Niraj Sehgal, MD, MPH Professor of Medicine & Hospitalist

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Presentation transcript:

Becoming Better Versions of Ourselves: Quality, Safety, Equity, and Value Niraj Sehgal, MD, MPH Professor of Medicine & Hospitalist Chief Quality Officer, UCSF Health

Session Goals What does “high quality” care mean? How do we approach measuring quality? How do we become better versions of ourselves?

What does “high quality” care mean to you?

Quality: IOM’s Six Aims for Improvement Safety: reducing harm & medical errors Effectiveness: match care to science (good “use”) Patient-centeredness: honor individual patient Timeliness: both for patients and providers Efficiency: appropriate resource utilization Equity: reduce disparities in health status VALUE = Clinical Quality x Patient Experience Costs of Care Quadruple Aim = highest quality, best patient experience, lowest cost and best provider experience

Examples of Quality Gaps include: What do we mean by “QI”? Examples of Quality Gaps include: Door to Balloon time for MI’s Immunizations & Cancer Screening MRI for Headaches in clinic The care we could be providing The “Quality Gap” Performance vs. Quality Improvement? The care we actually provide

QI versus PI: Subway or SFO?

Session Goals What does “high quality” care mean? How do we approach measuring quality? How do we become better versions of ourselves?

What Does High-Quality Care Look Like? I know it when I see it. The phrase "I know it when I see it" is a colloquial expression in the United States by which a speaker attempts to categorize an observable fact or event, although the category is subjective or lacks clearly defined parameters. The phrase was famously used by United States Supreme Court Justice Potter Stewart to describe his threshold test for pornography in Jacobellis v. Ohio (1964). Obscenity is not protected speech under the Miller test, and can therefore be censored.

How did you (or would you) measure the “quality” of ACGME training programs?

How Should We Measure Quality? No single metric will do it all Donabedian’s Triad Structure, Process, and Outcome Measures * Balancing Measures

Structure: How is care organized? Hospital Measures Is there an EHR? Do you have intensivists? Are you a trauma center? ACGME Measures Size of program Diversity of clinical settings (# of sites) Dedicated educational time

Process: What was done? Hospital Measures ACGME Measures Did patients with an AMI get an ASA prior to discharge? Did patients get appropriate VTE prophylaxis? Did PMDs receive a discharge summary within 48hrs? ACGME Measures % of education sessions attended? # of procedures completed? # times met with advisor/mentor?

Outcomes: What Happened? Hospital Measures Did patients survive? Were patients satisfied with their care? Did patients get readmitted to the hospital? ACGME Measures What % graduated with top choice for fellowship or job? Board pass rate Likelihood to recommend UCSF? (Resident Satisfaction)

Balancing: Unintended Consequences? Hospital Readmissions & Length of Stay ACGME: Handoffs & Work Hours

Case Study on Quality Measurement: How does UCSF Medical Center perform?

How much consistency between ranking systems?

“Honor Roll” 3 Stars “A” 3 Stars Award for Excellence 49 (100)

-Criticism from Many Program Directors There are no objective criteria that define what is meant by “the best.” -Criticism from Many Program Directors

Session Goals What does “high quality” care mean? How do we approach measuring quality? How do we become better versions of ourselves?

It’s not ALL about the data: the 4 Pillars Culture Education Improving Quality Systems Change Audit & Feedback

We Learn Everything in Kindergarten Niraj Brush Teeth in AM Brush Teeth in PM No Talking Back or Sulking Clean up Time

Better Versions of Ourselves: Take Home Points No single ”best way” to measure quality; need multiple lenses People and culture will drive the change: YOU (data and process are enablers) Practice “becoming a better version of yourself” from Day 1