Category Archives: Healthcare Systems

Patient care, quality improvement, patient safety, value based care, accountable care

Quality Improvement Project Charter

Watch the module from the IHI Online Open School “ QI Project Charter”

  1. Review the purpose of the QI project charter and the steps involved in completing the document.
  2. This module will guide you through the completion of the IHI project charter.

Watch the Ted Talk “Got a Wicked Problem? First tell me how you make toast.

  1. Discover how making steps in a process visible and tangible can lead to improvement by clarifying problems.
  2. This short Ted Talk describes the process map, a critical thinking tool used in quality improvement work to identify steps in a process for possible improvement changes.

IHI Online Open School courses in Quality Improvement and Patient Safety and Certificate program are available for additional support and review.

  1. Utilize the resources from the IHI online open school to provide additional support for project creation.  Interested students may wish to complete any final modules to obtain the IHI Certificate in Quality Improvement and Patient Safety.
  2. The IHI modules will provide a review or additional context regarding the model for improvement and the steps in the quality improvement process.      

 

SOAP-Q

Complete:

SOAP-Q is a communication tool designed to encourage providers to address health care quality effectively within oral case presentations and in note writing. This summary handout covers the basics of the SOAP-Q approach. 

This video demonstrates a third-year medical student modeling the case presentation in SOAP-Q format and this clinical note demonstrates SOAP-Q in note writing.

In both examples, the student implements strategies to advocate for quality patient careoptimal patient care systems, and safety culture within the context of a patient encounter while maintaining psychological safety in the setting of academic hierarchy.   

Additional resources:

Value Based Healthcare Policy

  1. READ AND REVIEW: “Medicare Delivery System Reform” https://www.kff.org/medicare-delivery-system-reform-the-evidence-link/

GOAL: Familiarize yourself with the most common Medicare value-based payment models: bundled payments, accountable care organization, and patient-centered homes.

The Centers for Medicare and Medicaid are major drives of innovative health care delivery models in the US.  There have been significant changes to payment and structure of care over the past 10 years.

Other Reference Materials:

The following papers report the impact of care models on outcomes of interest such as cost and quality. These do NOT need to read before class:

There are potential harms related to performance-based programs such as the creation of inappropriate incentives and inappropriate penalties. The following papers discuss these in more depth. These do NOT need to be read before class:

Value and Reducing Waste

Choosing Wisely: PDF

Things We Do for No Reason: PDF

Teachable Moment: PDF

American College of Radiology Appropriateness Criteria: PDF

Principles of High Value Care

  1. READ: Article: “What is Value-Based Healthcare?” https://catalyst.nejm.org/what-is-value-based-healthcare/

GOAL: Familiarize yourself with the goals of value-based healthcare as well as some of the models used to deliver value-based care.

The US-healthcare system is shifting to a value-based payment structure.  It is important to understand the goals and underlying principles of the concept as well as relevant care delivery models.

 

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?

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.

Introduction to Healthcare Systems

Review:

Review the fact sheet that includes fundamental information about healthcare financing.

Fact Sheet on Healthcare Financing and Reform

Watch:

Search the Khan Academy website (khanacademy.org) and create a log-in. Locate the “Health Care System” modules.  To do this, first select the “Science” category, then “Health and Medicine”, then “Health Care System”.  All students should arrive to class capable of quickly accessing the Khan Academy website.

View Khan Academy Modules as necessary. Three Khan academy modules are listed below.  The content of these modules is summarized.  Students with background knowledge in the listed content and fact sheet content are NOT required to view the modules.  The modules are a supplementary assignment and should be completed  based on student background and understanding of the US healthcare system and payment systems.  Note: students may need to access Khan Academy modules for small group work during the breakout session.

Module 1: Health care system overview (8 minutes)

Explains how patients/populations, providers, and payors interact.  Introduces government insurance, direct payment of patient to doctor, HMOs and PPOs.  Explains the rationale for insurance to mitigate risk and discusses the need to manage “moral hazard” as well as over-utilization of services when not directly responsible for payment.

Module 2: Paying doctors (12 minutes)

Defines FFS, capitation and salary.  Describes the lack of cost accountability to patients and providers in the third party payor system.  Describes issues with capitation with particular attention on “cherry picking” or patient shifting.

Module 3: Medicare overview  (16 minutes)

Introduces Medicare and Medicaid.  Defines populations covered for Medicare (Elderly/ALS/ESRD) and Medicaid (low income) as well as funding source (Federal Government for Medicare and combined Federal and State for Medicaid).  Defines Secretary of HHS and CMS (Centers of Medicare and Medicaid Services).  Describes Medicare parts A-D.

 

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)