Putting the Spotlight on the Quality Improvement Practicum
Wait times are frustrating — for busy patients and busy clinicians.
At The Dimock Center in Boston, at least once every week, lack of a prior authorization meant that providers had to deny a patient a Suboxone prescription. Sometimes this happened as many as five times in a week. And every time, it meant a now unhappy patient waited for as many as four hours at the clinic. Staff members at Dimock, meanwhile, were overwhelmed and frustrated with the process.
A Framework for Spread: From Local Improvements to System-Wide Change
A key factor in closing the gap between best practice and common practice is the ability of health care providers and their organizations to rapidly spread innovations and new ideas. Pockets of excellence exist in our health care systems, but knowledge of these better ideas and practices often remains isolated and unknown to others. One clinic may develop a new way to ensure that all diabetics have their HbA1c levels checked on a regular basis, or one medical-surgical unit in a hospital may develop a consistent way to reduce pain for post-operative patients.
Using Care Bundles to Improve Health Care Quality
In 2001, the Institute for Healthcare Improvement (IHI) developed the “bundle” concept in the context of an IHI and Voluntary Hospital Association (VHA) joint initiative — Idealized Design of the Intensive Care Unit (IDICU) — involving 13 hospitals focused on improving critical care. The goal of the initiative was to improve critical care processes to the highest levels of reliability, which would result in vastly improved outcomes.
Innovations in Planned Care
Despite significant efforts to improve the care provided to patients in clinics and office practices, it is still not nearly what it should be. Patients often cannot access or do not receive the care necessary to ensure positive health outcomes. Compounding this, the structure of service delivery, traditional workforce roles, and the reimbursement system all create barriers to making widespread improvements to primary care. A different system is needed, one that is reliable, proactive, efficient, and engages patients in ways that ensure the best outcomes.
Idealized Design of Perinatal Care
Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims.
The model described in this white paper represents the Institute for Healthcare Improvement’s best current assessment of the components of the safest and most reliable system of perinatal care. The four key components of the model are:
Team Based Competencies: Building a Shared Foundation For Education and Clinical Practice
Conference proceedings from the Team-Based Competencies: Building a Shared Foundation For Education and Clinical Practice conference. The conference took place February 16-17, 2011 in Washington, D.C. and was hosted by the Health Resources and Services Administration (HRSA) and co-sponsored by the Josiah Macy Jr. Foundation, the ABIM Foundation, and the Robert Wood Johnson Foundation.
This report outlines an action plan to solidify team-based competencies and advance interprofessional education.
Educating Nurses and Physicians: Toward New Horizons
In June 2010, the Josiah Macy Jr. Foundation and The Carnegie Foundation for the Advancement of Teaching hosted a workshop/conference in Palo Alto, CA to advance new models for inter-professional education within the nation’s academic health centers. The two foundations believe that if nursing, medical, and other health professions students learn jointly in clinical settings, as graduates they will improve patient outcomes by working more collaboratively, communicating better with each other, and fostering a health care delivery system that assures quality and patient safety.
Transforming Patient Care: Aligning Interprofessional Education with Clinical Practice Redesign
Malcolm Cox, MD and Mary Naylor, PhD, RN, FAAN chaired the January 2013 conference whose proceedings are recorded in this report.
As health professions education and healthcare delivery undergo rapid change, stimulated in part by the Affordable Care Act, it is critical that they not be developed in isolation. Educational reform must incorporate practice redesign, and delivery system change must include a central educational mission for transformation to endure.
Core recommendations:
Bridging the quality chasm: Interprofessional teams to the rescue?
Interprofessional education for collaborative practice, also referred to as education for “team-based healthcare,” is a recent innovation in US health professions education.1 Several specialties in medicine support this approach to care, for example, geriatrics, but educational preparation to deliver team-based care remains underdeveloped in the US. Will that change?
