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.

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

2. Then READ EITHER:

OR

Optional readings:

  1. NYT article on WA state resilient community success story
    • Goal: compare and contrast effective community interventions to promote resilience in our region
  1. 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: For students who want to read the Kaiser study that introduced the idea of ACES and the impact on health.  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.

Additional Resources:

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)