Alignment, Integration and Coordination Needed in a Care of a Patient

In a patient confined in a hospital, there are usually a good number of staff (physicians, nurses, medical technologists, radiology technicians, pharmacists, house keepers, etc.) taking care of him, that is, providing health care services.

See picture below:

people_in_one_episode_care

http://docplayer.net/14478453-Patient-experience-is-not-patient-satisfaction.html

There must be alignment, integration and coordination of the health care services to be provided in order to achieve quality and safe patient care and excellent patient experience.

Who should orchestrate this alignment, integration and coordination?

The attending or head physician?

The nurses?

The attending or head physician assisted by the nurses and the hospital-wide alignment, integration and coordination management system in patient care?

I think the best answer is the last one.

This is a challenge to all hospital administrators – how to accomplish the third task and responsibility!


ROJ@17dec9

 

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Governance of a Hospital Clinical Department Framework

Governance of a Clinical Department_roj_17dec6

 


ROJ@17dec6

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Quality vs Safety – Quality and Safety Patient Care – ROJoson’s Notes

Quality vs Safety – Quality and Safety Patient Care – ROJoson’s Notes

Quality vs Safety – Quality and Safety in Patient Care

ROJoson – 15feb12

Circa 1995s, I spelled out the universal goals in the management of a patient which consist of resolution of the patient’s health problem or concern in such a way that the patient does not end up dead, with disability, or with complication and in such a manner that the patient is satisfied and there is no medico-legal suit.  I have been using these formulated goals in the management of my patients.  I have also been telling my medical and surgical students to have these goals in mind whenever they treat patients.  I have not called these goals as quality or safety goals, just simply goals in the management of a patient.  It is only now as I prepare for a lecture on patient safety management to be held on February 12, 2015 that I come to realize that these goals are quality and safety goals.  One can see the quality and safety components if I restate the goals as such: resolution of the patient’s health problem (quality) in such a way that the does not end up dead (safety), with disability (safety), with complication (safety) and in such a manner that the patient is satisfied (quality) and there is no medicolegal suit (quality).

In 1999, when I started my journey in hospital quality management system, my practice had been to have “safety” subsumed by the goal of quality service and patient care without spelling it out.  It was only in 2010 when I was made aware by the assessors from Accreditation Canada International surveying Manila Doctors Hospital of the importance to have the “safety” goal spelled out.

So, what is the difference between quality and safety? Should the quality and safety goals be independent of each other?

Quality vs Safety (Agency for Healthcare Research and Quality)

Below is an excerpt from an article that gives a backgrounder on the evolution of safety from quality and attempts to differentiate the two. (Emmanuel L: What exactly is patient safety?  Ahrq.gov 2008)

“Part of the challenge lies in distinguishing safety from quality, a line that remains important to some, while being dismissed by others as an exercise in semantics. In 1998, the IOM convened the National Roundtable on Health Care Quality, which adopted the following definition of quality that was widely accepted: “Quality of care is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” (Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 1998; 280: 1000-1005.)  

Health care quality problems were classified into three categories: underuse, overuse, and misuse, all of which the evidence shows are common. Misuse was further defined as the preventable complications of treatment. Although the IOM Roundtable was careful to distinguish misuse from error (the latter may or may not cause complications), the misuse category became a common reference point for conceptualizing patient safety as a component of quality.

In 2006, Leape and Berwick observed that, as attention to patient safety has deepened, the lines between the overuse, underuse, and misuse categories have blurred. “It seems logical,” they wrote, “that patients who fail to receive needed treatments, or who are subjected to the risks of unneeded care, are also placed at risk for injury every bit as objectionable as direct harm from a surgical mishap.” (Leape LL, Berwick DM. Five years after “To Err Is Human.” What have we learned? JAMA 2005; 293: 2384-2390.)   

The National Patient Safety Foundation identified the key property of safety as emerging from the proper interaction of components of the health care system, thereby leading the way to a defined focus for patient safety, namely systems. (Cooper JB, Gaba DM, Liang B, et al. The National Patient Safety Foundation agenda for research and development in patient safety. Med Gen Med 2000; 2: E38.)  

Its goal has been defined as: “[t]he avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of care.” (Vincent C. Patient safety. London: Elsevier; 2006.)

Quality vs Safety; Quality and Safety (Accreditation Canada International)

Quality is “the degree of excellence; the extent to which an organization meets clients needs and exceeds their expectations”. Key attributes of high quality healthcare systems, as defined by the Institute of Medicine (U.S.) include safety, timeliness, effectiveness, efficiency, equity and patient centeredness.

Patient safety is often considered a component of quality, thus, practices to improve patient safety improve the overall quality of care.

