Privacy Policy for www.health-999.blogspot.com/
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Monday, March 14, 2011
Tough Talk helps people be gentle
Some people at the University of Washington and colleagues from around the country run a wonderful website called Tough Talk: Helping Doctors Approach Difficult Conversations. They call it a "toolbox for medical educators" who want to teach about ethics and communication. Topics include:
Common teaching challenges plus tips for recovering from them • Optimizing small group dynamics • Providing effective, honest feedback • Helping clinicians develop and operationalize personal learning goals • Motivating engagement and self-assessment in reluctant participants
Look at this statement of philosophy:
Many argue that ethics and communication cannot be taught. Since these skills lie in the realm of the interpersonal, they do build on skills and practices we begin developing from our earliest interactions. However, evidence shows that practice and experience can lead to development and enhancement of these skills. This human element is where the moral work of medicine happens. We have a responsibility to attend to these skills and work to develop them, even as we strive to perfect our other core clinical skills. Quality patient care depends on it.
Teaching future medical professionals is a gift. When we interact with students, residents, fellows, or colleagues, we have many opportunities to learn and grow ourselves, in addition to promoting growth in others. We have approached this work of teaching by thinking about it as a service. We are not there to impart knowledge or impress others. We are there, working with learners, because we are genuinely interested in helping them become better doctors. Ultimately, attending to the interests of physicians-in-training will promote better patient care.
This is a nice exception from the findings made by Linda Pololi in her book about the often dehumanizing relationships among faculty in medical schools.
I was curious about how it all got started and how well it is being accepted. Here's the note I received from Kelly Edwards at UW when I asked those questions:
Common teaching challenges plus tips for recovering from them • Optimizing small group dynamics • Providing effective, honest feedback • Helping clinicians develop and operationalize personal learning goals • Motivating engagement and self-assessment in reluctant participants
Look at this statement of philosophy:
Many argue that ethics and communication cannot be taught. Since these skills lie in the realm of the interpersonal, they do build on skills and practices we begin developing from our earliest interactions. However, evidence shows that practice and experience can lead to development and enhancement of these skills. This human element is where the moral work of medicine happens. We have a responsibility to attend to these skills and work to develop them, even as we strive to perfect our other core clinical skills. Quality patient care depends on it.
Teaching future medical professionals is a gift. When we interact with students, residents, fellows, or colleagues, we have many opportunities to learn and grow ourselves, in addition to promoting growth in others. We have approached this work of teaching by thinking about it as a service. We are not there to impart knowledge or impress others. We are there, working with learners, because we are genuinely interested in helping them become better doctors. Ultimately, attending to the interests of physicians-in-training will promote better patient care.
This is a nice exception from the findings made by Linda Pololi in her book about the often dehumanizing relationships among faculty in medical schools.
I was curious about how it all got started and how well it is being accepted. Here's the note I received from Kelly Edwards at UW when I asked those questions:
This project started as "Oncotalk" which has a linked site to "Tough Talk", an NCI-funded program to help prepare oncology fellows for difficult conversations with seriously ill patients. We ran two retreats a year, reaching 20 fellows each time, for four years and touched many of the training programs across the country through this program. We then received a five year grant to support a 'train-the-trainer' course to teach Oncology faculty to integrate more communication skills teaching into their clinical teaching of fellows. We have had one 20 person cohort per year for four years, and our last session is coming up in April.
Tough Talk was funded by the Greenwall Foundation and allowed us early on to study our process approach to teaching communication skills and post some teaching materials to share online. I know that our programs have impacted many practicing oncologists - and many patients in return - but we do not have specific data about the public websites that support these courses to know how many additional people find these resources.
Oncotalk was profiled in the New York Times about 5 years ago. And we have several published papers in the academic literature about our program, teaching model, and communication skills. I'd be glad to share any of these papers if you are interested.
We get emails from participants on nearly a weekly basis about how their clinical practice has been impacted by our programs. As one small sign of support, 50% of the Oncotalk alums wrote letters of support for our train-the-trainer course grant. To us, that was very moving, given how busy these oncologists are!
Other faculty-investigators involved with this program are: Tony Back (oncologist at UW, Seattle - Principle Investigator), Robert Arnold (Palliative Care physician, Pittsburgh), James Tulsky (Palliative care physician, Duke), and Walter Baile (Psychiatrist at MD Anderson). They are truly leaders in the field!
How to achieve compassionate end-of-life-care
A very special report is being released right now at the Boston Public Library from the Expert Panel on End-of-Life Care, a multidisciplinary group of 41 stakeholders, including health care professionals, service providers, policy makers, health care advocates and legislators. They were appointed by the state's Executive Office of Health and Human Services, as directed by the Legislature.
