terms of your ethical obligations as physicians.

3) Read Baby Aaron and the Elders by Ellen Wright Clayton and Eric Kodish

GOAL: Consider what you learned from Gilligan’s video and the above ethics key terms in this complex case of refusal of life sustaining treatment (LST).

Consider this is just one instance among a myriad of different clinical-community interactions. It will help us to begin to see the importance and sometimes the difficulty of respecting and valuing different community-based and relationship-based values and beliefs.

Have you ever found your own personal and community-based beliefs to be in tension with the norms of the institution of medicine?

 


You can also find substantial research on many diverse communities of Americans here in a “Diversity Toolkit” created by Cleveland Clinic: https://my.clevelandclinic.org/-/scassets/files/org/about/diversity/2016-diversity-toolkit.ashx.

Social Ecological Model

Social Ecological Model

McLeroy, Bibeau, Steckler and Glanz are generally credited with creating the social ecological model of care.  A quick Google search for the social ecological model will reinforce how widely it has been adopted.  There are numerous community, state, national and international organizations that utilize this model in their programs.

Think back to your session in immersion on the social history.  How often do you think beyond the individual and interpersonal factors that influence you and your patients health?

Image result for social ecological model uw

 

From CDC Colorectal Cancer Control Program (CRCCP)