Quality vs Safety; Quality and Safety (Joint Commission International)

Quality and safety are inextricably linked. Quality in health care is the degree to which its processes and results meet or exceed the needs and desires of the people it serves.  Those needs and desires include safety.

The Institute of Medicine defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Patient safety emerges as a central aim of quality. Patient safety, as defined by the World Health Organization, is the prevention of errors and adverse effects to patients that are associated with health care.  Safety is what patients, families, staff and the public expect. While patient safety events may not be completely eliminated, harm to patients can be reduced, and the goal is always zero harm.

The ultimate goals are quality of care and patient safety.

ROJoson’s Summary Statements: There is a difference between quality and safe patient care.  Safety is within the quality dimension.  It is recommended for the safety goals to be extracted from the quality goals for emphasis reason.  However, the ultimate goals should still be an alignment and integration of quality and safety in patient care.

ROJ-TPOR@15feb12


A Repost.


ROJ@17nov30

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Quality health care services revisited – ROJoson – 17nov30

Quality in health care services where quality is defined with the following parameters: accessible, timely, rational, cost-effective, cost-efficient, and safe medical care, whether in the hospital, clinic or any health care institution.  Ultimate parameter: excellent patient experience.

ROJoson – November 30, 2017



Quality vs Safety

It is said that there is a difference between quality and safe patient care.  Safety is within the quality dimension.  It is recommended for the safety goals to be extracted from the quality goals for emphasis reason.  However, the ultimate goals should still be an alignment and integration of quality and safety in patient care.

Quality vs Safety; Quality and Safety (Accreditation Canada International)

Quality is “the degree of excellence; the extent to which an organization meets clients needs and exceeds their expectations”. Key attributes of high quality healthcare systems, as defined by the Institute of Medicine (U.S.) include safety, timeliness, effectiveness, efficiency, equity and patient centeredness.

Patient safety is often considered a component of quality, thus, practices to improve patient safety improve the overall quality of care.

Quality vs Safety; Quality and Safety (Joint Commission International)

Quality and safety are inextricably linked. Quality in health care is the degree to which its processes and results meet or exceed the needs and desires of the people it serves.  Those needs and desires include safety.

The Institute of Medicine defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Patient safety emerges as a central aim of quality. Patient safety, as defined by the World Health Organization, is the prevention of errors and adverse effects to patients that are associated with health care.  Safety is what patients, families, staff and the public expect. While patient safety events may not be completely eliminated, harm to patients can be reduced, and the goal is always zero harm.

The ultimate goals are quality of care and patient safety.

 


ROJ@17nov30

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ROJoson Medical Clinic Booked Appointment Performance Report – November 2017

Booked Appointment Performance – November 2017

Target: No patient will have a waiting time for more than 60 minutes from booked appointment time.

Only two (2) patients waited for more than 60 minutes from booked appointment time (62 and 68 minutes). This was due to long consultation time and late arrival of booked patients of some patients that destroyed the flow.   [Year-to-date figures: 12 waited for more than 60 minutes from booked appointment from January to November 2017]

The range was 0-68 minutes with a mean of 12 minutes.

There was totally zero waiting time in one out of the 11 clinic sessions.

NO late in coming to clinic by ROJoson.  

Have to keep on reminding patients on lates and no-shows.

November 2017 Late No-show Range and Mean Waiting Time (From Booked Appt Time) Mean Waiting Time
2 0 0 0-5 3
4 0 0 0-32 11
7 0 0 0-62 28
9 2 2 0-6 2
11 5 1 0 0
16 3 1 0-33 12
18 3 0 0-26 5
21 5 0 0-68 47
23 2 3 0-25 4
25 4 0 0-25 6
28 5 3 0-43 8
  29 10 0-68 12

ROJ@17nov28

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Differences between patient satisfaction and patient experience

 

patient_experience_satisfaction_comparison

 

The trend is towards patient experience survey.

 

23795772_10154874286555800_5454281257854405985_n

 

patient_satisfaction_pitfall



ROJ@17nov26

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Training in Emergency Room Medicine

Retrieved File (circa 1991)

THE MANILA DOCTORS HOSPITAL EMERGENCY ROOM (MDH-ER)

THE MDH-ER TRAINING PROGRAM FOR PHYSICIANS


COURSE DESCRIPTION

GENERAL OBJECTIVE

SPECIFIC OBJECTIVES

TEACHING AND LEARNING ACTIVITIES AND MATERIALS

TRAINEES

TRAINORS

EVALUATION

LIST OF CONFERENCES AND MEETINGS

TOPICS FOR LECTURES AND DISCUSSIONS

TOPICS FOR PRACTICUM SESSIONS


COURSE DESCRIPTION

The course consists of a formal training in emergency room medicine. It includes management of a present day emergency room; evaluation and treatment of patients seen in the emergency room; decision-making of all problems involving the emergency room and the patients; and disaster control.