The have done very good work on an important topic. It is thoughtful, practical, and compassionate.
Here are some excerpts from the press release:
Included in the report are the Expert Panel’s professional training guidelines to assist physicians with end-of-life consultations with patients who wish to discuss advanced directives.
The panel identified several essential goals toward achieving the highest quality end-of-life care:
- Inform and empower residents of Massachusetts to understand and plan for end-of-life care;
- Support a health care system that ensures high-quality patient-centered care;
- Promote and support a knowledgeable, competent, and compassionate healthcare workforce;
and
- Employ quality indicators and performance management tools to measure results.
I really like all these, especially the last one. Like all process improvements, if you don't measure, you don't achieve. I also like that the report talks about guidelines, clearly being sensitive to the preogatives of doctors and nurses in their relationships with patients.
Notable quotes from two fine people:
"Any health care system should help doctors and other caregivers ensure that patient's wishes are understood and honored, perhaps most of all in the last phases of life," said Dr. Lachlan Forrow, Director of Ethics Programs at Beth Israel Deaconess Medical Center.
“Meeting with residents throughout the state, it is clear to me they want to talk about ‘a good death,’ and how will we respect and honor their wishes at the end of life," said Jim Conway, Senior Fellow at the Institute for Healthcare Improvement. "Implementing systematically the report’s recommendations will go a long way to ensure we, as a community, do that in partnership 100% of the time.”
The have done very good work on an important topic. It is thoughtful, practical, and compassionate.
Here are some excerpts from the press release:
Included in the report are the Expert Panel’s professional training guidelines to assist physicians with end-of-life consultations with patients who wish to discuss advanced directives.
The panel identified several essential goals toward achieving the highest quality end-of-life care:
- Inform and empower residents of Massachusetts to understand and plan for end-of-life care;
- Support a health care system that ensures high-quality patient-centered care;
- Promote and support a knowledgeable, competent, and compassionate healthcare workforce;
and
- Employ quality indicators and performance management tools to measure results.
I really like all these, especially the last one. Like all process improvements, if you don't measure, you don't achieve. I also like that the report talks about guidelines, clearly being sensitive to the preogatives of doctors and nurses in their relationships with patients.
Notable quotes from two fine people:
"Any health care system should help doctors and other caregivers ensure that patient's wishes are understood and honored, perhaps most of all in the last phases of life," said Dr. Lachlan Forrow, Director of Ethics Programs at Beth Israel Deaconess Medical Center.
“Meeting with residents throughout the state, it is clear to me they want to talk about ‘a good death,’ and how will we respect and honor their wishes at the end of life," said Jim Conway, Senior Fellow at the Institute for Healthcare Improvement. "Implementing systematically the report’s recommendations will go a long way to ensure we, as a community, do that in partnership 100% of the time.”
Why cognitive specialists lose out
His father is a cardiac surgeon. His mother is an internist.The little boy, aged 3 1/2, is asked by his girlfriend(!), "What do your parents do?"
"My father is a surgeon. He saves people's lives. My mother is just a regular doctor."
Saturday, March 12, 2011
Father shamelessly promotes Florida performances
For those readers in the Tampa area, here are surely excellent performances at the New Seeds Festival on March 19, 25, and 26th.
Thursday, March 10, 2011
Cars, planes, and trains. And later, there are the doctors.
I have great admiration for the Massachusetts Health Quality Partners. The mission is sound, and the organization uses what exists to good purpose.
But this post is about what exists, and it is not good enough. MHQP just published its annual review of primary care practices in the state, available here. You would like to think that you could use the information provided to conduct a comparative review of your MD's practice group compared to others, looking at compliance with generally accepted guidelines.
But you can't. Why not? Because the data are old.
If you review the report's technical appendix, you find that "This report provides information on the 2009 performance of Massachusetts Medical Groups on the selected HEDIS® Measure Set. ...The measurement periods vary somewhat by measure, but in general, HEDIS® 2010 measures report on performance during calendar year 2009."
What would be really useful is current information.
The data for this report come from the five major Massachusetts health plans. I have heard over and over from these insurers about the advanced information systems they have in place. So why does it take so long to collate rather simple data from that which was collected well over a year ago?
In contrast, let's look at the currency of the auto repair data provided by Consumer Reports. Here's how they do:
All our reliability information is completely updated annually. We begin sending out each year's survey in the spring. By late summer, we have collected and organized responses, and we complete our analysis and update the information online by late October. The new information first appears in print in the Consumer Reports Best & Worst New Cars, on newsstands in mid-November. ...All reliability information we publish is based on subscribers' experiences with cars in the 12-month period immediately preceding the survey.
