Current Reform Efforts in Health Professions Education - Essay Example

Current Reform Efforts in Health Professions Education Lesson 4 1. Discuss the current reform efforts in health professions education based on the Institute of Medicine (IOM) report, “Crossing the Quality Chasm: A new Health System for the 21st Century.” The Institute of Medicine (IOM) set forth five major recommendations on how to improve health professions education. These major recommendations included patient-centered care, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement, and utilizing informatics. The IOM recommends that health professions educations should focus on patient-centered care. This entails stressing upon health care students the need to identify and respect the varied preferences, values, and needs of patients. The reform efforts focus on relieving pain and suffering by listening and communicating well with their patients. The current reform efforts in health professions education also focus on instructing members of the health care profession to work in interdisciplinary teams. This entails collaboration and integration of services and expertise in order “to ensure that care is continuous and reliable” (Peterson, 2003). Employing evidence-based practice, according to IOM, involves integration of best evidence and researches with clinical practice in order achieve optimum care for the patient. This encourages various health care students and professionals “to participate in learning and research activities to the extent feasible” (Peterson, 2003). The IOM also discussed that health professions education integrate quality improvement practices into health care practice. This involves having to identify the different errors and dangers in care, understanding safety design principles, “continually understand[ing] and measure[ing] quality of care in terms of structure, process, and outcomes in relation to patient and community needs”(Peterson, 2003). Finally, according to the IOM, members of the health care profession should be instructed on the use of informatics. This will help ease communication, easily manage data and information, and mitigate errors in the practice. 2. Compose a brief history that led up to the current reform efforts to restructure the health professions education. The past 50 years in American history have yielded various changes in the health care practice. The cost of healthcare and the increase in health care allocation by the government and various investors have given birth to various improvements and innovations in the rehabilitation and care of patients. These new technology and new medical practices however have yielded various issues on quality and effectiveness of health care. The 1990s have produced various studies and reports revealing that advances in medical practice have not improved the quality of health care services for Americans. Medical errors have increased with the introduction of new medical breakthroughs. Little effort was undertaken towards “restructuring of health care systems to address both quality and cost concerns” (Institute of Medicine, 2001). For a time, health care in the Unites States focused primarily on acute care for chronic conditions. The mounting problems and questions on the quality of health care led to the formation of the Committee on the Health Professions Education. This committee organized a gathering of representatives from the healthcare profession to discus strategies on how to address five core areas of healthcare, namely, patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics (Greiner and Knebel, 2003). The Committee convened and came up with a report entitled, Crossing the Quality Chasm: A new Health System for the 21st Century. This report made various recommendations on possible changes and adjustments that may be adapted by the different health professionals in the education and training of their students and other potential members. 3. The two recommended strategies to be developed were presented in the report by the Committee on the Quality of Health Care in America. They are: * The restructuring of clinical education. * Assessing the implications of these changes. a) Explain the reasons why these recommended strategies were presented in the report, and what would be included in both strategies. The report by the Committee on the Quality of Health Care in America recommended the restructuring of clinical education and assessing the implications of these changes. These recommendations came about because the committee envisioned new skills and new ways of patient-care giver relationship with the transition into the 21st century. Health care services had to evolve with the introduction of new medical techniques and innovations, and the health care givers had to keep up with these changes. The committee recommended a redesign of the way health professionals were trained in order to emphasize the aims set forth by the committee, to modify the way health professionals were regulated in order to facilitate the needed changes in health care services, and to examine how the liability system can support changes in health care delivery. b) List the competency requirements that were identified in the strategy presented to restructure clinical education. The competency requirements that were identified in the strategy in order to restructure clinical education were identified herein as, delivering patient-centered care, working as part of interdisciplinary teams, practicing evidence-based medicine, focusing on quality improvement and, using information technology. 