 

GENERAL OBJECTIVE

To acquire the requisite knowledge, attitude, and skills relevant to the management of the emergency room and its patients.

 

SPECIFIC OBJECTIVES

At the end of the course, the trainee should be able:

1. To describe the types of patients consulting at a present day emergency room.

2. To enumerate the different patterns of medical staffing of the emergency room and indicate which one would be best for a particular situation.

3. To discuss the general functions of an emergency room officer.

4. To provide proper immediate resuscitative measures to patients with life-threatening conditions.

5. To make a logical and accurate diagnosis of medical problems of patients seeking help at the emergency room.

6. To identify which patients need to be hospitalized and who can be treated on an outpatient basis.

7. To identify which patients need the care of a subspecialist.

8. To provide proper definitive management to patients who do not need hospitalization nor care of a subspecialist.

9. To provide proper initial management to patients who need hospitalization and the care of a subspecialist.

10. To make proper decisions on any problems involving the emergency room and the patients.

11. To discuss the general principles and methods of disaster control.

12. To serve as an effective disaster medical officer or coordinator.

 

TEACHING AND LEARNING ACTIVITIES AND MATERIALS

1. Duties at the MDH-ER (hands-on training and preceptorship)

2. Lectures

3. Case discussions

4. Journal reports

5. Practicum sessions

6. Teaching and learning manual on emergency room medicine

 

TRAINEES

1. Interns – Rotation of 1 1/2 months

2. Residents – Rotation of 3 months

 

TRAINORS

1. The MDH-ER Director – Course Coordinator

2. The MDH Emergency Room Officers

3. The MDH Consultant Staff

 

EVALUATION

1. MDH-ER duty requirement

2. Attendance during conferences

3. Case presentations, lectures, and journal reports

4. Typewritten reports

5. Preceptorship grade

6. Practical examination

7. Written examination


LIST OF CONFERENCES AND MEETINGS

1. ENDORSEMENT CONFERENCE

– Every day except Sundays and holidays, 0730 – 0800

– Outgoing EROs endorse to incoming EROs

2. MEDICAL CONFERENCE

– Every day except Sundays and holidays, 0800 – 0900

– Lectures, case discussions, and journal reports

– Consultant ERO : every Mondays (Lectures)

– Intern ERO : every Tuesdays, Thursdays, Saturdays

– Resident ERO : every Wednesdays and Fridays

– Assignment by rotation and those who are not on duty

3. PRACTICUM SESSIONS

– Every day except Sundays and holidays, 0900 – 1000

– Instructor : Consultant ERO on duty

– Students : All residents and interns on duty

4. AUDIT CONFERENCE

– Every third Friday of each month, 1500 – 1700


TOPICS FOR LECTURES AND DISCUSSIONS

1. Management of an emergency room

2. The diagnostic and treatment processes in the ER

3. Basic and advanced life support

4. Common life-saving surgical procedures

5. Plain X-rays

6. Electrocardiogram

7. Arterial blood gases

8. Acute head

9. Acute eye

10. Acute ear, nose, and throat

11. Acute neck

12. Acute chest

13. Acute abdomen

14. Acute extremity (bone, nerve, blood vessel, and skin)

15. Acute male genitourinary system

16. Acute female urinary and reproductive system

17. Acute endocrine system

18. ER management of newborn and pediatric emergencies

19. ER management of shock

20. ER management of trauma

21. ER management of poisoning

22. ER management of seizures

23. ER management of coma

24. ER management of dyspnea

25. ER management of myocardial infarction

26. ER management of abdominal pain

27. ER management of gastrointestinal bleeding

28. Medicolegal issues in the ER

29. ER management of hypertension

30. ER management of gastroenteritis

31. ER management of bronchial asthma

32. ER management of sexually transmitted diseases

33. ER management of urinary tract infection

34. ER management of respiratory tract infection

35. ER management of burns and wounds

36. Disaster control


TOPICS FOR PRACTICUM SESSIONS

1. Basic and advanced life support

2. Plain X-ray interpretation (Skull, chest, abdomen, extremities, and spines)

3. Electrocardiogram interpretation

4. Arterial blood gases interpretation

5. Establishment of venous lines (Percutaneous and cut-down)

6. Nasogastric intubation

7. Urinary catheterization

8. Endotracheal intubation

9. Tracheostomy

10. Thoracentesis and tube thoracostomy

11. Pericardiocentesis

12. Peritoneal tap

13. Diagnostic process in the ER

14. Decision-making in the ER (diagnosis, treatment, disposition, referral, medical ethics, medicolegal issues, etc.)

 


ROJ@17nov24

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