ACMD 512 Class 6 Team 2 response
Ahmad Alawadhi; Dante Cerza; Mitzi D’Aquila; Pedro Tanaka
Assignment #6: Systems based practice is far reaching and diverse. As you know, the Patient Protection and Affordable Care Act (Health care reform) requests a number of assessments of community health needs, there is also the Medical home, the ACOs, ICD 10 coding, etc.
If you could pick one initiative that is key for your learners to know about and consider, what is it, and why did you choose it? How would you teach it to them and assess the outcomes?
INITIATIVE CHOSEN:
The initiative we chose is the Institute of Healthcare Improvement (IHI) Improvement Map. The IHI provides this map as one of the Strategic Initiatives proposed for improvement in medical care. It is an educational initiative and serves as a readily available on-line resource for health care practitioners.
The IHI Improvement Map covers dozens of important topics pertaining to health care and systems of care. Each topic addresses one or more aims of health care as defined by the IOM (effective, efficient, equitable, patient-centered, safe, and timely). These aims fit in with the spirit of systems-based practice (SBP) and thus serve as an approach to learning about SBP. The topics also fit into one of the following domains that are relevant to SBP: leadership/management processes, patient care processes, and processes to support patient care.
The IHI Improvement Map outlines a strategy for implementing patient care improvement processes by three domains, or by the aim to be affected by change. Each domain includes a module for understanding the reasons or requirements for process change, estimated cost, time, difficulty, and level of evidence to support change processes, and links for further learning.
i. Leadership/management processes: How to set aims for organizational improvement based on mission, vision, and current performance, through a partnership that involves those persons who are most involved in the related patient care work.
ii. Patient Care processes: 34 processes related to high quality patient care for individuals, based on specific content areas, including:
Acute delirium
Acute myocardial infarction
Acute respiratory distress syndrome prevention and management
Advance care planning
Cancer care in the hospital
Catheter-associated urinary tract infection prevention
Central line bundle
Communication with patients and families after adverse events
Community acquired pneumonia core processes
Disease-specific care for common comorbidities
Emergency department reliable care
Glycemic control in critical care
Heart failure core processes
High-alert medication safety
Neonatal intensive care unit standard care
Pain management
Palliative care
Pediatric common conditions
Percutaneous coronary intervention
Perinatal elective induction safety
Perinatal labor augmentation safety
Positive patient experience
Pre-operative patient assessment
Pressure ulcer prevention
Rapid response systems
Sepsis detection and management
Shared decision making
Stroke management
Surgical complications core processes
Venous thromboembolism prevention and treatment
Ventilator bundle
Well newborn care
iii. Processes to support patient care: 24 processes that support quality care change through a systems approach, including:
Antibiotic stewardship
Communication and teamwork
Critical results reporting
Daily goal setting and planning
Early warning signs
Efficient and reliable transportation systems
Emergency department timeliness
Fall prevention
Hand hygiene
Infection prevention
Laboratory testing and reporting
Medication administration
Medication ordering
Medication reconciliation
Multi-disciplinary rounding
Nutrition care services
Patient flow for efficiency and safety
Patient transitions and handoffs
Pharmacy safety and reliability
Radiology testing and reporting
Simulation for high-risk situations
Standard precautions
Surgical checklist
Transitioning out of the hospital
iv. By Aim: Content topics are mapped to a number of aims for process change, including:
Effective: evidence-based practice to produce better patient outcomes
Efficient: appropriate use of resources at the least expense to patients and systems
Equitable: care delivered fairly with consideration to need
Patient-centered care
Safe patient care
Timely patient care
TEACHING PLAN:
GOALS:
- Understand aspects and ramifications of SBP.
- Apply principles of SBP into different specialty practices.
- Introduce students to a resource for integration of principles of SBP into future practice, learning activities and system improvement efforts.
DESCRIPTION:
Third-year medical students completing their core clinical clerkships will be introduced to principles of SBP and to the IHI Improvement Map. During each clerkship rotation, the student will select one process relevant to the specialty and will compare the practice and activity of the system in that area (clinic, hospital, group practice, etc.) to the standards set forth in the modules.
OBJECTIVES:
At the end of this learning module students will be able to:
- Describe important components of SBP.
- Explain how SBP is important to health care practitioners.
- Apply principles of SBP into clinical learning experiences.
- Utilize an online resource for SBP.
- Evaluate practices and systems of health care based on proposed standards and recommended best practices set forth in the Improvement Map.
DESIGN OF INSTRUCTION:
- Pre-assignment reading:
Johnson J, Miller S, Horowitz S. Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work.
- On-line independent study:
Institute of Healthcare Improvement Map (http://app.ihi.org/imap/tool/)
- Lecture (one hour, at the beginning of the third year):
Introduction to the principles and goals of SBP
Introduction to resources for SBP, including the IHI Improvement Map
Description of the independent learning activity integrated into clerkship rotations
- Student assessment of practices and systems
The student will select a module that is provided by the IHI on its Improvement Map. He/she will observe practices and activities in the system in which he/she rotates. For example, he/she will observe the hospital system’s activity in the area the student selected during his/her inpatient internal medicine rotation. At the end of the rotation, the student will write a reflection in which he/she compares the practice he/she observed with the recommended practice or the ideals set forth by the IHI. Six reflections will comprise the entire SBP portfolio for this activity.
Guidelines for module selection:
- The topic must be relevant to the specialty in which he/she is rotating.
- By the end of the rotation, the topics selected must cover all the all 6 aims and the 3 domains.
LEARNER ASSESSMENT
- Peer assessment: each student’s portfolio will be read and critiqued by one classmate.
- Assessment by faculty: one faculty will read and critique each portfolio.
PROGRAM ASSESSMENT
Survey of the students on their comfort with assessing systems of care at the end of third year.
REFERENCES:
- Johnson J, Miller S, Horowitz S. Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf
- Institute of Healthcare Improvement Map (http://app.ihi.org/imap/tool/)
Comments (1)
Bev Wood said
at 5:51 am on Feb 15, 2012
The IHI is a wonderful source for information, ideas, and guidance. Thank you for developing something based on their improvement map and for your very nice elucidation of the purpose and intent of SBP. This is often a forgotten, but very important part of medical practice, and you have developed it into a worthwhile teaching and learning exercise.
The students will benefit greatly from the review of the student portfolio and from developing one pertinent aspect of the Improvement Map. The development you describe should also carry over well into practice.
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