Use of the Healthcare Matrix for Practice-Based Learning  Quality Assurance

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IMPROVEMENT. The Healthcare Matrix, 2004, John Bingham

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Use of the Healthcare Matrix for Practice-Based Learning Quality Assurance

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1. Use of the Healthcare Matrix? for Practice-Based Learning & Quality Assurance

3. 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). The matrix evolved out of 2 sea-changes that have occurred in Medicine. One of these changes occurred in the domain of healthcare, and the other in the area of medical education. The first change was brought about as the result of many forces and constituencies of healthcare, but was galvanized by the IOM in its seminal 1999 report, Crossing the Quality Chasm. The second change to the way in which particularly graduate medical education was formally envisioned was related to and largely resulted from the IOM report, and was galvanized by the Accreditation Council for Graduate Medical Education (ACGME). The matrix evolved out of 2 sea-changes that have occurred in Medicine. One of these changes occurred in the domain of healthcare, and the other in the area of medical education. The first change was brought about as the result of many forces and constituencies of healthcare, but was galvanized by the IOM in its seminal 1999 report, Crossing the Quality Chasm. The second change to the way in which particularly graduate medical education was formally envisioned was related to and largely resulted from the IOM report, and was galvanized by the Accreditation Council for Graduate Medical Education (ACGME).

4. 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. In this study, the IOM determined that there was a chasm between …..In this study, the IOM determined that there was a chasm between …..

6. Change in Graduate Medical Education: ACGME Competencies IOM’s 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 IOM’s 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 in the areas of patient care, medical knowledge, interpersonal and commun, skills, professionalism, systems-based practice, and practice-based medicine…. IOM’s 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 in the areas of patient care, medical knowledge, interpersonal and commun, skills, professionalism, systems-based practice, and practice-based medicine….

7. Competencies Patient Care Medical Knowledge Interpersonal & Communication Skills Professionalism Systems-Based Practice Practice-Based Learning & Improvement

11. 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.

13. APPLYING THE ACGME COMPETENCIES

14. Medical Knowledge: What Must We Know?

15. Interpersonal/Communication Skills: What Must We Say?

16. Professionalism: How Must We Behave?

17. Systems-Based Practice: What is the Process? On Whom Do We Depend? Who Depends On Us?

18. Practice-Based Learning & Improvement: What Have We Learned? What Will We Improve?

20. 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.

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