4. Explain the health professional development from the perspective of three quality improvement strategies: organizational-centered strategies, issue centered strategies, and clinical microsystem-centered strategies. Based on organizational-centered strategies, the health profession initially started appraising the delivery of health care services by hospitals through the American College of Surgeons. The assessment of quality of health care services focused on the macro-organization as a unit of attention. The concept of total quality was borne through this organization-centered strategy. Total quality strategies were first adapted by the automotive industry, and were later adapted by the health care service as an important and effective strategy in assessing and improving the quality of health care services (McLaughlin and Kaluzny, 2005). In issue-centered strategies, the observations of purchasers, private data companies, and public institutions revealed varying reports from information released to the public patient reports. The healthcare organizations told the public that their services were of high quality, but the patients were complaining of gaps in the quality of their health services. Issues similar to this nature brought together experts to test the actual claims and methods being adapted in the clinical practice. The results of these tests were released to the public. This made many organizations sit-up and take notice. The need to gain favorable test results and thereby receive public support prompted many organizations to undertake the tests (McLaughlin & Kaluzny, 2005). These tests were issue-centered, intended to review actual gaps in services and issues of quality in the health care service. Changes in execution were made based on issues raised, and the healthcare organization is assessed on how well it deals and resolves issues that were raised. In the 1990s, Mohr and Donaldson investigated the performance of clinical microsystems. Using clinical samples, they studied about 40 microsystems and analyzed how the system can improve the health profession. Their study was able to set forth the advantages of properly trained medical professionals working on specific needs of patients. This model was able to “enhance…efforts to achieve the mission of teaching and assessing specific core competencies within the academic clinical microsystem” (McLaughlin & Kaluzny, 2005). 5. Discuss the important characteristics of the three quality improvement strategies that are explained in question #4. Organization-centered strategies places much importance on the following: context for work, knowledge of work as a system or process, attention to patients as beneficiaries, the leader’s role in promoting learning, and organizational networks. The first area of importance in organizational-centered strategy is the focus on the context for work, stresses on clarifying what is meant by quality as a business strategy. In this instance the focus here is on how to encourage “a work environment that recognized and celebrated the value of learning at work” (McLaughlin & Kaluzny, 2005). In the second area-- knowledge of work as a system or process--various processes and systems change strategies are applied and adapted in the health care setting. Applying these systems through projects gave those involved newfound opportunity for involvement and consequently pride in their work. The third area--attention to patients as beneficiaries--emphasized on the personal preferences and circumstances of the patient. Patient care is focused on individual and varied patient needs, not on what is commonly acceptable and applicable to a greater number of patients. The fourth area--leader’s role in promoting learning--is very much dependent on the leader’s ability to command and control. Learning in the organizational set-up is possible with leaders encouraging their members to expand their knowledge and broaden their mind while in the work place. Finally, while sharing knowledge with each other, networking among organizations came about. With this networking, various new organizations were borne. This included Group Practice Improvement Network, Healthcare Quality Technology Network, and Healthcare Forum’s Quality Improvement Network, among others. In the issue centered strategy, the focus here is on “the public identification of gaps between what was known and what was usually done coupled with strategies to accelerate those closing gaps” (McLaughlin & Kaluzny, 2005). In issue-centered strategy the evaluation of healthcare organizations revealed variations in actual services being received by patients. The organization is assessed on how well it identifies and resolves issues in the healthcare setting. In the microsystem-strategy, the focus here is the “context within which students and trainees learn and are assessed” (McLaughlin & Kaluzny (2005). After these trainees are assessed, they are now linked to the specific and particular environment where their skills would most likely fit into. The improvement efforts here are made based on the changes needed by the smallest unit in the organization. The smaller problems or issues are addressed in the interest of the larger organization, hence it may be said that this system is a combination of the first two quality improvement strategies. 