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What_is_Systems-Based_Care - Systems-Based Care and...

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Unformatted text preview: Systems-Based Care and Systems-Based Practice Based Learning Practice and Improvement and The Problem The The American healthcare delivery The system is in need of fundamental change change The current systems cannot do the job Trying harder will not work Changing systems is necessary We’re Driving a Powerful Vehicle, but it has no: but Map Compass Speedometer Odometer, or Odometer, Clock Yet the pedal’s to the Yet floor floor Aims for Improving Healthcare Aims Safe Effective Patient-centered Timely Efficient Equitable To Err is Human: Building a To Building Safer Health System Why start with errors? Why Burden of injury Understandable to providers and Understandable consumers consumers Avoidable Experience in other industries Many People are Harmed Adverse event – an injury caused by dverse medical management medical Adverse events occur among 3-4% of Adverse hospitalized patients hospitalized About 1 in 10 results in death Over half are preventable Key Findings Errors occur Errors because of system system failures failures Preventing errors means designing a Preventing safer system of care system “Few newly qualified physicians have the Few necessary skills to improve health care and safety. These include the ability to perceive and work effectively in interdependencies, the ability to understand work as a process, skill in collecting, aggregating, analyzing, and displaying data on the processes and outcomes of care, skills in designing health care processes, an ability to work in teams and collaboration with managers and patients, and the willingness to examine honesty and learn from mistakes” from Professional Competence: a definition definition The habitual and judicious use of The habitual communication, knowledge, technical skills, evidence-based decision-making, emotions, values and reflection to improve the health of the individual patient and the community the Systems-Based Practice Systems-Based “Residents must demonstrate an Residents awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.” is Why Systems-Based Practice? Why Prepare physicians to work in the Prepare current system current Optimize cost and outcomes Improve the system Transform the health care system “Very few doctors understand Very what is happening to the health care system in which they practice, why the system is changing so rapidly, and what they can do about it” they -- Relman, Acad Med, 73, 1998 Why Systems-Based Care? Why “A systems view is critical to systems understanding patient outcomes, safety, values and quality” safety, What are the components of Systems-Based Care? Systems-Based For your Residency Program? For your institution/hospital? Some components of SystemsSome Based Practice System resources Patient advocacy Health care economics Teamwork Cost-benefit Cost-benefit considerations considerations Healthcare economics Healthcare Financing Practice management Insurance Types Medical-Legal Issues Coordination of health Coordination care care Documentation Issues Social and political Social history of US health care system care Elements of Systems: The Resident-System Interface Resident-System Within the hospital/clinic Admitting/scheduling Documentation Other clinical services Ancillary services Nursing Pharmacy Outside the Outside hospital/clinic hospital/clinic Referring physicians Insurers, HMO’s Community services External laboratory External and radiological services services Legal system Systems Thinking Principles and Concepts Concepts Interdependence Structure drives behavior Cause and effect are separated by time Cause and place and Any change in a system has Any unintended consequences unintended “The prominence of physicians The in highly interdependent medical systems confers tremendous power on them, individually and as a profession. With this power comes an ethical responsibility to be deeply concerned about medical systems.” medical --Nolan, Annals Intern Med, 1998 Practice-Based Learning and Improvement Improvement “Residents must be able to Residents investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.” practices.” Practice-Based Learning and Improvement Improvement Analyze practice and improve using Analyze systematic methodology systematic Locate, appraise and apply scientific Locate, evidence evidence Apply knowledge of study designs and Apply statistics statistics Obtain and use patient population data Use information technology Facilitate the learning of others Practice-Based Learning and Improvement Improvement Residents must internalize the value of Residents on-going, self-directed learning and improvement of practice improvement Reflect on and analyze practice Reflect experience experience Locate and apply scientific evidence Take steps to improve practice Demonstrate improvement “Whatever we measure we tend Whatever to improve.” to “We measure what we value.” Practice-Based Learning and Improvement Where should we start? Where Begin with what Begin you have in place – your resident interactions with their patients their What data can be gathered about a resident’s knowledge of Systems-Based Practice and Practice Based Learning through a patient encounter? through Questions from the attending? Was the care based on a healing Was relationship? relationship? Was the care customized based on patient’s Was needs? needs? Was evidence-based decision making used? Was safety a system property of the care? How did you anticipate the needs of the How patient? patient? Other venues for SBP and PBL Teaching and Evaluation Teaching Case analysis – focus on processes of Case care care Construction of a flow chart of a Construction hospitalized patient to analyze systems of care of Root cause analysis of an adverse Root event event Activity based cost analysis of a Activity hospital bill hospital Reasons this is hard Reasons Competence is a habit Medicine is a cooperative not a productive Medicine art art The important things are hard to measure Residents seek practical wisdom To become competent you have to “feel bad” Learning occurs in microsystems Becoming competent is a complex process Helpful Hints for Program Directors Directors Use current activities already in place Use (rounds, conferences, grand rounds, discharge planning rounds) to teach and evaluate SBP and PBL evaluate Issues related to SBP and PBL abound in Issues resident experiences resident Involve the residents in the process of Involve deciding how to incorporate these competencies into your curriculum competencies Faculty development is a key to success ...
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