Use of the Healthcare Matrix for PracticeBased Learning

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Use of the Healthcare Matrix? for Practice-Based
Learning Quality Assurance
Presentation adapted for use at New-York
Presbyterian Hospital

The Healthcare Matrix, 2004, John Bingham Doris
Quinn, Vanderbilt University
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IMPROVEMENT
The Healthcare Matrix, 2004, John Bingham Doris
Quinn, Vanderbilt University
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Change in Healthcare Institute of Medicine
Study

• Healthcare IOM study (1996-98) on the state of
  healthcare in America that led to a phase of
  generating recommendations/visions for improving
  quality of healthcare (1999-2001) and a final
  report (2001).

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2001 IOM Crossing the Quality Chasm

• Chasm between healthcare we have and healthcare
  we could have.
• Challenges to create system in which
• Care of every patient could improve care of all
  patients
• Competencies to ensure quality patience care are
  integrated into daily practice.
• Patient care decision making is guided by best
  evidence.
• Quality of healthcare is positively related to
  quality education.

IOM, Committee on Quality of Health Care in
America. 2001. Crossing the Quality Chasm A New
Health System for the 21st Century. Washington,
DC National Academy Press
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The Healthcare Matrix, 2004, John Bingham Doris
Quinn, Vanderbilt University
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Change in Graduate Medical Education ACGME
Competencies

• IOMs notion that Quality of health care is
  positively related to quality education,
  provided impetus for a shift in GME from focus on
  process, to focus on assuring resident
  competencies

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Competencies

• Patient Care
• Medical Knowledge
• Interpersonal Communication Skills
• Professionalism
• Systems-Based Practice
• Practice-Based Learning Improvement

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The Healthcare Matrix, 2004, John Bingham Doris
Quinn, Vanderbilt University
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The Healthcare Matrix, 2004, John Bingham Doris
Quinn, Vanderbilt University
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Assessment of Care
The Healthcare Matrix, 2004, John Bingham Doris
Quinn, Vanderbilt University
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Patient Care Should Be

• Safe Avoiding injuries to patients from care
  intended to help them.
• Timely Reducing waits and sometimes harmful
  delays for those who receive and give care.
• Effective Providing services based on scientific
  knowledge to all who could benefit refraining
  from providing services to those likely not to
  benefit.
• Efficient Avoiding waste of equipment, supplies,
  ideas, energy.
• Equitable Providing care that does not vary in
  quality because of personal characteristics.
• Patient-Centered Providing care that is
  respectful of and responsive to individual
  patient preferences, needs, values ensuring that
  patient values guide all clinical decisions.

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Noncomplex Example Internal Medicine
IMPROVEMENT
The Healthcare Matrix, 2004, John Bingham Doris
Quinn, Vanderbilt University
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APPLYING THE ACGME COMPETENCIES
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Medical Knowledge What Must We Know?
about established and evolving biomedical,
clinical, and cognate sciences, and application
of this knowledge to patient care.
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Interpersonal/Communication Skills What Must We
Say?
that will result in effective information
exchange and teaming with patients, their
families, other health professionals.
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Professionalism How Must We Behave?
as manifested through commitment to carrying
out professional responsibilities, adherence to
ethical principles, sensitivity to diverse
patient population.
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Systems-Based Practice What is the Process? On
Whom Do We Depend? Who Depends On Us?
as manifested by actions that demonstrate an
awareness of, and responsiveness to, a larger
context system of healthcare and ability to
effectively call on system resources to provide
care of optimal value.
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Practice-Based Learning Improvement What Have
We Learned? What Will We Improve?
involves investigation evaluation of
residents programs, or institutions own
patient care, appraisal and assimilation of
scientific evidence, and improvements in patient
care.
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IMPROVEMENT
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Improvements

• Timeliness Need to have direct contact with
  referring physician from outside the hospital.
  If outside records arrive, primary team should be
  paged or information should be flagged in the
  chart.
• Efficiency Direct communication must occur
  between teams if questions exist regarding
  proposed procedures.