1. Describe the barriers to the implementation of continuous quality improvement (CQI) processes into primary care organizations. What can be done to reduce or remove these barriers? Barriers in the implementation of CQI in primary care organizations revolve around the following issues: environmental, cultural, technical, strategic, structural. The environmental barriers refer to those factors relating to geographical characteristics of the hospital’s location that the hospital is having trouble dealing with. Cultural barriers refer to the values and norms hospitals that impact the way they behave and deal with their problems and hospital management. Sometimes, these cultural barriers prevent them from effectively creating a network in the care of the patient. Technical barriers refer to the lack of proper training by some members of the medical team that prevent the delivery of quality care to the patient and that consequently prevent the implementation of CQI. Strategic barriers refer to the lack of “linkage between a hospital’s quality improvement plans and strategic business plans” (Kimberly & Minvielle, 2000). Structural barriers are illustrated in large hospitals where their sheer size prevents effective communication between and among its different units. Some hospitals also have too many processes involved in the approval of different policies. This often interferes with effective and speedy communication within the hospital setting. Environmental barriers may be reduced by restructuring the primary care set-up. Reorganizing the hospital environment can help ease the geographical hindrances in the hospital daily activities. Simply rearranging furniture, adding, or subtracting something from the usual set-up can help ease tension and promote a better environment for the patients and for hospital staff. In order to eliminate, if not reduce cultural barriers an “open, employee-centered and customer focused culture” must be created in the primary care organization” (Kimberly & Minvielle, 2000). An environment conducive to learning must be encouraged. The employer-employee relationship must not be wrought with tension and discomfort. All employees in the hospital must undergo proper quality improvement training. This must be a continuously updated training in order to keep abreast of new techniques and new innovations in the healthcare service. Strategic barriers may be resolved by aligning “quality improvement initiatives in each of the hospital’s major care centers…to the hospital’s overall mission and strategic goals” (Kimberly & Minvielle, 2000). Each unit of the primary care organization was encouraged to develop their own improvement objectives as long as they were still aligned with the overall goals of the primary care organization. Structural barriers may be overcome by allowing the primary care organization to develop “more of a cross-functional approach to patient care that cuts across departments” (Kimberly & Minvielle, 2000). Through this strategy, it is possible to incorporate the best practices in the care of the patient without various loopholes and confusing processes. 2. Discuss the top rated change strategies that were identified in table 12-1 on page 301 of our text. Include in your discussion, one process that could be implemented for each “strategy change.” Table 12-1 outlines several change strategies. These are: use of systems support like reminders, registries, and task delegation; focusing on changes that would make physician work easier; reducing or removing barriers to implementation; measuring improvements periodically; providing information or training; delegating authority to the implementation planners; providing comparative feedback of relevant measurements; pretesting change through pilots and rapid cycling; tailoring implementation to each practice setting; and focusing changes that make it better for patients. The use of systems support like reminders, registries, and task delegation, helps prioritize and reduce workload. It also helps keep the different organization tasks organized. By focusing on changes that would make physician work easier, the physician is able to spend more time with other patients. In reducing or removing barriers to implementation, the organization would be able to effectively implement vital processes in the primary care setting. In measuring improvements periodically, it is possible to maintain the quality of healthcare in the organization, and to ensure that quality improvements are regularly updated in the healthcare organization. In providing information or training, the different healthcare professionals are able to improve and learn new skills in caring for the patient. By delegating authority to the implementation planners, it is possible to ensure that the different improvement strategies are being implemented throughout the healthcare setting. It is also possible to ensure that the smallest unit or system in the organization is reached by new processes and strategies for improvement. In providing comparative feedback of relevant measurements, it is possible to gauge the presence or the lack of improvement in the healthcare organization. It is also possible to assess gaps in the implementation of healthcare services from what is known and from what is actually being implemented in the healthcare organization. By pretesting change through pilots and rapid cycling, it is possible to establish the effectiveness of certain strategies or processes before it can be widely implemented. Pretesting changes can help reduce implementation problems and margins of error in the system. From pretesting, adjustments in implementation may be made. By tailoring implementation to each practice setting, individual patient needs may be addressed. Implementation of policies is done based on what would fit the patient, not on what would fit a majority of patients. In focusing changes that make it better for patients, the patient-centered approach is being implemented. Healthcare is fashioned based on the patients’ preferences, culture, race, and other peculiarities. What may be proven to work for a majority of patients, may not work for one particular patient who does not share the characteristics of the majority. 