How about airline on-times rates? Collected monthly, reported within three months. Curious about annual figures on that metric, but also many other quality metrics that might influence your choice of carriers (flights cancellations; chronically delayed flights; causes of delays; mishandled baggage; bumping; incidents involving pets; complaints about service; complaints about treatment of disabled passengers; discrimination complaints? Within two months of the end of the year.
The Boston transit system -- not always viewed as the paragon of efficiency! -- on-time rates? Monthly, published within weeks.
Don't you think we deserve more timely information about the quality of our primary care group than we can get about cars, airplanes, and commuter rail?
But this post is about what exists, and it is not good enough. MHQP just published its annual review of primary care practices in the state, available here. You would like to think that you could use the information provided to conduct a comparative review of your MD's practice group compared to others, looking at compliance with generally accepted guidelines.
But you can't. Why not? Because the data are old.
If you review the report's technical appendix, you find that "This report provides information on the 2009 performance of Massachusetts Medical Groups on the selected HEDIS® Measure Set. ...The measurement periods vary somewhat by measure, but in general, HEDIS® 2010 measures report on performance during calendar year 2009."
What would be really useful is current information.
The data for this report come from the five major Massachusetts health plans. I have heard over and over from these insurers about the advanced information systems they have in place. So why does it take so long to collate rather simple data from that which was collected well over a year ago?
In contrast, let's look at the currency of the auto repair data provided by Consumer Reports. Here's how they do:
All our reliability information is completely updated annually. We begin sending out each year's survey in the spring. By late summer, we have collected and organized responses, and we complete our analysis and update the information online by late October. The new information first appears in print in the Consumer Reports Best & Worst New Cars, on newsstands in mid-November. ...All reliability information we publish is based on subscribers' experiences with cars in the 12-month period immediately preceding the survey.
How about airline on-times rates? Collected monthly, reported within three months. Curious about annual figures on that metric, but also many other quality metrics that might influence your choice of carriers (flights cancellations; chronically delayed flights; causes of delays; mishandled baggage; bumping; incidents involving pets; complaints about service; complaints about treatment of disabled passengers; discrimination complaints? Within two months of the end of the year.
The Boston transit system -- not always viewed as the paragon of efficiency! -- on-time rates? Monthly, published within weeks.
Don't you think we deserve more timely information about the quality of our primary care group than we can get about cars, airplanes, and commuter rail?
Patient and Family Advisors on WIHI
Health Care’s Newest Improvers: Patient and Family Advisors
Thursday, March 10, 2011, 2:00 PM – 3:00 PM Eastern Time
Thursday, March 10, 2011, 2:00 PM – 3:00 PM Eastern Time
Guests: Kristine White, RN, BSN, MBA, Vice President, Innovation and Patient Affairs, Spectrum Health System
Cindy Sayre, MN, ARNP, Director, Professional Practice and Patient and Family Centered Care, University of Washington Medical Center
Dorothea Handron, EdD, APRN, Faculty Emeritus, College of Nursing, East Carolina University; Patient-Family Advisor, University Health Systems of Eastern North Carolina
Brandelyn Bergstedt, Coordinator, Patient and Family Advisor Program, Evergreen Hospital Medical Center
Martha Hayward, Executive Director, The Partnership for Healthcare Excellence; Founder, Women’s Health Exchange; Member, Dana Farber Cancer Institute Patient Advisory Council
Not that long ago, Patient and Family Advisory Councils (PFACs), where they existed at all, were pretty much concentrated in children’s hospitals. We have these pediatric pioneers to thank for their courage and for laying the groundwork for what’s now becoming a new standard for all hospitals that are serious about patient safety and better patient care.
As PFACs gain traction and acceptance and respect, the myriad of initiatives that their members have undertaken across hospital departments is truly mind boggling. That’s just one reason WIHI Host Madge Kaplan hopes you’ll tune in to the program on March 10. Kristine White, Cindy Sayre, Dorothea Handron, Brandelyn Bergstedt, and Martha Hayward are going to describe what it’s like to engage with board members, be part of teams to redesign physical space, round with health care providers, rewrite educational materials, and much, much more. As leading patient advisors, all five guests also have valuable wisdom to share about what makes for an effective PFAC, what sort of homogeneity and heterogeneity matter, how to establish ground rules for members, and how to become more knowledgeable about quality improvement.
In Massachusetts, the creation of PFACs is mandated through legislation. But the best reason to collaborate with patients and families at your organization is because of the perspective anyone who receives care brings to the table. In other words, the most complete team to drive change at your facility is one that includes patients and families.
To find out why, to add to the picture, or to get some tips on how to start a PFAC, please join this next WIHI. Encourage a colleague or two to sign up as well!
To enroll, please click here.
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