3. Explain the involvement that the Care Delivery Organizations, Managed Care, Purchasers, and Quality Improvement Collaboratives have in the CQI process of Primary Care Practices. “Care Delivery Organizations, especially those organized to provide ambulatory care are currently part of a slowly evolving revolution in the structure and function of care…” (McLaughlin & Kaluzny, 2005). The original set-up was solo practice for doctors; now medical group practice has emerged as a growing trend in the present healthcare service. These medical groups have established “multi-specialty organizations to provide every type of medical service” (McLaughlin & Kaluzny, 2005). And these organizations have helped coordinate their efforts to ensure better negotiating terms with managed care plans. These organizations also created an effective referral system for various patients with different needs and conditions. These medical groups came up with ways on how to improve the quality of health care services. From interviews with medical groups, lessons and trends on how to best deal with various medical problems and issues were formulated by various researchers and QI evaluators. They published the synthesis of their interviews revealed in the question previously answered. Managed care plans ensure that the cost of the medical intervention or care administered is within affordable management range. They ensure this by reducing inpatient care through various administrative and regulatory mechanisms. This often creates competition and “destructive price wars” (McLaughlin & Kaluzny, 2005). Competing elements seek to improve their viability and competitiveness in the market. Ultimately, the patient benefits from competition because the best possible care is given to him in the end. “Purchasers, both private and governmental, clearly have a role in providing needed external motivational support for QI” (McLaughlin & Kaluzny, 2005). Purchasers and health plans have to protect their investments by ensuring that nothing hurts their ability to contract with their members. This helps in keeping up the quality of health care services and in ensuring that members get the best possible care that they deserve. Local, regional, or national quality improvement collaboratives (QIC) help provide consistency and comprehensiveness in health care. QICs like the ICSI “began as a way to develop local buy-in for evidence-based guidelines and soon moved to emphasize implementation and improvement of broad quality topics beyond any particular guideline” (McLaughlin and Kaluzny, 2005). QICs facilitate the efforts of managed care groups and purchasers in establishing “external incentives that motivate leaders of primary care medical groups to work hard on QI” (McLaughlin & Kaluzny, 2005). 4. Discuss the background, trial design, findings, conclusions, and recommendations of the IMPROVE trial. This trial was started because of the growing need to improve preventive services in primary care. Preventive services were largely dependent on the memory of clinicians who had their hands full with other patients with more immediate needs. This trial became focused on preventive services with large clinician support. This included: mammography, clinical breast exam, pap smears, influenza and pneumococcal immunizations, blood pressure, smoking, and cholesterol. The trial design for IMPROVE involved first and foremost, identifying the problem, followed by collecting data to understand the human processes currently existing in the patient, then analyzing the data in order to understand the root causes of the problem. Next step was to develop alternative solutions that address the root causes of the problem. After this, there was a need to generate recommendations to implement the best alternatives and pilot test them. After the pilot test, there was now a need to implement the tested new process using systematic preparation steps, including orientation and training. Finally, it is now possible to use the cycle to evaluate the effectiveness of the new process being implemented and to improve it until it becomes better. IMPROVE generated a great deal of information “about clinics, the change process, and the delivery of preventive services” (McLAughlin, Kaluzny, 2005). It also helped various clinics improve their services and their readiness to deal with the various needs of the patient. It also helped improve their managerial and operational styles. The trial also revealed that quality improvement techniques do not clearly indicate measurable changes in the quality and quantity of clinical services. The trial recommends that before clinic changes can be made, adequate incentives should be in place, and that various medical groups have committed themselves to these changes. Another recommendation is that an assessment process should be made ready for clinics to be able to engage in necessary changes. The proposed improvements should also be substantial enough to lead to real change. The improvement process should fit with the size of the task and fits the nature of the task. Finally, the trial recommends the use of measurement in repeated cycles, “both in the improvement process and in assessing the value of the process” (McLaughlin & Kaluzny, 2005). Reference Read More